Traitements médicamenteux de la dépression

[Prevalence and characteristics of sexual dysfunction among Moroccan patients consulting for a first depressive episode]

Depression as such causes emotional and physical disturbances that affect biological functions such as sleep, appetite, decreased libido and lack of interest in sexual function. Indeed, there is a significant incidence of sexual dysfunction in depressed patients. In addition, depression and sexual dysfunction have a significant impact on the quality of life of couples which can be improved by managing these two conditions between which there seems to be a two-way causal link. Sexual dysfunction has long been neglected in the clinic of depression. In Morocco, depression affects more than a quarter of the population. However, to date, no study has focused on the assessment of sexual function in relation to depression among Moroccans.

OBJECTIVES

This work aimed to evaluate the prevalence and characteristics of sexual dysfunction in Moroccan patients consulting for a first depressive episode.

METHODS

This is a descriptive cross-sectional study. All subjects included in this study were consulting for a first major depressive episode according to DSM-5 criteria from June 1st to November 30th, 2017 at the psychiatric university department at Ibn Nafis hospital in Marrakech. The severity of depression was assessed using the Hamilton scale. The ASEX (Arizona Sexuel Experience) scale was used to define sexual dysfunction. Statistical analysis was performed using SPSS 22 software.

RESULTS

Fifty eight patients were recruited 34 of whom were female. They had an average age of 37 years. The majority were between 27 and 42 years old (59 %), married (81 %), with an average level of education (34.5 %). The average duration of the episode was 57 days. The major depressive episode was severe in 62 % of patients. According to the ASEX, 77.6 % of the depressed patients had a clinically significant sexual dysfunction. The majority of our patients (60.3 %) consulting for depression attach their sexual dysfunction to their depressed mood, either by reporting the onset of sexual dysfunction at the same time as depression (53.4 %), or worsening after the depression onset (6.9 %). The frequency of sexual intercourse with the pre-depressive state was decreased in the majority of our sample. Sexual desire was the most impaired phase of the sexual response (58.6 %) followed by excitation (53.4 %) and then orgasm (51.7 %). Of the 47 married patients, more than two thirds (32 patients) were dissatisfied with their life as a couple as well as with different aspects of their relationship life. The majority of patients reporting marital dissatisfaction attributed the cause to the quality of their sexual intercourses rather than to their frequency or other relational aspects. Sexual dysfunction was significantly correlated with the severity of depression (P=0.031), whereas it was not correlated with duration of depressive episode (P=0.412) or age or patient sex (P=0.114, P=0.202 respectively).

CONCLUSIONS

The prevalence of sexual dysfunction is high in depressed patients. It significantly impacts the couple's quality of life. Although our main limitation was the small sample size which prevented us from doing a multi-varied analysis, the robust nature of this study lies in documenting the initial prevalence and types of sexual dysfunctions in both sexes in the first major depressive episode unrelated to the dysfunctions induced by antidepressant drugs. The early identification of sexual disorders and the consideration of couple dynamics would be two important elements in the management of the depressed patient.