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Sexual Function in Postpartum Women Treated for Depression: Results From a Randomized Trial of Nortriptyline Versus Sertraline

Teresa Lanza di Scalea, M.D.; Barbara H. Hanusa, Ph.D.; and Katherine L. Wisner, M.D.

Objective: The primary aim of this article is to describe sexual concerns in postpartum women with DSM-IV diagnoses of major depressive disorder (MDD) before and during treatment with antidepressants in an 8-week double-blind randomized trial.

Method: Seventy women aged 19-42 years participated and were randomly assigned to either the tricyclic antidepressant nortriptyline (N = 38) or the serotonin selective reuptake inhibitor sertraline (N = 32). Women completed the Arizona Sexual Experience Scale to evaluate sexual concerns at enrollment and weekly during the trial. The outcome measure for depression, Hamilton Rating Scale for Depression, was completed in clinical interviews at the same time points. Comparisons of demographic and other characteristics of women were completed with t tests for continuous measures and with chi2 or Fisher exact statistics for categorical measures. Mixed-effects regressions were used to test for significance of the main effects of depression symptom scores, drug assignment, weeks treated with medication, and the interactions of these variables. Data were collected from April 1997 to April 2002.

Results: At entry into the randomized trial, 73% (N = 51) of the women reported problems in 3 or more areas of sexual concern compared to 37% (N = 26) at week 8. There were no significant differences at study entry in women randomly assigned to nortriptyline compared to those randomly assigned to sertraline in summary scores of sexual function nor in specific sexual concerns at any time point. At week 8, women whose MDD remitted were more likely to report fewer (< 3) sexual concerns than women whose MDD did not remit (76% vs. 24%, p =.006), independent of drug assignment.

Conclusion: In postpartum women, sexual concerns are primarily affected by remission of depression rather than side effects of either a tricyclic or serotonergic antidepressant.


(J Clin Psychiatry 2009;70(3):423-428. Online Ahead of Print March 10, 2009. doi:10.4088/JCP.08m04625)

Received Aug. 20, 2008; accepted Oct. 30, 2008. From the Department of Psychiatry (all authors), Women's Behavioral HealthCARE (Drs. Hanusa and Wisner), and Departments of Obstetrics and Gynecology and Reproductive Sciences, Epidemiology, and Women's Studies (Dr. Wisner), Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pa., and the Department of Neurosciences, Operative Unit of Psychiatry, University of Rome Tor Vergata, Italy (Dr. Lanza di Scalea).

This study was supported by National Institute of Mental Health (NIMH) grants R01 MH60335, R01 MH071825, and R01 MH075921 (Dr. Wisner, principal investigator).

Dr. Wisner has also received grant support from NIMH (SBIR #043), Stanley Medical Research Foundation, New York Mid-Atlantic Consortium for Genetics and Newborn Screening Services, the State of Pennsylvania, American Society for Bariatric Surgery, and Heinz Foundation; is a member of the speakers' bureau of GlaxoSmithKline; has a grant application pending at Wyeth; and is conducting a trial of transdermal estradiol for postpartum depression with the donation of placebo patches from Novogyne, a joint venture between Novartis and Noven. Drs. Lanza di Scalea and Hanusa report no additional financial affiliations or other relationships relevant to the subject of this article.

Corresponding author and reprints: Katherine L. Wisner, M.D., Department of Psychiatry, Women's Behavioral HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213 (e-mail: