Recognition and Assessment of Sexual Dysfunction Associated With Depression
Background: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewersexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaireis needed. Method: The authors analyzed the incidence of antidepressant-related sexual dysfunctionin a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study ofPsychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 onpatients with previously normal sexual function who were being treated with antidepressants alone or antidepressantsplus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; meanage = 39.8 ± 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire,which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction.Results: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunctionwas compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine,62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine,24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26).Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higherseverity. About 40% of patients showed low tolerance of their sexual dysfunction. Conclusion: The incidenceof sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as comparedwith serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
J Clin Psychiatry 2001;62(suppl 3):10-21
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