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Tram M, Meyerson B, Welliver C, Inouye B. Differences in sexual adverse events for premature ejaculation medications from a public federal database. Int J Impot Res 2024; 36:515-520. [PMID: 36806781 DOI: 10.1038/s41443-023-00676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/19/2023]
Abstract
American Urological Association (AUA) guidelines recommend selective serotonin reuptake inhibitors (SSRI) as first-line pharmacotherapy for premature ejaculation (PE). While previous studies have described sexual adverse events (AE) associated with each medication, there is limited data directly comparing rates of specific sexual AEs across SSRIs. This study investigates the Food and Drug Administration Adverse Event Reporting System (FAERS) database for reports of monotherapy use of fluoxetine 20 mg, paroxetine 20 mg, sertraline 50 mg, and sertraline 100 mg in males from January 2004-June 2021. We examined 2608 reports from patients using SSRIs for PE or other psychiatric conditions. The average number of AEs was significantly different (p < 0.01) with paroxetine 20 mg having the highest (5.1 AEs/case report). Changes in libido was the most common sexual AE for fluoxetine 20 mg (6.7% of reports), paroxetine 20 mg (4.2%), and sertraline 50 mg (7.2%) while orgasm disorder was the most reported for sertraline 100 mg (3.9%). The SSRIs had different rates of changes in libido, erection disorder, orgasm disorder, and other sexual dysfunction (outside those listed). The SSRIs also differed in the rates of fatigue, ear/hearing changes, headache, and psychological AEs. The differences in specific AEs warrant future studies to determine true differences that would affect patient counseling.
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Affiliation(s)
- Michael Tram
- Department of Urology, Albany Medical Center, Albany, NY, USA.
| | - Brian Meyerson
- Department of Urology, Albany Medical Center, Albany, NY, USA
| | - Charles Welliver
- Department of Urology, Albany Medical Center, Albany, NY, USA
- Albany Stratton Veterans Affairs Medical Center, Albany, NY, USA
| | - Brian Inouye
- Department of Urology, Albany Medical Center, Albany, NY, USA
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Montejo AL, Sánchez-Sánchez F, De Alarcón R, Matías J, Cortés B, Matos C, Martín-Pinto T, Ríos P, González-García N, Acosta JM. Switching to Vortioxetine in Patients with Poorly Tolerated Antidepressant-Related Sexual Dysfunction in Clinical Practice: A 3-Month Prospective Real-Life Study. J Clin Med 2024; 13:546. [PMID: 38256680 PMCID: PMC10816261 DOI: 10.3390/jcm13020546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings. STUDY OBJECTIVES To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting. METHODOLOGY observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale (* Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up. RESULTS global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), p < 0.001. There was a significant improvement (p < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit. CONCLUSION switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.
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Affiliation(s)
- Angel L. Montejo
- Nursing School, University of Salamanca, Av. Donantes de Sangre SN, 37004 Salamanca, Spain
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente SN, 37007 Salamanca, Spain;
| | | | - Rubén De Alarcón
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Juan Matías
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Benjamin Cortés
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Claudia Matos
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Tomás Martín-Pinto
- Servicio de Psiquiatría, Hospital Universitario de Salamanca, 37007 Salamanca, Spain; (R.D.A.); (J.M.); (B.C.); (C.M.); (T.M.-P.)
| | - Peñitas Ríos
- Hospital Universitario Cáceres, 10004 Cáceres, Spain;
| | | | - José María Acosta
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente SN, 37007 Salamanca, Spain;
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Weiss F, Pacciardi B, D’Alessandro G, Caruso V, Maremmani I, Pini S, Perugi G. The Role of Vortioxetine in the Treatment of Depressive Symptoms in General Hospital Psychiatry: A Case-Series and PRISMA-Compliant Systematic Review of the Literature. J Clin Med 2024; 13:531. [PMID: 38256665 PMCID: PMC10816732 DOI: 10.3390/jcm13020531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine's safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.
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Affiliation(s)
- Francesco Weiss
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Bruno Pacciardi
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Giulia D’Alessandro
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Valerio Caruso
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Icro Maremmani
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
- G. De Lisio Institute of Behavioural Sciences, 56121 Pisa, Italy
| | - Stefano Pini
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Giulio Perugi
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
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Gil-Sanchez A, Canudes M, Valcheva P, Nogueras L, González-Mingot C, Hervás JV, Peralta S, Solana M, Brieva L. Effects of Vortioxetine on Cognition and Fatigue in Patients with Multiple Sclerosis and Depression: A Case Series Study. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:395-401. [PMID: 36944623 DOI: 10.2174/1871527322666230321093133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Vortioxetine is a multimodal antidepressant drug that has been reported to have a positive impact on cognition, social function, and fatigue. Nevertheless, it has not been widely studied. Our objective was to explore the effects of vortioxetine on these and other parameters in patients with multiple sclerosis (MS) and depression. PATIENTS AND METHODOLOGY This observational case series study included patients with MS and depression who received treatment with vortioxetine for at least 6 months. The patient history of depression and depressive symptoms was assessed. A neuropsychiatric evaluation was carried out using different scales, both before and after treatment. RESULTS Of the 25 patients who enrolled in the study, 17 completed the treatment. Significant improvements were observed in health status (EQ-5D; p = 0.002), mood (Beck's Depression Inventory, BDI-II; p = 0.006), anxiety (State-Trait Anxiety Inventory, STAI-State; p = 0.021, and STAI-Trait; p = 0.011), and in the general health test (Short Form Health Survey, SF-36) for the vitality (p = 0.028) and mental health (p = 0.025) domains of the patients who completed the treatment. However, no statistically significant differences were observed in the cognitive tests related to attention, information processing speed, or fatigue. CONCLUSION In this population, vortioxetine treatment was effective in reducing the symptoms of depression and improving anxiety, vitality, and mental health. In contrast, it did not produce any improvement in cognition or fatigue but an increase in sample size would be necessary to confirm these results.
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Affiliation(s)
- Anna Gil-Sanchez
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Marc Canudes
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Petya Valcheva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Lara Nogueras
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Cristina González-Mingot
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - José Vicente Hervás
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Silvia Peralta
- Multiple Sclerosis Foundation (FEM) of Lleida, Lleida, España
| | - Maria Solana
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Luis Brieva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
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Cowen PJ. SSRIs in the Treatment of Depression: A Pharmacological CUL-DE-SAC? Curr Top Behav Neurosci 2024; 66:1-19. [PMID: 37922101 DOI: 10.1007/7854_2023_447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
The widespread adoption of selective serotonin reuptake inhibitors (SSRIs) as first-line pharmacological treatments in the management of clinical depression transformed the landscape of drug therapy for this condition. SSRIs are safer and better tolerated than the tricyclic antidepressants (TCAs) that they replaced. However, they have limitations that may have placed a ceiling on the expectations of first-line pharmacological treatment. Notable problems with SSRIs include induction of anxiety on treatment initiation, delayed onset of significant therapeutic effect, sexual dysfunction, sleep disturbance and overall modest efficacy. The latter is linked with an inability of SSRIs to effectively treat syndromes of anhedonia and cognitive impairment. Combined serotonin and noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine, have produced some limited improvements over SSRIs in efficacy, at the cost of a greater side-effect burden. Attempts to supplement serotonin reuptake activity with actions at serotonin receptor sub-types have not yet yielded substantial benefits; however, vortioxetine may provide more utility in the management of cognitive impairment. Future advances might come from the development of SNRIs, which more closely mimic the actions of effective TCAs. There may also be possible benefits to be derived from combining SSRIs with 5-HT4 receptor agonists and 5-HT7 receptor antagonists.
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Affiliation(s)
- Philip J Cowen
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Sánchez-Sánchez F, Ponce-Buj B, Montejo-González AL, Sipán-Sarrión Y, Gimeno-Marqués A, Merino-Gámez A. [Impact of vortioxetine on sexual function compared to other antidepressants]. Semergen 2023; 49:101997. [PMID: 37329592 DOI: 10.1016/j.semerg.2023.101997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To analyze the impact of the antidepressant vortioxetine on sexual function, compared to selective serotonin reuptake inhibitors (SSRIs) and mixed selective serotonin and norepinephrine reuptake inhibitors (IRSN or Dual) in patients with depression. MATERIAL AND METHODS Analytical, observational, longitudinal and prospective study, which included men and women over 18years of age, with depressive disorder and sexual activity with a partner, separating them into two groups: (i)study, starting treatment with vortioxetine; (2)control, maintaining treatment with SSRIs or Duals. Three visits were made: inclusion, follow-up at 4weeks and final 3months from inclusion. The total follow-up period was 3months. RESULTS A total of 87 patients were included (mean age 46.85years). At the end of the study, significant differences (SD) were found in the mean value of the sum of the scores of the evaluative domains of the sexual response of the Women's Sexual Function Questionnaire (FSM-2) between the study group and the control (22.42±4.39 and 16.13±7.76, respectively), with a lower risk of sexual dysfunction in women treated with vortioxetine. Also, lower risk of sexual dysfunction in these same women in the domains of desire, lubrication, orgasm, sexual frequency and sexual satisfaction. These differences were not found when assessing male sexual function. CONCLUSIONS Women treated with vortioxetine presented better sexual function than those treated with SSRIs or Duals and a lower risk of sexual dysfunction.
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Affiliation(s)
- F Sánchez-Sánchez
- Medicina de Familia y Comunitaria, Centro de Salud Xàtiva, Xàtiva, Valencia, España.
| | - B Ponce-Buj
- Medicina de Familia y Comunitaria, Centro de Salud Alaquàs, Alaquàs, Valencia, España
| | - A L Montejo-González
- Servicio de Psiquiatría, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Y Sipán-Sarrión
- Medicina de Familia y Comunitaria, Centro de Salud Xàtiva, Xàtiva, Valencia, España
| | - A Gimeno-Marqués
- Medicina de Familia y Comunitaria, Centro de Salud L'Alcúdia, L'Alcúdia, Valencia, España
| | - A Merino-Gámez
- Medicina de Familia y Comunitaria, Centro de Salud Rafelbunyol, Rafelbunyol, Valencia, España
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Alıcı YH, Kumcu MK. Potential Effect of Vortioxetine on Restless Leg Syndrome. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:599-603. [PMID: 37424427 PMCID: PMC10335914 DOI: 10.9758/cpn.22.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 07/11/2023]
Abstract
Restless legs syndrome (RLS) is a chronic progressive movement disorder characterized by abnormal sensations, especially at rest and at night, as the need and urge to move the lower extremity. It has been reported that RLS severity and frequency increase in patients with anxiety and depression. It has been reported that serotonin-noradrenaline reuptake inhibitors such as venlafaxine and selective serotonin reuptake inhibitors such as citalopram, fluoxetine, paroxetine, and sertraline can cause RLS symptoms. No adverse effects of vortioxetine on RLS have been reported in the literature. In this case series, we report the effect of vortioxetine in patients with RLS with symptoms of depression and anxiety. In this case series, the effect of adding vortioxetine to treatment on RLS symptoms is reported in 7 patients (5 female). After the use of vortioxetine, 5 of 7 patients' symptoms regressed without the need to start a separate drug for primary movement disorder. In conclusion, we believe that studies should be conducted to investigate the efficacy of vortioxetine in the treatment of RLS. Therefore, randomized controlled studies are needed to determine the effect and safety of vortioxetine on RLS symptoms.
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Affiliation(s)
- Yasemin Hoşgören Alıcı
- Department of Psychiatry, Başkent University, Ankara, Turkey
- Department of Neuroscience, Ankara University, Ankara, Turkey
| | - Müge Kuzu Kumcu
- Department of Neuroscience, Ankara University, Ankara, Turkey
- Department of Neurology, Lokman Hekim University School of Medicine, Ankara, Turkey
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Identification of a novel off-target of paroxetine: Possible role in sexual dysfunction induced by this SSRI antidepressant drug. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Waters K. The clinical utility of newer antidepressant agents: Understanding the role in management of MDD. Ment Health Clin 2022; 12:309-319. [PMID: 36405509 PMCID: PMC9645287 DOI: 10.9740/mhc.2022.10.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Whereas MDD is characterized in part by changes in mood, other symptoms can also cause significant impairment, including sexual dysfunction, cognitive impairment, and fatigue. Newer antidepressants are explored with the goal of more optimally treating these non–mood-related symptoms of MDD. The 3 oral antidepressants that have been FDA-approved most recently include vortioxetine, vilazodone, and levomilnacipran. Unique features of these antidepressants are explored through 3 patient cases.
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Affiliation(s)
- Kristin Waters
- 1 (Corresponding author) Assistant Clinical Professor, University of Connecticut, Storrs, Connecticut,
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Rao TSS, Andrade C. Antidepressants and Sexual Dysfunction: Is Vortioxetine Among the Exceptions? JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221116038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Chittaranjan Andrade
- Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Hentzen C, Musco S, Amarenco G, Del Popolo G, Panicker JN. Approach and management to patients with neurological disorders reporting sexual dysfunction. Lancet Neurol 2022; 21:551-562. [DOI: 10.1016/s1474-4422(22)00036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/28/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022]
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Winter JR, Curtis K, Hu B, Clayton AH. Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management. Expert Opin Drug Saf 2022; 21:913-930. [PMID: 35255754 DOI: 10.1080/14740338.2022.2049753] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management. AREAS COVERED A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40 - 45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed. EXPERT OPINION MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.
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Affiliation(s)
- Joan R Winter
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Suite 210, Charlottesville, VA, 22903
| | - Kimberly Curtis
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Suite 210, Charlottesville, VA, 22903
| | - Bo Hu
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Suite 210, Charlottesville, VA, 22903
| | - Anita H Clayton
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia, 2955 Ivy Road, Suite 210, Charlottesville, VA, 22903
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Montano CB, Jackson WC, Vanacore D, Weisler RH. Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD). Neuropsychiatr Dis Treat 2022; 18:867-879. [PMID: 35440869 PMCID: PMC9013418 DOI: 10.2147/ndt.s337703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/04/2022] [Indexed: 01/10/2023] Open
Abstract
Primary care clinicians have a vital role to play in the diagnosis and management of patients with major depressive disorder (MDD). This includes screening for MDD as well as identifying other possible psychiatric disorders including bipolar disorder and/or other comorbidities. Once MDD is confirmed, partnering with patients in the shared decision-making process while considering different treatment options and best management of MDD over the course of their illness is recommended. Vortioxetine has been approved for the treatment of adults with MDD since 2013, and subsequent US label updates indicate that vortioxetine may be particularly beneficial for specific populations of patients with MDD, including those with treatment-emergent sexual dysfunction and patients experiencing certain cognitive symptoms. Given these recent label updates, this prescribing guide for vortioxetine aims to provide clear and practical guidance for primary care clinicians on the safe and effective use of vortioxetine for the treatment of MDD, including how to identify appropriate patients for treatment.
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Affiliation(s)
- C Brendan Montano
- Montano Wellness LLC, Cromwell, CT, USA.,Department of Family Medicine, University of Connecticut Medical School, Farmington, CT, USA
| | - W Clay Jackson
- Department of Psychiatry and Family Medicine, West Cancer Center, Germantown, TN, USA.,Department of Psychiatry and Family Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
| | - Denise Vanacore
- Department of Nursing, Messiah University, Mechanicsburg, PA, USA
| | - Richard H Weisler
- Richard H. Weisler MD, P.A. & Associates, Raleigh, NC, USA.,Department of Psychiatry, Duke University and the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mattingly G, Brunner E, Chrones L, Lawrence DF, Simonsen K, Ren H. Effectiveness of vortioxetine for major depressive disorder in real-world clinical practice: US cohort results from the global RELIEVE study. Front Psychiatry 2022; 13:977560. [PMID: 36683990 PMCID: PMC9845760 DOI: 10.3389/fpsyt.2022.977560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Effective treatment of major depressive disorder (MDD) involves addressing both depressive and functional symptoms, increasing patients' overall sense of well-being and quality of life (QoL). METHODS RELIEVE was an international observational, prospective study in patients ≥18 years with a current diagnosis of a major depressive episode (MDE) initiating vortioxetine in routine clinical practice; outcomes for the cohort of participants from the United States are presented here. Functioning was assessed at weeks 12 and 24 versus baseline using the Sheehan Disability Scale (SDS). Secondary effectiveness analyses assessed changes from baseline to weeks 12 and 24 in functioning, depression severity, cognitive symptoms, sexual function, and QoL. RESULTS 244 participants had an average of 8.2 previous MDEs; mean duration of their current MDE at baseline was 93.5 weeks. Vortioxetine was used as second- or later-line treatment for 80.5% of participants. Least-squares mean (SE) SDS total score significantly decreased from baseline by 7.19 (0.52) points at week 12 and 8.19 (0.56) points at week 24 (p < 0.0001 for both). Significant improvements were also reflected across SDS subscores, depression severity, cognitive function, sexual function, and QoL. Healthcare resource utilization and productivity parameters also improved. Adverse events were observed in 21.8% of patients, with nausea being the most common (7.3%). CONCLUSION This real-world study demonstrated improvements in functioning, depressive symptoms, and cognitive function in patients with MDD treated with vortioxetine in routine clinical practice in the cohort of patients enrolled in the United States. Outcomes were consistent with the efficacy and safety profile of vortioxetine in randomized controlled trials.
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Affiliation(s)
| | | | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Debra F Lawrence
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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De Diego-Adeliño J, Crespo JM, Mora F, Neyra A, Iborra P, Gutiérrez-Rojas L, Salonia SF. Vortioxetine in major depressive disorder: from mechanisms of action to clinical studies. An updated review. Expert Opin Drug Saf 2021; 21:673-690. [PMID: 34964415 DOI: 10.1080/14740338.2022.2019705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vortioxetine is a multimodal-acting antidepressant that provides improvements on cognitive function aside from antidepressants and anxiolytic effects. Vortioxetine has been found to be one of the most effective and best tolerated options for major depressive disorder (MDD) in head-to-head trials. AREAS COVERED The present review intends to gather the most relevant and pragmatic data of vortioxetine in MDD, specially focusing on new studies that emerged between 2015 and 2020. EXPERT OPINION Vortioxetine is the first antidepressant that has shown improvements both in depression and cognitive symptoms, due to the unique multimodal mechanism of action that combine the 5-HT reuptake inhibition with modulations of other key pre- and post-synaptic 5-HT receptors (agonism of 5-HT1A receptor, partial agonism of 5-HT1B receptor, and antagonism of 5-HT3, 5-HT1D and 5-HT7 receptors). This new mechanism of action can explain the dose-dependent effect and can be responsible for its effects on cognitive functioning and improved tolerability profile. Potential analgesic and anti-inflammatory properties observed in preclinical studies as well as interesting efficacy and tolerability results of clinical studies with specific target groups render it a promising therapeutic option for patients with MDD and concomitant conditions (as menopause symptoms, pain, inflammation, apathy, sleep and/or metabolic abnormalities).
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Affiliation(s)
- Javier De Diego-Adeliño
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau (Iib-sant Pau), Universitat Autònoma de Barcelona (Uab), Centro de Investigación Biomédica En Red de Salud Mental (Cibersam), Spain
| | - José Manuel Crespo
- Department of Psychiatry, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Fernando Mora
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Adrián Neyra
- Department of Psychiatry, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Pedro Iborra
- Department of Psychiatry, San Juan University Hospital, Alicante, Spain
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Fasero M, Jurado-López AR, San Martín-Blanco C, Varillas-Delgado D, Coronado PJ. A higher quality of life by the Cervantes Short-Form Scale is related to a better sexual desire in postmenopausal women. Gynecol Endocrinol 2021; 37:1014-1019. [PMID: 34018895 DOI: 10.1080/09513590.2021.1929150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Evaluate the association between health relate quality of life and sexual desire in postmenopausal women and the influence of demographic descriptors on sexual desire. METHODS A observational-cross-sectional study was conducted in 521 postmenopausal women in La Zarzuela Hospital between 2018-2020. Cervantes-short form (Cervantes-SF) scale and Brief profile female sexual function (B-PFSF) scale were filled out in the consultation. High score in Cervantes-SF implies worse health-related quality of life (HR-QoL). If score is lower or equal to 20 in B-PFSF implies diagnosis of hypoactive sexual desire disorder. RESULTS There is a positive relationship between HR-QoL measured by Cervantes-SF and sexual desire measured by B-PFSF (p < .001; correlation coefficient: .223). The mean score on Cervantes-SF was 30.8 ± 14.9 and on B-PFSF was 18.7 ± 7.4. The B-PFSF score was worse in those women using systemic or vaginal hormonal treatment versus using non-hormonal treatment (18.7 ± 7.8 or 17.2 ± 7.4 vs 19.7 ± 6.5; p = .033. Smoking (b exp: .384; p = .029) and using vaginal hormonal treatment (b exp: 1.759; p = .033) are independent factors related to sexual desire. No difference was found in the wellbeing perceived by women in the different treatments (mean of minimal clinically important difference score was 2.9 in systemic vs. 3.0 in vaginal hormonal treatment). CONCLUSIONS Improvement on HR-QoL is related to improvement on sexual desire. Sexual desire is better in women with non-hormonal treatment than in women with systemic or vaginal hormonal treatment. The vaginal hormonal treatment and being current smoker are independent factors of low and high sexual desire, respectively.
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Affiliation(s)
- Maria Fasero
- Departament of Obstetrics and Gynecology, La Zarzuela Hospital, Madrid, Spain
- Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Ana Rosa Jurado-López
- Departament of Medical Sexology, HC International Hospital. Marbella (Málaga), Marbella, Spain
| | | | | | - Pluvio J Coronado
- Instituto de Salud de la Mujer, Hospital Clínico San Carlos, IdISSC, Complutense University, Madrid, Spain
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NAMLI Z, TAMAM L, DEMİRKOL ME, KARAYTUĞ MO, UĞUR K, ERİŞ Ö. Antidepresanların ilaç ilişkili hareket bozuklukları ve cinsel yan etkiler açısından karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.865933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Larsen KG, Areberg J, Åström DO. Are self-reported and self-monitored adherence good proxies for reaching relevant plasma concentrations?: Experiences from a study of anti-depressants in healthy volunteers. Clin Trials 2021; 18:505-510. [PMID: 33938259 DOI: 10.1177/17407745211012683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of electronic-based devices to measure and to improve adherence of subjects in clinical trials is increasing. AiCure has developed a mobile technology that is claimed to provide visual confirmation of drug ingestion. While there is evidence suggesting that including such self-monitoring device in a study increases adherence, the quality of the data produced by the device may be questionable. Can the mobile technology reliably distinguish whether a subject takes the study drug or not? METHODS Adherence was calculated based on exposure, self-reporting and self-monitoring for subjects randomized to an anti-depressant. Levels of adherence and agreement between the three approaches were investigated based on calculation of proportions, two-way tables and receiver operating curves. RESULTS A total of 214 subjects had measured concentrations of study drug at all three time points (end of weeks 3, 4 and 5), along with adherence data to define proportion of days adherent based on self-reporting and the self-monitoring instrument developed by AiCure. Self-reported adherence proportions were higher than self-monitored adherence proportions, although both were high (>90%). Neither self-reported and self-monitored adherence agreed with exposure-based adherence. CONCLUSION Both self-reported and self-monitored adherence overestimated adherence. Neither the self-reported nor the self-monitored adherence measure reflected subjects' actual adherence. This prompts for cautiousness when interpreting either of them, and it underlines the need for thorough validation of electronic devices and software that claims to measure adherence. The AiCure instrument may not be able to reliably determine whether the subjects swallow the study medication.
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Affiliation(s)
- Klaus Groes Larsen
- Department of Biostatistics & Programming, H. Lundbeck A/S, Copenhagen, Denmark
| | - Johan Areberg
- Department of PKPD Modelling & Simulation, H. Lundbeck A/S, Copenhagen, Denmark
| | - Daniel Oudin Åström
- Department of Value Evidence Analytics, H. Lundbeck A/S, Copenhagen, Denmark
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Chou J, Kiebalo T, Jagiello P, Pawlaczyk K. Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics. Life (Basel) 2021; 11:life11040311. [PMID: 33918412 PMCID: PMC8065963 DOI: 10.3390/life11040311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022] Open
Abstract
Patient survival continues to increase with the growing quality of dialysis and management of chronic kidney disease (CKD). As such, chronic therapy must include considerations of quality of life (QOL), and this includes the disproportionate prevalence of sexual dysfunction (SD) in this patient population. This review aims to describe the pathophysiological and the psychosocial causes of SD with regard to renal replacement therapy, particularly hemo- and peritoneal dialysis. The differences in its manifestation in men and women are compared, including hormonal imbalances—and therefore fertility, libido, and sexual satisfaction—the experience of depression and anxiety, and QOL. The impact of comorbidities and the iatrogenic causes of SD are described. This review also presents validated scales for screening and diagnosis of SD in CKD patients and outlines novel therapies and strategies for the effective management of SD. Increased prevalence of CKD invariably increases the number of patients with SD, and it is crucial for health care professional teams to become familiar with the clinical tools used to manage this sensitive and under-quantified field. As a known predictor of QOL, sexual function should become a point of focus in the pursuit of patient-centered care, particularly as we seek to achieve as “normal” a life as possible for individuals who receive dialysis.
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Danielak D. Vortioxetine in management of major depressive disorder - a favorable alternative for elderly patients? Expert Opin Pharmacother 2021; 22:1167-1177. [PMID: 33650935 DOI: 10.1080/14656566.2021.1880567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Depressive disorders are common in older patients, and their prevalence may reach up to 17.1%. Though for older adults, the initial recommended treatment is either life-review treatment or group cognitive-behavioral therapy, a combination of pharmacotherapy with interpersonal psychotherapy is also an option. There are many classes of antidepressants, and some meta-analyses suggest that the efficacy of different antidepressant groups is similar. Therefore, depression treatment in an elderly patient should consider preference, safety, and tolerability. Most reports suggest that SSRIs, such as citalopram, escitalopram, or sertraline, should be proposed as first-time medications.Areas covered: This article discusses the pharmacokinetic and pharmacodynamic properties of vortioxetine, emphasizing the observed differences, benefits, and risks for older patients. Vortioxetine - a multimodal antidepressant drug - was shown to be effective against major depressive disorders in both double-blinded, placebo-controlled trials and open-label studies.Expert opinion: Compared with commonly used antidepressants, vortioxetine appears to have unique properties that may be beneficial for elderly patients. Not only does it enhance cognitive function, but it also has a favorable safety profile.
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Affiliation(s)
- Dorota Danielak
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
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21
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Adamo D, Calabria E, Coppola N, Pecoraro G, Mignogna MD. Vortioxetine as a new frontier in the treatment of chronic neuropathic pain: a review and update. Ther Adv Psychopharmacol 2021; 11:20451253211034320. [PMID: 34497709 PMCID: PMC8419528 DOI: 10.1177/20451253211034320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic neuropathic pain (CNP) is a disabling medical condition that impairs the health-related quality-of-life of affected patients. A high prevalence of anxiety, depression, sleep disturbance and cognitive impairment has frequently been reported in association with CNP, making the management of this disease complex and often multidisciplinary. Dual-acting agents such as selective serotonin and noradrenalin reuptake inhibitors (SNRIs) are considered particularly useful in the modulation of pain and in treatment of the mood disorders frequently associated with CNP. Recent evidence suggests that the top-down inhibitory control of pain involves the engagement and enhancement of descending endogenous opioidergic, cannabinoid and serotonergic systems, with the effect of serotonin being particularly related to the receptor subtypes that are preferentially activated; indeed serotonin induces analgesia via activation of 5-HT7 receptors and hyperalgesia via activation of 5-HT3 receptors. Vortioxetine (VO) is a novel multimodal serotonergic antidepressant with a unique mechanism of action. It has been demonstrated recently in experimental and clinical studies to have efficacy on pain hypersensitivity and on mood disorders. This drug inhibits the serotonin transporter with a high affinity, antagonises the 5-HT3, 5-HT1D and 5HT7 serotonin receptors, and activates the 5-HT1A and 5-HT1B receptors. In clinical studies, VO has proved effective at a dose of 10-20 mg/daily in short- and long-term treatment of patients with chronic orofacial pain, demonstrating a higher rate of clinical response and remission, a better acceptability, safety rate and tolerability, and a lower latency of action compared with other antidepressants. In the light of these recent findings, VO may be considered as a new pharmacological treatment also in relation to various types of CNP, particularly in elderly patients with concomitant mood disorders and cognitive impairment. The purpose of this review is to provide an up-to-date overview of the pharmacology and clinical applications of VO and to highlight its potential therapeutic properties and advantages in the management of CNP.
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Affiliation(s)
- Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, via Pansini no.5, Naples, 80131, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Slack P, Aziz VM. Sexuality and sexual dysfunctions in older people: a forgotten problem. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SUMMARYThis article considers sexuality in older adults and the associated stereotypes and stigmas that lead to this area being underappreciated. Normal physiological changes in ageing are discussed and how they can cause sexual dysfunction. The elderly population has a higher burden of comorbid physical illness and this review considers evidence on the interplay between physical health and sexual health. Mental illness is also strongly linked with sexual functioning and is discussed, as is the evidence on psychotropics and sexual side-effects. Attitudes on sexuality in long-term care settings are highlighted and approaches to managing sexual disinhibition are included.
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