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Ben-Sheetrit J, Hermon Y, Birkenfeld S, Gutman Y, Csoka AB, Toren P. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry 2023; 22:15. [PMID: 37085865 PMCID: PMC10122283 DOI: 10.1186/s12991-023-00447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Sexual dysfunction is a common side effect of Serotonergic antidepressants (SA) treatment, and persists in some patients despite drug discontinuation, a condition termed post-SSRI sexual dysfunction (PSSD). The risk for PSSD is unknown but is thought to be rare and difficult to assess. This study aims to estimate the risk of erectile dysfunction (ED) and PSSD in males treated with SAs. METHODS A 19-year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase-5 inhibitors prescriptions. 12,302 males aged 21-49 met the following criteria: non-smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or substance use. Logistic regression was used for estimation of ED risk in SA-treated subjects compared to non-SA-treated controls, assessed with and without the effects of age, body mass index (BMI), socioeconomic status (SES), depression and anxiety, yielding crude and adjusted odds ratios (cOR and aOR, respectively). RESULTS SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8-4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3-4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000. CONCLUSIONS This work offers a first assessment of the small but significant risk of irreversible ED associated with the most commonly prescribed class of antidepressants which should enhance the process of receiving adequate informed consent for therapy.
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Affiliation(s)
- Joseph Ben-Sheetrit
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Yehonathan Hermon
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel.
| | - Shlomo Birkenfeld
- Clalit Health Services, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Antonei B Csoka
- Department of Anatomy, School of Medicine, Howard University, Washington DC, US
| | - Paz Toren
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Huller Harari L, Blasbalg U, Arnon S, Ben-Sheetrit J, Toren P. Risk factors for postpartum depression among sexual minority and heterosexual parents. Australas Psychiatry 2022; 30:718-721. [PMID: 36264652 DOI: 10.1177/10398562221133990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents. METHOD Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD. CONCLUSIONS Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD.
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Affiliation(s)
- Liat Huller Harari
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel, Faculty of Medicine, 58408Tel-Aviv University Sackler, Israel
| | - Uri Blasbalg
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Shay Arnon
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Joseph Ben-Sheetrit
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Paz Toren
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel, Faculty of Medicine, 58408Tel-Aviv University Sackler, Israel
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Ginati YD, Madjar N, Ben-Sheetrit J, Lev-Ran S, Weizman A, Shoval G. A Nationwide Study Comparing Mental Health Professionals' Willingness to Try Hallucinogenic Drugs in Basic Research or Clinical Practice. J Psychoactive Drugs 2021; 54:177-187. [PMID: 34308787 DOI: 10.1080/02791072.2021.1941444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored whether personal attitudes toward drug users are associated with professional approaches and whether the association between personal and professional attitudes varies across different mental health professions. Participants (N = 347) included medical (psychiatrists and psychiatric nurses) and other (clinical psychologists and social workers) mental health professions from all 13 mental health centers in Israel. They completed questionnaires aimed to assess familiarity with medical usage of hallucinogenic drugs, personal attitudes toward recreational drug users and willingness to use five hallucinogens in research of clinical practice. Hypotheses were tested using multiple-group structural equation modeling (SEM). Psychiatrists reported the highest levels of familiarity with and willingness to use all types of hallucinogenic drugs, as compared to other mental health professionals. Psychiatrists held the strongest belief in the potential utility of hallucinogenic drugs; yet, their personal attitudes toward drug users affected negatively their willingness to try hallucinogenic drugs in clinical practice. This was the only significant association that was found. Future research and treatment programs should address the topic of hallucinogenic drug therapy, and specifically the need to separate between individual beliefs and professional clinical decision-making.
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Affiliation(s)
- Yotam D Ginati
- Child and Adolescent Division, Geha Mental Health Center, Petach Tikva, Israel
| | - Nir Madjar
- School of Education, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | | | - Shaul Lev-Ran
- Substance Use Disorder Services, Lev Hasharon Mental Health Center, Netanya, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Child and Adolescent Division, Geha Mental Health Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Laboratory of Molecular Psychiatry Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Gal Shoval
- Child and Adolescent Division, Geha Mental Health Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, USA
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Rotem A, Ben-Sheetrit J, Newcorn J, Danieli Y, Peskin M, Golubchik P, Ben-Hayun R, Weizman A, Manor I. The Placebo Response in Adult ADHD as Objectively Assessed by the TOVA Continuous Performance Test. J Atten Disord 2021; 25:1311-1320. [PMID: 31965885 DOI: 10.1177/1087054719897819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We compared the placebo response (PR) as measured by the Test of Variables of Attention (TOVA) and the Conners' Adult ADHD Rating Scale (CAARS) scores. Method: A retrospective data analysis from a double-blind placebo-controlled study of metadoxine-ER in adults with ADHD. An additional database was used for comparison to TOVA response after methylphenidate challenge (TOVA-MPH-R). Results: PR was highest when calculated from the TOVA-Attention Composite Score (ACS). The PR showed significantly fewer variables improving concomitantly compared with MPH-R. The most prominent correlation between the CAARS-PR and the TOVA-PR was in the Omissions score (p = .032), which was age-dependent (b = .0007, p <.001). Discussion: TOVA-PR has an index-specific profile compared with CAARS-PR and TOVA-MPH-R. The partial correlation of TOVA-PR with CAARS-PR suggests that a composite score of TOVA specific indices and CAARS could have a synergic impact to improve the reliability of the response assessment in adult ADHD.
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Affiliation(s)
- Ann Rotem
- Geha Mental Health Center, Petah Tikva, Israel
| | | | | | | | - Miriam Peskin
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Pavel Golubchik
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Rachel Ben-Hayun
- Rambam Health Care Campus, Haifa, Israel.,Bar-Ilan University, Ramat Gan, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel.,The Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
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Ben-Sheetrit J, Tasker H, Avnat L, Golubchik P, Weizman A, Manor I. Possible Age-Related Progression of Attentional Impairment in ADHD and Its Attenuation by Past Diagnosis and Treatment. J Atten Disord 2021; 25:14-21. [PMID: 29233062 DOI: 10.1177/1087054717743328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of the study is to evaluate attentional impairment in different age groups with ADHD. Method: In all, 58 children, 73 adolescents, and 104 adults with ADHD were evaluated using the Test of Variables of Attention (TOVA). Subjects with comorbidities or psychotropic treatment were not included. Results: Considering Response Time Variability (RTV), adults were 10.6 and 4.0 times more likely to be severely impaired (standard score < 40) than children and adolescents, respectively. Adults were twice as likely as adolescents to be very impaired (standard score< 70) in Omissions. Considering d' (decrement of attentional performance over time), all severely impaired participants were adults. Age predicted impairment in Attention Performance Index (API), RTV, and d', but not Omissions or Commissions. Past treatment with stimulants predicted less impairment in d', past diagnosis predicted less impairment in RTV, and each predicted less impairment in Omissions and API. Conclusion: Adults had more attentional impairment than children and adolescents. Past diagnosis and treatment were associated with less ADHD-related attentional impairment.
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Affiliation(s)
| | | | - Lee Avnat
- Jaffa Academic College, Tel Aviv, Israel
| | - Pavel Golubchik
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel.,Felsenstein Medical Research Center, Petah Tikva, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel Aviv University, Israel
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Abstract
Objective: Several ADHD pharmacological trials reported high placebo response (PR) rates. This study aims to characterize the PR in adult ADHD. Method: A retrospective cohort analysis of the placebo arm (140 adults with ADHD, 18-55 yrs, M:F 46.4%-53.6%) of a 6-week randomized, multicenter, double-blind metadoxine study, using Conners' Adult ADHD Rating Scale (CAARS) and the Adult ADHD Self-Report Scale (ASRS), was conducted. Results: Pre-post changes in placebo-treated adults were significant for both the CAARS and ASRS, F(2.9, 404.5) = 61.2, p < .00001, F(2.8, 383.0) = 43.1, p < .00001, respectively. Less than half of the participants had a PR which began early in treatment and persisted; almost 50% had a variable, inconsistent PR. Conclusion: In the current sample, PR in adult ADHD was prominent on both symptom scales and the investigator-rater instrument. Therefore, using investigator ratings as a primary endpoint does not necessarily attenuate PR. Of note, about half of the PR is variable, suggesting unreliable determination of efficacy.
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Affiliation(s)
| | - Miriam Peskin
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
| | | | | | - Liat Shbiro
- Geha Mental Health Center, Petah Tikva, Israel
| | - Ann Rotem
- Geha Mental Health Center, Petah Tikva, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
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Rotem A, Danieli Y, Ben-Sheetrit J, Bashari A, Golubchik P, Ben-Hayun R, Weizman A, Manor I. Apparent lack of practice effects in the Test of Variables of Attention (TOVA) in adult ADHD. ACTA ACUST UNITED AC 2019; 11:73-81. [DOI: 10.1007/s12402-018-0278-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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