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Nguyen V, Dolendo I, Uloko M, Hsieh TC, Patel D. Male delayed orgasm and anorgasmia: a practical guide for sexual medicine providers. Int J Impot Res 2024; 36:186-193. [PMID: 37061617 PMCID: PMC11035123 DOI: 10.1038/s41443-023-00692-7] [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: 09/21/2022] [Revised: 03/15/2023] [Accepted: 03/24/2023] [Indexed: 04/17/2023]
Abstract
Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.
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Affiliation(s)
- Vi Nguyen
- Department of Urology, University of California, San Diego, CA, USA
| | - Isabella Dolendo
- Department of Urology, University of California, San Diego, CA, USA
| | - Maria Uloko
- Department of Urology, University of California, San Diego, CA, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California, San Diego, CA, USA
| | - Darshan Patel
- Department of Urology, University of California, San Diego, CA, USA.
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2
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Bailey AM, Barrett A, Havens L, Leyder E, Merchant T, Starnes H, Thompson SM. Changes in social, sexual, and hedonic behaviors in rats in response to stress and restoration by a negative allosteric modulator of α5-subunit containing GABA receptor. Behav Brain Res 2023; 452:114554. [PMID: 37356670 PMCID: PMC10528636 DOI: 10.1016/j.bbr.2023.114554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
Major depressive disorder (MDD) is a debilitating and costly human condition. Treatment for MDD relies heavily on the use of antidepressants that are slow to produce mood-related changes and are not effective in all patients, such as selective serotonin reuptake inhibitors (SSRIs). Several novel compounds, including negative allosteric modulators of GABA-A receptors containing the α5-subunit (GABA-NAMs), are under investigation for potential fast acting therapeutic use in MDD. Preclinical evidence that these compounds produce a rapid antidepressant-like response comes primarily from simple tests of escape behavior and preference for rewarding stimuli after chronic stress. To increase the ethological relevance of these compounds, we tested the hypothesis that the GABA-NAM, L-655,708, would produce an antidepressant-like response in more complex stress-sensitive social and sex behaviors, which are of relevance to the symptoms of human depression. In male rats subjected to chronic restraint stress, injection of L-655,708 increased reward in a sexual conditioned place preference task, increased male sexual activity with a receptive female, and re-established male social dominance hierarchies within 24 h. We also report increased sucrose preference in the social defeat stress (SDS) model of depression following GABA-NAM administration, demonstrating that its antidepressant-like actions are independent of the type of chronic stress administered. This work extends the impact of GABA-NAMs beyond traditional tests of anhedonia and further supports the development of alpha5 subunit-selective GABA-NAMs as a potential fast-acting therapeutic approach for treating human MDD.
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Affiliation(s)
- Aileen M Bailey
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States.
| | - Allison Barrett
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Lane Havens
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Erica Leyder
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Taylor Merchant
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Hannah Starnes
- Department of Psychology, St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Scott M Thompson
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
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3
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Adus-salam A, Jimoh M, Ehiedu CG. Sexual characteristics of patients with prostate cancer seen for radiation treatment. Ecancermedicalscience 2023; 17:1577. [PMID: 37533949 PMCID: PMC10393305 DOI: 10.3332/ecancer.2023.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 08/04/2023] Open
Abstract
Background Prostate cancer was estimated to be the second most diagnosed cancer and the fifth leading cause of cancer mortality among men, with an estimated 1.4 million new cases and 375,000 deaths globally in 2020. There are significant changes in sexual activities and subsequent changes in quality of life associated with the diagnosis and treatment of prostate cancer. Sexual problems experienced by prostate cancer patients include erectile dysfunction, reduced sexual desire, reduced sexual function, problems with ejaculation, as well as problems with orgasm, and these could occur before and/or after treatment. This study aims to highlight the sexual characteristics of prostate cancer patients, which would help identify altered sexuality that might require intervention by healthcare providers. Method All patients who presented with pathologically diagnosed, organ-confined prostate cancer referred for high-dose-rate brachytherapy were approached for participation in the study. An interviewer-administered questionnaire was administered to the consenting patients. Results A total of 56 patients gave consent for the study out of 60. All the patients were married, with 5 (8.9%) having multiple wives. Only ten respondents (17.9%) reported having other sexual partners besides their wives. More than half of the patients (34) (60.7%) started having sexual intercourse between the ages of 18 and 20. Many patients claimed that the diagnosis of prostate cancer had affected their sexual lives. About half of the respondents (44.6%) believed that their partners were less satisfied with their sexual performance, as evidenced by the loss of partners (5.4%), partners refusing sexual advances (14.3%), partners complaints (10.7%), and partners' reduced inclination to ask for sex (33.9%). One patient expressed fears of passing the disease to their partners. Conclusion The management of prostate cancer should include sex therapy and rehabilitation in couples from the point of diagnosis to maintain sexual function as close as possible to that in the general population in order to maintain an improved quality of life.
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Affiliation(s)
- Abbas Adus-salam
- Department of Radiation Oncology, University College Hospital/University of Ibadan, Ibadan 200212, Nigeria
- University College Hospital, Ibadan 200005, Nigeria
| | - Mutiu Jimoh
- Department of Radiation Oncology, University College Hospital/University of Ibadan, Ibadan 200212, Nigeria
- University College Hospital, Ibadan 200005, Nigeria
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Akbarzadeh F, Eslamzadeh M, Behravan G, Ebrahimi A, Emami SA, Gilan A, Hoseinian NS. Assessing the effect of Alpinia galanga extract on the treatment of SSRI-induced erectile dysfunction: A randomized triple-blind clinical trial. Front Psychiatry 2023; 14:1105828. [PMID: 37143784 PMCID: PMC10151528 DOI: 10.3389/fpsyt.2023.1105828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
Objective SSRIs are considered the first line in the medical treatment of depression and anxiety disorders. One of their most common side effects, sexual dysfunction, has led many patients to discontinuing their medication and treatment course. Alpinia galanga, a plant from the ginger family, has been shown to enhance androgenic activity and sexual function. This study aimed to assess whether the addition of Alpinia galanga extract to the treatment regimen of adult males consuming SSRIs can improve SSRI-induced erectile dysfunction. Materials and methods This triple-blind randomized clinical trial was conducted on 60 adult males who were being treated with SSRIs at the time of the study. The participants were divided into two groups, a group of 30 people receiving 500 mg of Alpinia galanga extract and a group of 30 subjects receiving placebo. The population were re-assessed on week 2 and week 4 of the study using the international index of erectile function (IIEF), the Beck Depression Inventory, and the Beck Anxiety Inventory. In all the tests, a p-value of 0.05 was considered as the cut-off for significance. Results At the beginning of the study, the IIEF scores of the placebo group and the intervention group were 10.6 ± 3.8 and 11.2 ± 4.8, respectively, which were not significantly different (p-value = 0.577). By week 4 of the study, the IIEF scores of the control group and the Alpinia galanga group had increased to 13.7 ± 4.3 and 17.4 ± 3.7 respectively, which demonstrates a remarkably larger increase in the group receiving Alpinia galanga extract in comparison to the placebo group (p-value < 0.001). Conclusion In this study, the effect of the addition of Alpinia galanga extract to the treatment regimen of male patients using SSRIs on the sexual dysfunction experienced by this group has been promising. Similar results, if proven, can aid both patients and clinicians in making and following better treatment plans with more pleasant outcomes. Clinical trial registration [https://clinicaltrials.gov/], identifier [IRCT20101130005280N41].
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Affiliation(s)
- Farzad Akbarzadeh
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Eslamzadeh
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghazal Behravan
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ebrahimi
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Emami
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefe Gilan
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najme Sadat Hoseinian
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- *Correspondence: Najme Sadat Hoseinian,
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Petrova NN. [Sexual dysfunction on the background of antidepressant therapy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:115-121. [PMID: 38127711 DOI: 10.17116/jnevro2023123112115] [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: 12/23/2023]
Abstract
The review is devoted to the problem of sexual dysfunction caused by taking antidepressants. Sexual dysfunction is widespread, but it is not reported, and its impact on the quality of life and compliance of patients is underestimated. Partly because of its bidirectional association with depression, sexual dysfunction is difficult to diagnose. Possible mechanisms and risk factors associated with sexual dysfunction in patients with depression are considered. The data on the frequency of sexual dysfunction with the use of various antidepressants are given. Therapeutic strategies for sexual dysfunction associated with taking antidepressants are described. The advantages of agomelatin as an antidepressant associated with a low risk of sexual side effects are emphasized.
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Affiliation(s)
- N N Petrova
- Saint Petersburg State University, St. Petersburg, Russia
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6
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Petković A, Chaudhury D. Encore: Behavioural animal models of stress, depression and mood disorders. Front Behav Neurosci 2022; 16:931964. [PMID: 36004305 PMCID: PMC9395206 DOI: 10.3389/fnbeh.2022.931964] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Animal studies over the past two decades have led to extensive advances in our understanding of pathogenesis of depressive and mood disorders. Among these, rodent behavioural models proved to be of highest informative value. Here, we present a comprehensive overview of the most popular behavioural models with respect to physiological, circuit, and molecular biological correlates. Behavioural stress paradigms and behavioural tests are assessed in terms of outcomes, strengths, weaknesses, and translational value, especially in the domain of pharmacological studies.
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Affiliation(s)
| | - Dipesh Chaudhury
- Laboratory of Neural Systems and Behaviour, Department of Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
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[Adverse effects of opioids, antidepressants and anticonvulsants on sex hormones : Often unnoticed but clinically relevant]. Schmerz 2022; 36:293-307. [PMID: 35831621 DOI: 10.1007/s00482-022-00655-9] [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: 03/30/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022]
Abstract
Androgen insufficiency under treatment with opioids, antidepressants and anticonvulsants in chronic pain diseases is a side effect with a high prevalence. It can lead to clinical metabolic alterations, adynamia, stress intolerance, anemia or osteoporosis and has a significant impact on the quality of life. Opioids, antidepressants and anticonvulsants affect the hypothalamic-pituitary-gonadal axis of sex hormones. A urologist, andrologist or endocrinologist should be involved in the treatment at an early stage. The recommendation of a differential therapeutic selection of certain substances is only indicative and does not meet evidential criteria. The indications for androgen substitution must be individualized and in consideration of the risk-benefit profile. Awareness of this side effect of an otherwise lege artis medicinal pain therapy must be sharpened and compulsory included in the differential diagnostic considerations.
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8
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Chua AL, Mehla S, Orlova YY. Drug Safety in Episodic Migraine Management in Adults. Part 2: Preventive Treatments. Curr Pain Headache Rep 2022; 26:493-504. [PMID: 35587859 DOI: 10.1007/s11916-022-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to aid in decision-making when choosing safe and effective options for preventive migraine medications. RECENT FINDINGS In Part 2, we have compiled clinically relevant safety considerations for commonly used migraine prophylactic treatments. Preventive treatment of episodic migraine includes nonspecific and migraine-specific drugs. While medications from several pharmacological classes-such as anticonvulsants, beta-blockers, and antidepressants-have an established efficacy in migraine prevention, they are associated with a number of side effects. The safety of migraine-specific treatments such as anti-CGRP monoclonal antibodies and gepants are also discussed. This review highlights safety concerns of commonly used migraine prophylactic agents and offers suggestions on how to mitigate those risks.
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Affiliation(s)
- Abigail L Chua
- Geisinger Health Systems, Neurology, 1000 E. Mountain Boulevard, Wilkes-Barre, PA, 18711, USA.
| | - Sandhya Mehla
- Ayer Neurosciences Institute, Hartford HealthCare Medical Group, University of Connecticut School of Medicine, Norwich, CT, USA
| | - Yulia Y Orlova
- Neurology Department, University of Florida, Gainesville, USA
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Espinola CW, Khoo Y, Parmar R, Demchenko I, Frey BN, Milev RV, Ravindran AV, Parikh SV, Ho K, Rotzinger S, Lou W, Lam RW, Kennedy SH, Bhat V. Males and females differ in reported sexual functioning with escitalopram treatment for major depressive disorder: A CAN-BIND-1 study report. J Psychopharmacol 2022; 36:604-613. [PMID: 35546043 DOI: 10.1177/02698811221095832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Antidepressant use for major depressive disorder (MDD) is frequently associated with sexual dysfunction. AIMS Cross-sectional and longitudinal relationships between antidepressant treatment outcomes and sexual functioning (SF) were evaluated separately for males and females receiving escitalopram. We further assessed the association between pre- and posttreatment SF. METHODS In all, 208 of the 211 CAN-BIND-1 trial participants (77 males and 131 females) with MDD and detectable drug blood levels were eligible for the analyses. All received escitalopram (10-20 mg) for 8 weeks. At baseline and Week 8, participants completed the Montgomery-Åsberg Depression Rating Scale (MADRS) and the SexFx scale, which measures sexual satisfaction and SF frequency. Mixed-model repeated measures assessed baseline to Week 8 SF changes among participants with different response/remission statuses. Multiple linear regression analyses examined SF differences between treatment outcomes at Week 8 as well as associations between pretreatment and eventual SF. RESULTS For both sexes, overall sexual satisfaction improved among responders but not among nonresponders (p < 0.05). For females, overall SF frequency did not change significantly over time regardless of response status. For males, overall SF decreased significantly among nonresponders; orgasm decreased significantly among nonresponders and, to a lesser extent, among responders (p < 0.05). For both sexes, pretreatment SF was significantly associated with SF at Week 8 across all domains (p < 0.05). CONCLUSION For both sexes, sexual satisfaction improves with response to escitalopram. For females, the response does not correspond to improvements in SF frequency. For males, SF frequency, particularly that of orgasm, declines regardless of response/nonresponse.ClinicalTrials.gov identifier: NCT01655706.
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Affiliation(s)
- Caroline W Espinola
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuelee Khoo
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Roohie Parmar
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Roumen V Milev
- Departments of Psychiatry and Psychology, Queen's University, Providence Care Hospital, Kingston, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Keith Ho
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Susan Rotzinger
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Centre for Depression & Suicide Studies, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute & Krembil Research Institute, Toronto, ON, Canada
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Canpolat S, Ulker N, Yardimci A, Tancan E, Sahin E, Yaman SO, Bulmuş O, Alver A, Ozcan M. Irisin ameliorates male sexual dysfunction in paroxetine-treated male rats. Psychoneuroendocrinology 2022; 136:105597. [PMID: 34861466 DOI: 10.1016/j.psyneuen.2021.105597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 01/23/2023]
Abstract
Sexual dysfunction is a common clinical condition due to different causes including the use of selective serotonin reuptake inhibitors (SSRI). Especially, SSRI paroxetine is known to cause numerous types of sexual dysfunction in men. There is growing interest in exercise as a non-pharmacological approach for the treatment of SSRI-induced sexual dysfunction. With these in mind, we investigated the effects of irisin, which is a recently detected exercise-linked hormone, on paroxetine-induced sexual dysfunction in male rats. Our findings showed that circulating irisin levels were lower in paroxetine-induced sexual dysfunction in male rats (20 mg/kg/day for 8 weeks by oral gavage than in vehicle-treated rats). In addition, results from sexual behavioral tests revealed that subcutaneous irisin perfusion (100 ng/kg/day via mini-osmotic pumps for 28 days) ameliorated sexual motivation and copulatory performance in sexually impaired male rats treated with paroxetine. The significantly reduced serum testosterone levels and α1-adrenoceptors (ADRA1A) and tyrosine hydroxylase gene (TH) expression levels in the nucleus accumbens (NAc) in paroxetine-induced sexually dysfunctioning male rats were markedly increased following irisin exposure. Similarly, the expression levels of ADRA1A and TH in the medial preoptic area (mPOA) significantly increased in male rats co-administered with paroxetine and irisin compared to the vehicle-treated male rats. These results demonstrate that irisin may be a therapeutic modality that mimics/supports the beneficial effects of exercise for improving SSRI-associated sexual dysfunction in men through increase in serum testosterone levels and increased expression of α1-adrenoceptors and TH in the NAc and mPOA associated with sexual motivation and copulatory behaviors.
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Affiliation(s)
- Sinan Canpolat
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey.
| | - Nazife Ulker
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Ahmet Yardimci
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Emre Tancan
- Department of Physiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Elif Sahin
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Serap Ozer Yaman
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ozgur Bulmuş
- Department of Physiology, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Ahmet Alver
- Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mete Ozcan
- Department of Biophysics, Faculty of Medicine, Firat University, Elazig, Turkey
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Li Q, Zhang H, Lin G, Shi S, Zhang Y, Ji J, Yang L, Yao J, Wu W. Relative Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial. Neuropsychiatr Dis Treat 2022; 18:1653-1664. [PMID: 35968511 PMCID: PMC9374096 DOI: 10.2147/ndt.s366048] [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: 03/11/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the relative safety and efficacy of different doses of tandospirone in treating generalized anxiety disorder (GAD). PATIENTS AND METHODS This parallel randomized controlled trial enrolled patients with GAD from eight centers in China. The patients were randomly assigned to 60 mg/day or 30 mg/day tandospirone groups. The primary endpoint was the overall response rate after receiving 6-week treatment. The secondary endpoints included significant response rate, clinical recovery rate, change in the Hamilton Anxiety Scale (HAMA) total score, HAMA subscale score, Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression-Severity Scale (CGI-S) score, and Impression-Improvement scale (CGI-I) score. RESULTS No significant difference was found in the overall response rate between the two groups (65.7% vs 58.4%, p = 0.213). A higher significant response rate and change in the HAMA total score were found in the 60 mg/day group. The reduction in the CGI-S score and percentage of patients with a CGI-I score of ≤2 were higher in 60 mg/day group. The reduction in HAMA somatic anxiety factor, cardiovascular symptom factor, gastrointestinal symptom factor, and HAMD-17 score were more significant in the 60 mg/day group. The incidence of total adverse events was higher in the 60 mg/day group than in the 30 mg/day group. No significant difference was found in the proportion of withdrawal due to adverse events. CONCLUSION Both 60 mg/day and 30 mg/day tandospirone show good efficacy in treating patients with GAD. High doses of tandospirone may have advantages in relieving the somatic symptoms but also present disadvantages due to their high level. TRIAL REGISTRATION The trial registration no. was NCT01614041.
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Affiliation(s)
- Qingwei Li
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Haiyin Zhang
- Clinical Psychology, Shanghai Mental Health Center, Shanghai, People's Republic of China
| | - Guozhen Lin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shenxun Shi
- Psychiatry Department, Fudan University Affiliated Huashan Hospital, Shanghai, People's Republic of China
| | - Yingli Zhang
- Department of Depressive Disorders, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, People's Republic of China
| | - Jianlin Ji
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Lipeng Yang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Jun Yao
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Wenyuan Wu
- Department of Psychiatry, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Tolerability of High-Dose Venlafaxine After Switch From Escitalopram in Nonresponding Patients With Major Depressive Disorder. J Clin Psychopharmacol 2021; 41:62-66. [PMID: 33208708 DOI: 10.1097/jcp.0000000000001312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Within a single depressive episode, most patients receive different antidepressants because of an inadequate response to the first-line antidepressant. A commonly used strategy is to switch from a selective serotonin reuptake inhibitor to a selective serotonin-norepinephrine reuptake inhibitor. However, little is known about the tolerability of this switch with consideration of dose and drug concentration in blood. METHODS After 4 weeks of inadequate response to escitalopram (10-20 mg/d), medication was switched to another 4 weeks of venlafaxine (VF, 150-375 mg/d) in 234 depressed patients. Serum concentrations, depression severity, and adverse drug reactions (ADRs) were assessed weekly. RESULTS The switch of medication led to an increase of ADRs such as reduced salivation (+11%), orthostatic dizziness (+11%), and sweating (+9.8%). The most frequent ADRs during treatment with VF were reduced salivation (28.6%), sweating (24.6%), and orthostatic dizziness (15.8%). In patients receiving high-dose VF, a significant improvement of depressive symptomatology was observed, and most ADRs decreased during the course of treatment, even in patients above the therapeutic reference range. LIMITATIONS Patients and physicians were aware of medication, and there was no direct comparison with the herein presented switch of medication. IMPLICATIONS This study provides important information about the tolerability of a commonly used antidepressant treatment strategy. More detailed information about putative ADRs may help clinicians increase compliance through effective patient education. Because ADRs of VF were associated with the plasma concentration, therapeutic drug monitoring is recommended to guide the therapy and manage problems of tolerability.
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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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Jansen N, Daniels C, Sunil T, Xu X, Cota J, Ganesan A, Agan BK, Okulicz JF. Factors associated with erectile dysfunction diagnosis in men with HIV infection: a case-control study. HIV Med 2021; 22:617-622. [PMID: 33899322 DOI: 10.1111/hiv.13107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV infection is associated with increased risk of erectile dysfunction (ED); however, factors associated with ED remain unclear. We evaluated the prevalence of ED among men living with HIV and factors associated with ED diagnosis in the US Military HIV Natural History Study (NHS). METHODS A retrospective cohort study evaluated participants in the NHS, a cohort of HIV-positive active duty members and beneficiaries with HIV infection. Men with a diagnosis of ED after HIV diagnosis were included. Cohort controls without ED diagnosis were matched 2:1 by age at HIV diagnosis and duration of follow-up. Multivariate logistic regression models were used to identify factors associated with ED. RESULTS A total of 543 of 5682 male participants (9.6% prevalence) had a diagnosis of ED, of whom 488 were included in the analysis. The median (interquartile range, IQR) age at ED diagnosis was 43 (37.0-49.0) years and the time from HIV diagnosis to antiretroviral therapy (ART) start was longer for cases (5.0 years, IQR: 2.0-9.0) than for controls (3.0 years, 1.0-6.0; P < 0.01). Cases had higher proportions of multiple comorbid conditions, including depression (33.4% vs. 21.7%), tobacco use (19.7% vs. 9.0%) and sleep apnoea (14.8% vs. 4.2%) compared with controls (P < 0.01 for all). Logistic regression showed increased odds of ED for delayed ART initiation > 4 years [odds ratio (OR) = 2.05, 95% confidence interval (CI): 1.56-2.71], protease inhibitor use ≥ 1 year (OR = 1.81, 95% CI: 1.38-2.38) and sleep apnoea (OR = 2.60, 95% CI: 1.68-4.01). CONCLUSIONS Erectile dysfunction was common in men with HIV and associated factors included both HIV-related and traditional factors.
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Affiliation(s)
- N Jansen
- San Antonio Military Medical Center, San Antonio, TX, USA
| | - C Daniels
- Department of Sociology, University of Texas San Antonio, San Antonio, TX, USA
| | - T Sunil
- Department of Sociology, University of Texas San Antonio, San Antonio, TX, USA.,West China School of Public Health, Sichuan University, Chengdu, China
| | - X Xu
- Department of Sociology, University of Texas San Antonio, San Antonio, TX, USA.,School of Public Administration, Sichuan University, Chengdu, China
| | - J Cota
- San Antonio Military Medical Center, San Antonio, TX, USA.,University of the Incarnate Word Feik School of Pharmacy, San Antonio, TX, USA
| | - A Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Rockville, MD, USA
| | - B K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Rockville, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - J F Okulicz
- San Antonio Military Medical Center, San Antonio, TX, USA
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Adefegha SA, Oboh G, Olopade EO. β-caryophyllene improves sexual performance via modulation of crucial enzymes relevant to erectile dysfunction in rats. Toxicol Res 2020; 37:249-260. [PMID: 33868981 DOI: 10.1007/s43188-020-00061-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022] Open
Abstract
This study sought to investigate the effect of β-caryophyllene (BCP) on sexual performance, crucial enzymes linked to erectile function as well as lipid peroxidation in the penile tissue of paroxetine (PD)-induced rats. Animals were randomly divided into ten groups of five animals each: normal control (NC), BCP (10 mg/kg), BCP (20 mg/kg), sildenafil citrate (SD) (20 mg/kg), BCP + SD (20 mg/kg), PD (20 mg/kg), PD + BCP (10 mg/kg), PD + BCP (20 mg/kg), PD + SD (20 mg/kg) and PD + BCP (20 mg/kg) + SD (20 mg/kg). Oral administration of 20 mg/kg body weight of PD for the first 7 days was done while treatment with BCP and SD were performed between 8 and 14 days prior to euthanasia. The sexual performance study revealed that PD caused erectile dysfuction. Elevated activities of phosphodiesterase-5' (PDE-5'), arginase, adenosine deaminase (ADA), acetylcholinesterase (AChE) and angiotensin-I converting enzyme (ACE) as well as lipid peroxidation level were observed in PD-induced rats when compared to the NC group. However, treatment with sildenafil and/ or β-Caryophyllene significantly reduced the activities of AChE, PDE-5', arginase, ADA, and ACE in penile tissues of PD-induced rats. In addition, co-administration of β-caryophyllene and sildenafil citrate showed better modulatory effects. Thus, β-caryophyllene could represent a potential nutraceutical in the management of erectile dysfunction.
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Affiliation(s)
- Stephen A Adefegha
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
| | - Ganiyu Oboh
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
| | - Elijah O Olopade
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
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Watkins LV, Angus-Leppan H. Valproate, sexual health, and men: A narrative review. Epilepsy Behav 2020; 103:106835. [PMID: 31892466 DOI: 10.1016/j.yebeh.2019.106835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This article explores current evidence about the effects of valproate (VPA) medicines on sexual health in men, how to monitor symptoms, communicate with patients, and improve clinical outcomes. There has been a lot of focus on VPA use in women of childbearing age following recent changes to prescribing regulations owing to the well-established and significant teratogenic risk. Concerns have been raised by patients and clinicians as to the risk of adverse sexual effects of VPA use in men. RESULTS The evidence base for the effect of VPA on sexual function compared with other antiepileptic drugs (AEDs) in men is limited with no randomized controlled trials. Sexual function in men with epilepsy is complex, and there is no direct relationship between objective measures of sexual function and sexual satisfaction. Epilepsy, comorbidities, psychosocial factors, and most AEDs including VPA may cause sexual dysfunction in men, including reduced sexual desire, erectile dysfunction, and fertility problems. Sexual and reproductive function should be discussed with men prior to treatment with AEDs including VPA. CONCLUSION Early and proactive discussion of sexual and reproductive functioning mitigates, rather than increases, the risk of sexual problems and potentially improves adherence. Sexual dysfunction in men with cognitive impairment [such as intellectual disability (ID) and dementia] may present with behavioral disturbance. Identification of sexual adverse effects of medication could significantly change treatment plans which is of particular importance for individuals with treatment resistance. We provide an information fact sheet for men to help guide prescribing discussions.
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Affiliation(s)
- Lance Vincent Watkins
- Swansea Bay University Health Board, Mental Health and Learning Disability Delivery Unit, LLwyneryr Unit, Swansea, United Kingdom.
| | - Heather Angus-Leppan
- Epilepsy Initiative Group, Royal Free London, United Kingdom; University College London, United Kingdom
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Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med 2019; 8:jcm8101640. [PMID: 31591339 PMCID: PMC6832699 DOI: 10.3390/jcm8101640] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) has a low rate of spontaneous reports by patients, and this side effect therefore remains underestimated in clinical practice and in technical data sheets for antidepressants. Moreover, the issue of TESD is rarely routinely approached by clinicians in daily praxis. TESD is a determinant for tolerability, since this dysfunction often leads to a state of patient distress (or the distress of their partner) in the sexually active population, which is one of the most frequent reasons for lack of adherence and treatment drop-outs in antidepressant use. There is a delicate balance between prescribing an effective drug that improves depressive symptomatology and also has a minimum impact on sexuality. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antidepressant with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: for low sexual desire, switching to a non-serotoninergic drug, lowering the dose, or associating bupropion or aripiprazole; for unwanted orgasm delayal or anorgasmia, dose reduction, “weekend holiday”, or switching to a non-serotoninergic drug or fluvoxamine; for erectile dysfunction, switching to a non-serotoninergic drug or the addition of an antidote such as phosphodiesterase 5 inhibitors (PD5-I); and for lubrication difficulties, switching to a non-serotoninergic drug, dose reduction, or using vaginal lubricants. A psychoeducational and psychotherapeutic approach should always be considered in cases with poorly tolerated sexual dysfunction.
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Chapitre 8 : Sexualité et ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S103-S121. [DOI: 10.1016/j.jogc.2019.02.147] [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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Fervaha G, Izard JP, Tripp DA, Rajan S, Leong DP, Siemens DR. Depression and prostate cancer: A focused review for the clinician. Urol Oncol 2019; 37:282-288. [DOI: 10.1016/j.urolonc.2018.12.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/03/2018] [Accepted: 12/22/2018] [Indexed: 12/14/2022]
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Abstract
Sexual dysfunction is one of the more common features of depressive disorders, presenting with dysfunction across sexual response cycle. Variety of factors play a role in causing sexual dysfunction in these patients, such as psychological, biological, social and interpersonal factors. Another cause of sexual dysfunction in these patients can be the side effect of antidepressants making it difficult to conclude if the dysfunction is the result of the depression or the treatment of depression. Clinicians need to be aware about the sexual dysfunction as it can have big impact on the overall quality of life of an individual.
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Affiliation(s)
- Shivananda Manohar J.
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Arpit Koolwal
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
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Adefegha SA, Oyeleye SI, Dada FA, Olasehinde TA, Oboh G. Modulatory effect of quercetin and its glycosylated form on key enzymes and antioxidant status in rats penile tissue of paroxetine-induced erectile dysfunction. Biomed Pharmacother 2018; 107:1473-1479. [DOI: 10.1016/j.biopha.2018.08.128] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/07/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022] Open
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Meston CM, Stanton AM. Comprehensive Assessment of Women's Sexual Arousal Requires Both Objective and Subjective Measurement. J Sex Med 2018; 15:423-425. [DOI: 10.1016/j.jsxm.2018.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 11/28/2022]
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Effects of tandospirone augmentation in major depressive disorder patients with high anxiety: A multicenter, randomized, parallel-controlled, open-label study. J Psychiatr Res 2018; 99:104-110. [PMID: 29433063 DOI: 10.1016/j.jpsychires.2018.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND High levels of anxiety symptoms are common in individuals with major depressive disorder (MDD). Adjunctive anxiolytics are widely used in such patients; however, only a few studies have examined the strategy using tandospirone. This study aimed to evaluate the efficacy and safety of adjunctive tandospirone in individuals with MDD and high level of anxiety symptoms. METHODS A multicenter, randomized, parallel-controlled, open-label study was conducted to evaluate the efficacy and safety of tandospirone coupled with selective serotonin reuptake inhibitors (SSRIs) in patients with MDD and high level of anxiety symptoms. Two hundred and forty-five patients fulfilling the DSM-IV-TR criteria for MDD were randomly assigned to 6 weeks of either SSRIs and tandospirone or SSRIs alone treatment. The efficacy was measured by HAMA total scores, HAMD-17 total scores, and Clinical Global Impressions severity subscale (CGI-S) score. RESULTS After a 6-week follow-up, two hundred and thirty patients completed this study. Tandospirone coupled with SSRIs significantly improved depressive and anxiety symptoms compared to monotherapy with SSRIs as assessed by HAMD-17 total score (P = 0.003), HAMA total score (P = 0.010), and CGI-S score at week 6 (P = 0.003). The incidence rate of treatment-emergent adverse events (TEAEs) was similar in both groups; the therapy was well-tolerated. CONCLUSIONS Short-term tandospirone augmentation was effective and well-tolerated in this study. Addition of tandospirone may improve outcomes in MDD patients with high anxiety.
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Guarraci FA, Gonzalez CM, Lucero D, Womble PD, Abdel-Rahim H, DeVore J, Kunkel MN, Quadlander E, Stinnett M, Boyette-Davis J. The effects of ketamine on sexual behavior, anxiety, and locomotion in female rats. Pharmacol Biochem Behav 2018; 165:36-44. [DOI: 10.1016/j.pbb.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022]
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Montejo AL, Montejo L, Baldwin DS. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management. World Psychiatry 2018; 17:3-11. [PMID: 29352532 PMCID: PMC5775119 DOI: 10.1002/wps.20509] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.
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Affiliation(s)
- Angel L Montejo
- Department of Nursing and Institute of Biomedicine of Salamanca, Neurosciences Area, University Hospital of Salamanca, Salamanca, Spain
| | - Laura Montejo
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Rotenberg VS. Sexual Disorders Caused by Antidepressants: Considerations in the Context of Brain Hemisphere Functions. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/bf03379566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
All phases of normal sexual activity are under the control of the right hemisphere coupled with limbic structures, and depression is characterized by the functional insufficiency of this system. At the same time, those modern antidepressants that cause sexual disorders are activating the left hemisphere and determine its domination on the expense of the right one and disturb free and spontaneous emotional interrelationships, sexual behavior and pleasure. Those antidepressants that do not cause sexual dysfunction are not activating predominantly the left hemisphere structures and activate the limbic brain zones responsible for reward, reinforcement and emotional excitement.
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Schlichthorst M, Sanci LA, Hocking JS. Health and lifestyle factors associated with sexual difficulties in men - results from a study of Australian men aged 18 to 55 years. BMC Public Health 2016; 16:1043. [PMID: 28185600 PMCID: PMC5103242 DOI: 10.1186/s12889-016-3705-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Sexual difficulties (SD) are common among men of all ages and can have considerable impact on quality of life and indications for future health. SD are associated with mental and physical wellbeing and with relationship satisfaction, yet they are rarely discussed with medical professionals who are often ill equipped to assess and manage them. This paper provides an updated overview on the status of SD in Australian men from 18 to 55 years of age and will form a baseline comparison for future analyses of SD based on Ten to Men data. Methods We used data from Ten to Men, the Australian Longitudinal Study on Male Health. SD was measured using eight items capturing specific sexual difficulties. We examined associations of a range of health and lifestyle factors (smoking, alcohol consumption, illicit drug use, obesity and new sexual partners, self-rated health status, disability, pain medication, diagnosed physical and mental health conditions) with each SD using logistic regression. The sample included 12,636 adult males who had previously been sexually active. Analysis was stratified by age (18–34 years versus 35–55 years). Results This paper shows that experiencing SD is relatively common among Australian men – overall half the sample (54 %; 95 % CI: 0.53–0.55) experienced at least one SD for more than 3 months over the past 12 months. While more common in older men aged 45 to 55 years, almost half the 18 to 24 year old men (48 %) also reported at least one SD highlighting that SD affects men of all ages. We found that SDs were associated with both lifestyle and health factors, although the strongest associations were observed for health factors in both age groups, in particular poor self-rated health, having a disability and at least one mental health condition. Lifestyle factors associated with SDs in men of all ages included smoking, harmful alcohol consumption and drug use in the past 12 months. Obesity was only associated with an increased rate of SD in men aged 35 to 55 years. Conclusion Sexual difficulties are common among men of all ages and increasingly more prevalent as men grow older. They are strongly associated with both health and lifestyle factors. With previous literature showing that SDs can be a precursor of an underlying or developing physical and mental health condition, it is imperative that sexual health and sexual functioning is discussed with a doctor as part of a standard health check and across the lifespan.
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Affiliation(s)
- Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Hralth, The University of Melbourne, Melbourne, 3010, Australia.
| | - Lena A Sanci
- Department of General Practice, The University of Melbourne, Melbourne, 3010, Australia
| | - Jane S Hocking
- Centre for Mental Health, Melbourne School of Population and Global Hralth, The University of Melbourne, Melbourne, 3010, Australia
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Abstract
Sexual functioning is important to assess in patients with psychiatric illness as both the condition and associated treatment may contribute to sexual dysfunction (SD). Antidepressant medications, mood stabilizers, antipsychotics, and antianxiety agents may be associated with SD related to drug mechanism of action. Sexual adverse effects may be related to genetic risk factors, impact on neurotransmitters and hormones, and psychological elements. Effective strategies to manage medication-induced sexual dysfunction are initial choice of a drug unlikely to cause SD, switching to a different medication, and adding an antidote to reverse SD. Appropriate interventions should be determined on a clinical case-by-case basis.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Andrew R Alkis
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Nishant B Parikh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Jennifer G Votta
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
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The quest for an increased genital size drives sex stimulant abuse among male subjects in Calabar, Cross River State, Nigeria. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Quinn-Nilas C, Benson L, Milhausen RR, Buchholz AC, Goncalves M. The Relationship Between Body Image and Domains of Sexual Functioning Among Heterosexual, Emerging Adult Women. Sex Med 2016; 4:e182-9. [PMID: 27036088 PMCID: PMC5005305 DOI: 10.1016/j.esxm.2016.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/27/2016] [Accepted: 02/19/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Research suggests that body image affects sexual functioning, but the relationship between specific types of body image (evaluative, affective, and behavioral) and domains of sexual functioning (desire, arousal, and orgasm) has not been investigated. Aim To determine whether, and to what degree, body image concerns (evaluative, affective, and behavioral) influence aspects of women’s sexual functioning (desire, arousal, and orgasm). Methods Eighty-eight sexually active women in heterosexual romantic relationships completed surveys assessing evaluative, affective, and behavioral body image and sexual functioning. Body composition data also were collected using dual energy x-ray absorptiometry. Main Outcome Measures Sexual functioning was assessed using the desire, arousal, and orgasm subscales of the Female Sexual Functioning Index. Results Hierarchical multiple regression analysis indicated that poor evaluative, affective, and behavioral body image were detrimental to women's sexual functioning. Specifically, dissatisfaction with one's body predicted decrements in desire (β = −0.31, P < .05) and arousal (β = −0.35, P < .01). Similarly, feeling that others evaluate one's body negatively predicted decrements in desire (β = 0.22, P < .05) and arousal (β = 0.35, P < .01). Feeling negatively about one’s appearance predicted decrements in arousal (β = 0.26, P < .05). Negative thoughts and feelings about one’s body during a sexual encounter (body image self-consciousness) predicted decrements in arousal (β = −0.37, P < .01) and orgasm (β = −0.25, P < .05). Conclusion Findings from this study suggest important linkages between body image and sexual functioning constructs and indicates that interventions to improve body image could have concomitant benefits related to sexual experience.
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Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol 2016; 140:359-68. [PMID: 26556768 PMCID: PMC4835814 DOI: 10.1016/j.ygyno.2015.11.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. METHODS A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. RESULTS Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. CONCLUSION Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems.
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Affiliation(s)
- Laura B Huffman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ellen M Hartenbach
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Joanne K Rash
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - David M Kushner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Fakhari A, Farahbakhsh M, Aboulghasemi fakhri N, Minashiri A. Investigation of the difference between the expression and presence of sexual symptoms and dysfunction in depressed women treated with fluoxetine. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2015. [DOI: 10.15171/jarcm.2015.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Pleasurable sexual activity is important in many human relationships and can provide a sense of physical, emotional and social well-being. Depressive symptoms and depressive illness are associated with impairments in sexual function and sexual dissatisfaction in untreated and treated patients. Most currently available antidepressant drugs are associated with development or worsening of sexual dysfunction in a substantial proportion of patients. Sexual difficulties during antidepressant treatment often resolve as depression lifts, but can persist over long periods, reducing self-esteem and affecting mood and relationships adversely. Sexual difficulties during antidepressant treatment typically have many possible causes but the incidence and nature of dysfunction varies between drugs. Many interventions can be considered when managing sexual dysfunction associated with antidepressants but no approach is 'ideal'. Because treatment-emergent sexual difficulties are less frequent with certain drugs, presumably related to differences in pharmacological properties, and since current interventions are suboptimal, a lower incidence of sexual dysfunction is a relevant tolerability target when developing novel antidepressants.
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Milhausen RR, Buchholz AC, Opperman EA, Benson LE. Relationships Between Body Image, Body Composition, Sexual Functioning, and Sexual Satisfaction Among Heterosexual Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1621-33. [PMID: 25063473 DOI: 10.1007/s10508-014-0328-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 06/27/2013] [Accepted: 10/12/2013] [Indexed: 05/10/2023]
Abstract
This study investigated the association between body image and body-image self-consciousness on sexual satisfaction, accounting for relationships between body fat and body image, and between sexual functioning and sexual satisfaction, while controlling for relationship satisfaction. Participants were 143, 18-25 year-old Caucasian men and women in heterosexual monogamous relationships, recruited from the University of Guelph and surrounding community in Ontario, Canada. Various domains of body image, body-image self-consciousness, sexual satisfaction and functioning, and relationship satisfaction data were collected by questionnaires. Body fat was measured using dual energy X-ray absorptiometry. Among men, body image was positively associated with sexual satisfaction, after controlling for relationship satisfaction. Men with greater body fat were more likely to have poorer behavioral and affective body image. Only body image specific to the sexual encounter influenced sexual functioning. Among women, no domain of body image was associated with sexual satisfaction, after controlling for relationship satisfaction. Women with greater body fat were more likely to have poorer affective and sexual-encounter-specific body image. As percent total fat increased, sexual functioning decreased. Our results suggest a complex pattern of relationships exists among body image and body composition constructs and sexual and relationship variable; and that these relationships are not the same for men and women.
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Affiliation(s)
- Robin R Milhausen
- Department of Family Relations and Applied Nutrition, MacDonald Institute, University of Guelph, Guelph, ON , N1G 2W1, Canada
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Martinez JM, Ferguson MB, Pangallo BA, Oakes TM, Sparks J, Dellva MA, Zhang Q, Liu P, Bangs M, Ahl J, Goldberger C. Safety and tolerability of edivoxetine as adjunctive treatment to selective serotonin reuptake inhibitor antidepressants for patients with major depressive disorder. Drugs Context 2015; 4:212279. [PMID: 26005493 PMCID: PMC4434861 DOI: 10.7573/dic.212279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/23/2015] [Accepted: 02/06/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this analysis was to assess the safety profile of edivoxetine as adjunctive treatment to selective serotonin reuptake inhibitor (SSRI) antidepressants. Methods: A pooled analysis was conducted on data obtained from the integrated safety database of edivoxetine as adjunctive treatment to SSRIs. Safety and tolerability assessments included discontinuation rates, spontaneously reported treatment-emergent adverse events (TEAEs), clinical laboratory tests, blood pressure (BP) and pulse, and electrocardiograms (ECGs). Results: The analysis included 1260 patients treated with adjunctive edivoxetine and 806 treated with adjunctive placebo. Study completion rates were 85.2% and 84.5% (p=0.994), respectively. Discontinuations due to adverse events were 4.9% and 3.5% (p=0.07), respectively. Significantly more patients in the adjunctive edivoxetine group compared with adjunctive placebo group reported at least one TEAE (56.8 vs 43.7%, p<0.001). The most common TEAEs (occurred ≥5% frequency) were hyperhidrosis, nausea, and tachycardia. Mean changes in sitting BP and pulse at the last visit were increased significantly in patients treated with adjunctive edivoxetine compared with adjunctive placebo (SBP: 2.7 vs 0.5 mm Hg, p<0.001; DBP: 4.1 vs 0.8 mm Hg, p<0.001; pulse: 8.8 vs −1.3 bpm, p<0.001). There were no clinically significant changes in laboratory measures. Conclusions: The tolerability and safety profile of edivoxetine as adjunctive treatment to SSRI antidepressants was consistent with its norepinephrine reuptake inhibitor mechanism of action, and was comparable with edivoxetine monotherapy treatment in patients with major depressive disorder.
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Affiliation(s)
| | | | | | | | | | | | - Qi Zhang
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Peng Liu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Mark Bangs
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Jonna Ahl
- Eli Lilly and Company, Indianapolis, IN, USA
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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Cavariani MM, de Almeida Kiguti LR, de Lima Rosa J, de Araújo Leite GA, Silva PVE, Pupo AS, De Grava Kempinas W. Bupropion treatment increases epididymal contractility and impairs sperm quality with no effects on the epididymal sperm transit time of male rats. J Appl Toxicol 2015; 35:1007-16. [PMID: 25645087 DOI: 10.1002/jat.3089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 11/09/2022]
Abstract
Bupropion is a dopamine (DA) and norepinephrine (NE) reuptake inhibitor used as smoking cessation and antidepressant drug with a lower incidence of male sexual dysfunction. We showed previously that sibutramine, a norepinephrine/serotonine reuptake inhibitor, reduced male rat fertility. As there are no studies evaluating the impact of bupropion treatment on spermatic parameters and male fertility, we evaluated the effects of bupropion treatment (15 and 30 mg kg(-1), 30 days) on sexual behavior, spermatic parameters and fertility of male Wistar rats and on the epididymal duct in vitro contractility. Bupropion 15 mg kg(-1) increased the serum luteinizing hormone level and the epididymal duct contractility, but the sperm quality was not affected. At 30 mg kg(-1) bupropion impaired sperm quality increasing the incidence of non-progressive sperm. The male sexual behavior and fertility were not modified at both bupropion doses. These results, in rats, suggest the importance of studies evaluating the effects of bupropion on the human male sperm quality.
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Affiliation(s)
- Marilia Martins Cavariani
- Department of Morphology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | - Josiane de Lima Rosa
- Department of Morphology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Gabriel Adan de Araújo Leite
- Department of Morphology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Patrícia Villela E Silva
- Department of Morphology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
| | - André Sampaio Pupo
- Department of Pharmacology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Wilma De Grava Kempinas
- Department of Morphology, Institute of Biosciences, UNESP - Univ. Estadual Paulista, Botucatu, São Paulo, Brazil
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Khazaie H, Rezaie L, Rezaei Payam N, Najafi F. Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial. Gen Hosp Psychiatry 2015; 37:40-5. [PMID: 25467077 DOI: 10.1016/j.genhosppsych.2014.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/25/2014] [Accepted: 10/27/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are common treatments for patients with major depressive disorder (MDD). However, adverse effects of SSRIs on sexual function are common in the treatment of patients with MDD. There is a discrepancy in the reported frequency of SSRI-induced sexual dysfunction. On the other hand, there is also less evidence about sexual dysfunction with serotonin receptor antagonists and reuptake inhibitors (SARIs). Therefore, we aimed to assess sexual dysfunction in MDD patients who received fluoxetine, sertraline and trazodone. METHOD In a single-blind, randomized, controlled trial in Kermanshah, Iran, during 2009-2010, 195 patients who met the DSMIV-IR criteria for MDD were enrolled. The patients completed the Hamilton Depression Rating Scale (HAM-D) and the sexual function questionnaire (SFQ). Eligible patients were allocated in three treatment groups (receiving fluoxetine, sertraline or trazodone) for 14 weeks randomly. Measurement of HAMD was repeated in 4-week interval. Analysis for comparing sexual dysfunction among three groups and men and women was performed. RESULTS There were 102 men and 93 women in the three groups receiving fluoxetine (n=64), sertraline (n=67) and trazodone (n=64). There was no significant difference in the sexual dysfunction of the patients in the three groups at baseline (P>.05). After treatment, both men and women who had received fluoxetine had the most impairment in desire/drive items (43%-51% and 44%-50%, respectively), while patients receiving trazodone had the least impairment in these items (12%-18% and 23%-24%, respectively). Trazodone was also induced with a lower rate of impairment in arousal/orgasm items in men (9%-15%) compared with the other two drugs. Compared with fluoxetine and trazodone, sertraline was associated with intermediate impairment in sexual function (39%-42% in desire/drive items and 32%-39% in arousal/orgasm items) that was lower than that with fluoxetine and more than that with trazodone. CONCLUSION There were different rates of sexual dysfunction with different antidepressants drugs in under treated patients. Compared with fluoxetine, and sertraline, trazodone was associated with the fewest sexual dysfunction. Fluoxetine was also associated with more sexual dysfunction than sertraline. Further research to better identify the differences among antidepressant drugs is recommended.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Science (KUMS), Kermanshah, Iran.
| | - Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Science (KUMS), Kermanshah, Iran.
| | - Nastarn Rezaei Payam
- Psychiatrist, Farabi hospital, Department of psychiatry, Kermanshah University of Medical Science (KUMS), Kermanshah, Iran.
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), School of Population Health, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
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Goldfarb S. Endocrine therapy and its effect on sexual function. Am Soc Clin Oncol Educ Book 2015:e575-e581. [PMID: 25993225 DOI: 10.14694/edbook_am.2015.35.e575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
KEY POINTS Breast cancer and its treatment, especially endocrine therapy, can cause sexual dysfunction, which is often multifactorial in nature with both a physical and mental component. Clinicians should discuss sexual health with all women with breast cancer and survivors of the disease. Women with breast cancer often experience premature menopause, which causes greater intensity and duration of symptoms than women undergoing natural menopause. Hot flashes, vaginal dryness, urogenital atrophy, dyspareunia, decreased libido, and changes in sexual response have been shown to negatively affect quality of life, compliance with medication, and overall outcome. Treatment options for sexual dysfunction in women with breast cancer depend on the etiology of the problem and concomitant medical conditions. Some possible treatments include: lubricants, moisturizers, counseling, sex therapy, altering contributing medications, physical therapy for pelvic floor disorders, and mechanical devices/vibrators.
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Affiliation(s)
- Shari Goldfarb
- From the Departments of Medicine and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College
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Davis SR, Worsley R. Androgen treatment of postmenopausal women. J Steroid Biochem Mol Biol 2014; 142:107-14. [PMID: 23727129 DOI: 10.1016/j.jsbmb.2013.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/12/2013] [Accepted: 05/18/2013] [Indexed: 01/23/2023]
Abstract
Testosterone is physiologically important for women. Serum testosterone levels decline with age, with the most precipitous fall being prior to menopause. There is no level of testosterone which defines a woman as being testosterone deficient. However, there is substantial high quality evidence to support the use of testosterone for the treatment of hypoactive sexual desire disorder in postmenopausal women. Although preliminary data suggests testosterone has favorable effects on bone and muscle mass, cognitive function and the cardiovascular system, further research regarding its therapeutic effects in these domains is warranted. As no testosterone product has been approved for women there is extensive off-label prescribing of testosterone products for women as well as the prescription of compounded therapy. This raises serious safety concerns and together with the evidence for the negative impact of FSD on quality of life, highlights the need for an approved testosterone formulation for women. This article is part of a Special Issue entitled 'Menopause'.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Roisin Worsley
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Abstract
Psychotropic-induced sexual dysfunction is a common and bothersome side effect of psychotropic medications. The majority of information available on the subject primarily pertains to antidepressants, but antipsychotics can also cause significant sexual dysfunction. The mechanisms behind these adverse events are thought to be primarily due to antidepressants' effects on serotonin and to antipsychotics' anti-dopaminergic activity. Sexual dysfunction can have many causes, not just psychotropic medication, therefore this article aims to examine the etiology of sexual dysfunction, as well as discuss differential diagnoses. Treatment for psychotropic-induced sexual dysfunction will be discussed, with more data available for the treatment of antidepressant-induced sexual dysfunction. The paucity of data for antipsychotic-induced sexual dysfunction does make it more difficult to treat.
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Affiliation(s)
- Erik R. Borg
- Assistant Professor, Pacific University Oregon School of Pharmacy
| | - Benjamin Chavez
- Associate Professor, Pacific University Oregon School of Pharmacy
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Fooladi E, Bell RJ, Jane F, Robinson PJ, Kulkarni J, Davis SR. Testosterone improves antidepressant-emergent loss of libido in women: findings from a randomized, double-blind, placebo-controlled trial. J Sex Med 2014; 11:831-9. [PMID: 24433574 DOI: 10.1111/jsm.12426] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Female sexual dysfunction is a side effect of selective serotonin reuptake inhibitor (SSRI)/serotonin noradrenalin reuptake inhibitor (SNRI) therapy. AIMS The aim of this study is to investigate the efficacy of transdermal testosterone (TT) as a treatment for SSRI/SNRI-emergent loss of libido. METHODS This was a double-blind, randomized, placebo-controlled study. Forty-four women, aged 35-55 years, on a stable dose of SSRI or SNRI with treatment-emergent loss of libido were randomly allocated to treatment with a TT patch delivering 300 mcg of testosterone/day or an identical placebo patch (Pl) for 12 weeks. MAIN OUTCOME MEASURES The primary outcome measure was the change in the Sabbatsberg Sexual Self-rating Scale (SSS) total score over 12 weeks. The 4-week frequency of Satisfactory Sexual Events (SSEs) and the Female Sexual Distress Scale-Revised (FSDS-R) were also measured. RESULTS At baseline, there were no differences between the treatment groups. At week 12, the change in the SSS score did not differ between the two groups. The increase in the 4-week frequency of SSEs was significantly greater for the TT group than for the Pl group (an increase of 2.3 events vs. 0.1, P = 0.02). The between-group difference in the change in the FSDS-R score approached statistical significance (P = 0.06). The mean total serum testosterone level at 12 weeks in the TT group was 2.1 nmol/L. No women withdrew because of androgenic adverse events. CONCLUSIONS TT therapy resulted in a significant increase in the number of SSEs compared with Pl therapy in women with SSRI/SNRI-emergent loss of libido. The lack of improvement in the SSS total score may reflect lack of sensitivity of this instrument for the measurement of change in sexual function. This provides the first evidence that TT therapy may be a treatment option for women with SSRI/SNRI-emergent loss of libido who need to remain on their antidepressant therapy.
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Affiliation(s)
- Ensieh Fooladi
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Chronic Escitalopram Treatment Induces Erectile Dysfunction by Decreasing Nitric Oxide Bioavailability Mediated by Increased Nicotinamide Adenine Dinucleotide Phosphate Oxidase Activity and Reactive Oxygen Species Production. Urology 2013; 82:1188.e1-7. [DOI: 10.1016/j.urology.2013.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/19/2013] [Accepted: 07/26/2013] [Indexed: 12/21/2022]
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Abstract
There are a variety of noradrenergic antidepressants available, most of which act by inhibiting neuronal noradrenaline re-uptake, although few drugs are specific for this action. Where drugs have numerous actions the adverse effects of noradrenaline reuptake may be difficult to isolate, although in this respect the adverse effects of reboxetine, a specific noradrenaline re-uptake inhibitor, are illuminating. Noradrenergic antidepressants typically cause minor changes in blood and heart rate, sweating and insomnia. Other pharmacological actions shown by non-specific antidepressants may act to worsen or mitigate these adverse effects. Noradrenergic drugs are less likely than selective serotonin reuptake inhibitors (SSRIs) to cause sexual dysfunction but more likely to cause urinary hesitancy. Doubts remain over the relative propensity for antidepressants with different modes of action to cause diabetes and hyponatraemia. Noradrenergic actions do not seem to confer a risk of death in overdose.
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Affiliation(s)
- Eromona Whiskey
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
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Gender difference in antidepressant-related sexual dysfunction in Taiwan. Gen Hosp Psychiatry 2013; 35:407-11. [PMID: 23639184 DOI: 10.1016/j.genhosppsych.2013.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/01/2013] [Accepted: 03/19/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Sexual dysfunction accompanied by depression may be altered by antidepressants. The effects of antidepressants on sexual dysfunction among males and females remain to be investigated. METHODS Three groups of subjects, drug-free patients with depression (N=125), medicated patients with depression (N=145) and healthy volunteers (N=255), were recruited. A Chinese version of the Changes in Sexual Functioning Questionnaire was employed to assess sexual function as the primary outcome. RESULTS Drug-free depressed females and medicated depressed males had more sexual dysfunction than healthy controls. The desire for sexual behaviors among healthy females and medicated depressed females was higher than that of drug-free depressed females. CONCLUSION Depression and antidepressants may have different impacts on the sexual function of males and females.
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Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334-85. [PMID: 23879318 DOI: 10.3109/15622975.2013.804195] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions. METHODS The 2013 update was conducted by a systematic update literature search and appraisal. All recommendations were approved by the Guidelines Task Force. RESULTS This first part of the guidelines (Part 1) covers disease definition, classification, epidemiology, and course of unipolar depressive disorders, as well as the management of the acute and continuation phase treatment. It is primarily concerned with the biological treatment (including antidepressants, other psychopharmacological medications, electroconvulsive therapy, light therapy, adjunctive and novel therapeutic strategies) of adults. CONCLUSIONS To date, there is a variety of evidence-based antidepressant treatment options available. Nevertheless there is still a substantial proportion of patients not achieving full remission. In addition, somatic and psychiatric comorbidities and other special circumstances need to be more thoroughly investigated. Therefore, further high-quality informative randomized controlled trials are urgently needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany.
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Quinn C, Happell B, Welch A. Talking about sex as part of our role: making and sustaining practice change. Int J Ment Health Nurs 2013; 22:231-40. [PMID: 22882255 DOI: 10.1111/j.1447-0349.2012.00865.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care.
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Affiliation(s)
- Chris Quinn
- Central Queensland University, Institute of Health and Social Science Research, Centre for Mental Health Nursing Innovation, Rockhampton, Australia
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Reports of Sexual Disorders Related to Serotonin Reuptake Inhibitors in the French Pharmacovigilance Database: An Example of Underreporting. Drug Saf 2013; 36:515-9. [DOI: 10.1007/s40264-013-0069-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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