The reported incidence of sexual dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidence or prevalence.
The sexual problems reported range Ginkgo biloba sexual dysfunction ssri decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, to erection or delayed ejaculation problems.
There are a number of case reports of sexual side effects, such as priapism, painful ejaculation, penile anesthesia, loss of sensation in the vagina and nipples, persistent genital arousal and nonpuerperal lactation in women. The focus of this article is to explore the incidence, pathophysiology, and treatment of antidepressant iatrogenic sexual dysfunction. Sexual dysfunction is a common side effect of antidepressants, particularly of selective serotonin reuptake inhibitor SSRIs and norepinephrine reuptake inhibitor SNRIs medications.
During the 60s and 70s, reports of antidepressant-associated sexual dysfunction were rare; 4 possibly due to underreporting, lack of discussion and assessment, and an assumption that people with mental health problems were asexual and lacked any sexual desire.
The focus of this article is to explore the incidence, pathophysiology, and treatment of antidepressant-associated sexual dysfunction. Pharmacotherapy of depression involves the use of antidepressants which modulate central neurotransmitter levels, namely serotonin, norepinephrine, and dopamine.
Treatment-emergent sexual dysfunction has been reported with virtually all of the antidepressants. The reported incidence of dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidents or prevalence.
In a multicenter, prospective, Spanish study involving people, Montejo et al 12 reported a The differences between drugs are summarized in Table 1 and were as follows: Moclobemide, a reversible MAOI, 3. Clayton et al, 13 in an adult outpatient population women and men receiving antidepressant monotherapy, reported rates of sexual dysfunction as follows: The Maudsley Prescribing Guidelines.
Modell et al 11 investigated through self-reported anonymous questionnaires, the sexual side effects of bupropion and the SSRIs fluoxetine, paroxetine, and sertraline among outpatients. The three SSRIs, to an equal degree, significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm below levels experienced pre-morbidly. In comparison, bupropion-treated clients reported significant increases in libido, level of arousal, intensity of orgasm, and duration of Ginkgo biloba sexual dysfunction ssri beyond levels experienced premorbidly.
Consequently, the authors concluded that adverse sexual effects appear to be the rule rather than the exception with SSRIs. Similar to other studies, rates of sexual dysfunction were higher for sertraline, paroxetine, and venlafaxine, when compared with moclobemide.
No difference was found across the four antidepressants in men, whereas rates of sexual dysfunction were higher in women who were prescribed with sertraline and paroxetine. A number of double blind comparative studies without placebo control have also been conducted. Kavoussi et al 14 in a randomized double-blind study, of people with moderate to severe depression, compared sustained-release bupropion and sertraline on sexual function.
Segraves et al 15 also compared the effects of sustained-release bupropion and sertraline on sexual function, in people with moderate to severe depression. Sexual dysfunction was noted as early as day 7 in sertraline-treated clients and persisted until the end of the week treatment phase.
Four clients, all of whom were treated with sertraline, discontinued from the study prematurely because of sexual dysfunction. Feiger et al 16 compared the effects of nefazodone with sertraline in clients with major mood disorder. In women, nefazodone was superior to sertaline on measure of ease of achieving orgasm and satisfaction with orgasmic ability. Some years later, Ferguson et al 17 in an 8-week double-blind study, also compared nefazodone with sertraline, this time among people who were experiencing sexual dysfunction attributable to sertraline.
Clients were randomly assigned to either group following a 1-week wash out period and a subsequent 7—day placebo phase.
Similar to the previous studies, sertaline-treated clients reported more drug-related sexual dysfunction. In this study, 5 of the sertaline-treated clients discontinued therapy because of sexual dysfunction.
A small number of double-blind comparative studies with placebo control have been conducted. Croft et al 1 compared the effects of sustained-release bupropion, sertraline, and placebo on sexual function with people with moderate to severe depression.
Findings indicated that people treated with sertraline experienced significantly more sexual dysfunction throughout the duration of the study compared with those treated with bupropion SR or placebo. Orgasmic dysfunction occurred after only 1 week of treatment in sertaline-treated clients and continued throughout the 8-week treatment. There were no significant differences in the occurrence of orgasmic dysfunction between bupropion SR and placebo at any time during the study.
Coleman et al 18 compared the sexual function effects of bupropone, fluoxetine, and placebo in people. Again, decline in sexual
Ginkgo biloba sexual dysfunction ssri, sexual desire, and sexual arousal were more frequently associated with fluoxetine treatment than with bupropine or placebo.
These findings support findings from other studies that suggest bupropion SR is relatively free of sexual side effects, 1119 and supports the contention that bupropion SR may be an appropriate antidepressant for clients concerned about sexual function.
Within the literature there are also a number of case study-anecdotal accounts of other sexual side effects, such as: Over the years, several case reports have been published on a relationship between antidepressants and nonpuerperal lactation or galactorrhea in women. Egberts et al 29 concluded from their analysis of reported drug reactions to the Netherlands Pharmacovigilance Foundation, between andthat SSRIs and clomipramine were associated with approximately eight times higher risk of nonpuerperal lactation in women, when compared with women taking nonserotonergic antidepressants.
Although rare, withdrawal syndromes that impact on sexuality and sexual function have also been described. In a recent article, Leiblum and Goldmeier 30 describe persistent genital arousal disorder in five women who attribute the onset of their sensations to either the usage or discontinuation of an SSRI.
There are very few studies that examine the impact of antidepressants on people without a mental health problem.
Kowalski et al 31 conducted a double-blind trial in a group Ginkgo biloba sexual dysfunction ssri men without psychiatric diagnosis, to compare the impact of amitriptyline, mianserin, and placebo on nocturnal sexual arousal. Both amitriptyline and mianserin significantly decreased the amplitude and duration of nocturnal erections.
Kennedy et al 32 compared the effects of moclobemide and placebo on 60 healthy male and female adults and found no difference in the effects on sexual interest or sexual function in healthy volunteers. It needs to be remembered, however, that moclobemide is an antidepressant with the lowest incidence of reported sexual dysfunction in clients being treated for depression. Although the research provides firm evidence that antidepressant medication is associated with sexual dysfunction in both men and women, reaching any firm conclusion about the exact prevalence is difficult.
In their review of evidence of sexual dysfunction associated with antidepressants, Montgomery et al 33 describe methodological problems such as absence of comparison groups, inconsistent definitions of sexual dysfunction, absence of baseline assessment of sexual functioning, and the use of various measures of sexual functioning as well as the questionable validity of the rating scales used.
There is also a difficulty within the studies in separating sexual dysfunction resulting from depression and that resulting from the drugs — as depression itself is associated with decreased libido, decreased sexual activity, and decreased erectile and orgasmic excitement.
The variation in rates between studies is also possibly due to the wide variety of measures used to measure sexual functioning, use of different samples, and recruitment strategies.
However, a number of writers suggest that, in all probability, the difference in rates is due to substantial underreporting rather than under occurrence. In general, the mechanisms of action involve either the inhibition of breakdown of norepinephrine or blocking the reuptake of serotonin and norepinephrine at the presynaptic terminal, resulting in increased neurotransmitter availability at the synapse.
Sex is more than a physical act.
Ginkgo biloba sexual dysfunction ssri also includes emotional and psychological dimensions. The normal sex cycle consists of four successive phases: Different classes of antidepressants impact on all phases of the sexual response cycle to varying degrees, and the details pertaining to each class of antidepressant are summarized in Table 1.
The challenge is to understand how antidepressants impact on normal sexual function. Because most antidepressants modulate serotonin concentration, it is generally thought that elevated serotonin levels diminish sexual function. In addition, serotonin inhibits nitric oxide production, which normally has a role in relaxing the smooth muscle of the vasculature including the vasculature of the reproductive structuresthus enabling vasodilation and allowing sufficient blood supply to the sexual organs during the sexual response cycle.
The autonomic nervous system regulates the mechanistic aspects of sexual function eg, orgasm and ejaculation and utilizes acetylcholine parasympathetic and sympathetic systems and norepinephrine sympathetic system. Many antidepressants have some efficacy at cholinergic and alpha1-adrenergic receptors, thereby inhibiting the autonomic nervous system and consequently inhibiting normal sexual function.
As stated earlier, the normal sexual response cycle consists of four successive phases:
Ginkgo biloba sexual dysfunction ssri, this is not entirely possible as, as Jespersen 45 suggests, poor overall sexual satisfaction is a common complaint of clients with antidepressant-associated sexual dysfunction.
Therefore, the first stage of effective management is a thorough assessment to ensure that the reported sexual dysfunction is Ginkgo biloba sexual dysfunction ssri a consequence of antidepressant treatment. This will involve a re-evaluation of the depressive episode, including a physical and sexual assessment.
This may "Ginkgo biloba sexual dysfunction ssri" be as easy as it appears. The main challenge faced by practitioners is managing antidepressant-associated sexual dysfunction without compromising the mental wellbeing of the client. Noncompliance may constitute a big problem for practitioners as this will have a positive effect on antidepressant-associated sexual dysfunction.
However, the obvious complication here is for relapse into the depressive state. Therefore, practitioners must be honest and open with the client in order to build trust, which can empower them to make better decisions about both their physical health and mental wellbeing.
There are various pharmacological and non-pharmacological ways of managing antidepressant-induced sexual dysfunction.