Sexual dysfunction among patients treated with antidepressants—a Hungarian retrospective study

The authors have investigated the incidence and several aspects of sexual problems in Hungarian outpatients (N = 637) treated by antidepressive medication. In this multicentre epidemiological survey the sexual dysfunctions (SD) was assessed by psychiatrists using structured interviews. Seventy-eight of the sample has sexual problems, more than half of them mentioned SD after starting antidepressive medication. Comparing various groups of antidepressants, patients taking a RIMA compound reported the occurrence of SD not so often as in TCA or SSRI groups, where the rate of SD was very high. Authors pointed out that physicians have to pay special attention to this problem in everyday clinical practice, since the recognition and treatment of sexual dysfunction is critical for the patient's satisfaction, medication compliance and the quality of life.     

Sexual dysfunction and hyperprolactinemia in Japanese schizophrenic patients taking antipsychotics

This study aimed to estimate the prevalence of sexual dysfunction, evaluated by the Nagoya Sexual Function Questionnaire (NSFQ), and hyperprolactinemia in patients with schizophrenia and examine a relationship between sexual dysfunction and serum prolactin levels. This cross-sectional, comparative study was performed using a sample comprising 195 Japanese schizophrenic in- and outpatients treated with antipsychotics (117 males and 78 females). Data were collected from October 2009 to January 2010 using single, cross-sectional ratings of sexual function assessed by the NSFQ and concurrent measurement of serum prolactin levels. The prevalence of sexual dysfunction in patients with schizophrenia was high (males 66.7%; females 79.5%). Hyperprolactinemia (>25ng/ml) was highly prevalent among schizophrenia patients, affecting 53.8% of females and 51.3% of males. Among female patients, 16.7% had prolactin levels>100ng/ml. There was no relationship between sexual dysfunction and serum prolactin levels. The present study demonstrated a higher prevalence of sexual dysfunction and hyperprolactinemia in Japanese schizophrenia patients. Clinicians should keep these problems in mind and discuss potential solutions with patients to improve patients' quality of life and adherence to therapy.     

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

Objective

Antidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient''s quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting.

Methods

Participants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records.

Results

One hundred and one patients (46 male, 55 female, age 42.2±7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3±8.5 mg/day), 24 were taking paroxetine (mean dose 20.4±7.2 mg/day), 20 taking citalopram (mean dose 22.1±6.5 mg/day), 22, venlafaxine (mean dose 115.7±53.2 mg/day) and 22, mirtazapine (mean dose 18±8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group''s total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups.

Conclusion

The incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients'' sexual functioning in the course of treatment with antidepressants.     

Self-Reported Sexual Function and Sexual Arousability in Women with Epilepsy

Summary: Purpose: Women with epilepsy are at risk for sexual dysfunction but the frequency and types of dysfunction have not been well characterized.
Methods: Self-reported sexual function was evaluated in 116 women aged 18-65 years with epilepsy and no concomitant medical or psychiatric illness, including 99 with localization-related epilepsy (LRE) and 17 with primary generalized epilepsy (PGE). Variables evaluated included seizure frequency, age of seizure onset, and antiepileptic drug (AED) exposure. Standardized inventories assessed sexual functioning, sexual arousability and anxiety, sexual behavior, and depression.
Results: Although sexual experience was not reduced, women with PGE and LRE reported significantly less sexual arousability and women with LRE reported significantly more sexual anxiety. Women with LRE experienced significantly more dyspareunia, vaginismus, arousal insufficiency, and sexual dissatisfaction, whereas women with PGE experienced an-orgasmia and sexual dissatisfaction. Sexual symptoms were not associated with seizure frequency, AED exposure, sexual experience, depression, or prepubertal seizure onset.
Conclusions: In contrast to subjects of previous research, the women in our study did not have a disorder of sexual desire, but more than one third experienced disorders of sexual arousal, implying a physiological deficit. Although the etiology for these arousal phase dysfunctions has not been defined, such conditions are treatable and warrant referral to a gynecologist versed in the treatment of sexual disorders.     

早期合用丁螺环酮对抗抑郁剂西酞普兰所致性功能障碍的影响

目的：观察早期合用丁螺环酮对抗抑郁剂西酞普兰所致性功能障碍的影响.方法本研究为随机、双盲、前瞻性研究,纳入天津市复员退伍军人精神病疗养院就诊的200例首发抑郁症患者,按随机数字表分为丁螺环酮组(85例,西酞普兰＋丁螺环酮)和安慰剂组(91例,西酞普兰＋安慰剂),采用HAMD、HAMA、亚利桑那性体验量表(ASEX)在就诊时,治疗第2,4,6,8周时对两组患者进行评估,比较两组患者的一般资料、抑郁、焦虑及性功能障碍情况.结果两组患者在年龄、文化程度、性别方面比较,差异无统计学意义(P ＞0．05);丁螺环酮组8周末时 HAMD 评分显著低于安慰剂组,差异有统计学意义(P ＜0．05);丁螺环酮组第2,4,6及8周末 ASEX 评分别低于安慰剂组,差异有统计学意义(P ＜0．05);两组患者第2,4,6及8周末时 HAMD、HAMA 及 ASEX 评分与就诊时比较,差异有统计学意义(P ＜0．05);丁螺环酮组女性第2,4,6及8周末 ASEX 评分显著低于安慰剂组,差异有统计学意义(P ＜0．05).结论丁螺环酮可改善抗抑郁剂西酞普兰所致的性功能障碍程度,尤其是女性首发抑郁症.     

Interaction of zinc with antidepressants in the tail suspension test

The antidepressant-like effect of zinc has been shown in several animal models of depression. In this study, zinc chloride (ZnCl2) was given alone or in combination with different classes of antidepressants by oral route (p.o.) to mice and the behavioral response in the tail suspension test (TST), a predictive test of antidepressant action, was investigated. ZnCl2 at a dose of 10 and 30 mg/kg, p.o., reduced the immobility time in the TST, without affecting the locomotor activity in open-field test. The antidepressants fluoxetine, paroxetine, imipramine, desipramine and bupropion produced a significant reduction in the immobility time in TST at the doses of 10, 1, 1, 1 and 10 mg/kg, p.o., respectively. The combined treatment of sub-effective doses of ZnCl2 (1 mg/kg) with sub-effective doses of fluoxetine (5 mg/kg), paroxetine (0.1 mg/kg), desipramine (0.1 mg/kg), imipramine (0.1 mg/kg) or bupropion (1 mg/kg) induced a significant reduction in the immobility time in the TST when compared with the groups treated with ZnCl2 or with antidepressants alone. The treatment with sub-effective doses of ZnCl2 and antidepressants alone or in combination did not affect the locomotion in open-field test, except that desipramine alone reduced the ambulation. The results first indicate that ZnCl2 administered by p.o. route produces an antidepressant-like effect in the TST. Moreover, synergistic effects of zinc with antidepressants were shown in the TST, suggesting that an improvement in the response to the antidepressant therapy occurs when zinc is combined with different classes of antidepressants.     

抗抑郁药物治疗儿童青少年抑郁症的临床试验进展

本文目的是归纳并总结新型抗抑郁药物治疗儿童青少年抑郁症的效果和安全性,为儿童青少年抑郁症的药物干预提供参考。抑郁症是儿童青少年常见的精神疾病之一,严重影响患者的健康成长,可造成自杀等严重不良后果。使用抗抑郁药物是治疗儿童青少年抑郁症的重要手段,然而可用于儿童青少年的抗抑郁药物种类较少,临床应用受到一定限制。本文就近十年抗抑郁药物治疗儿童青少年抑郁症的临床试验进展进行综述。     

Sexual dysfunction during treatment with serotonergic and noradrenergic antidepressants: Clinical description and the role of the 5-HTTLPR

Abstract

Objectives. Sexual dysfunction (SD) is a frequently reported side-effect of antidepressant treatment, particularly of selective serotonin reuptake inhibitors (SSRIs). In the multicentre clinical and pharmacogenetic GENDEP study (Genome-based Therapeutic Drugs for Depression), the effect of the serotonin transporter gene promoter polymorphism 5-HTTLPR on sexual function was investigated during treatment with escitalopram (SSRI) and nortriptyline (tricyclic antidepressant). Methods. A total of 494 subjects with an episode of DSM-IV major depression were randomly assigned to treatment with escitalopram or nortriptyline. Over 12 weeks, depressive symptoms and SD were measured weekly with the Montgomery–Asberg Depression Rating Scale, the Antidepressant Side-Effect Checklist, the UKU Side Effect Rating Scale, and the Sexual Functioning Questionnaire. Results. The incidence of reported SD after 12 weeks of treatment was relatively low, and did not differ significantly between antidepressants (14.9% escitalopram, 19.7% nortriptyline). There was no significant interaction between the 5-HTTLPR and antidepressant on SD. Improvement in depressive symptoms and younger age were both associated with lower SD. The effect of age on SD may have been moderated by the 5-HTTLPR. Conclusions. In GENDEP, rates of reported SD during treatment were lower than those described in previous reports. There was no apparent effect of the 5-HTTLPR on the observed decline in SD.     

Screening for anxiety disorders in depressed patients

The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong, questionnaire designed to screen for common Axis I disorders. In the present report, we examine the ability of the PDSQ to identify anxiety disorders in psychiatric outpatients with a principal diagnosis of major depressive disorder. Eight hundred patients presenting for treatment were evaluated with the Structured Clinical Interview for DSM-IV (SCID) after completing the PDSQ. Two hundred ninety-five patients had a principal diagnosis of major depressive disorder. The mean sensitivity and negative predictive value of the anxiety disorder subscales was 88.5% and 96.5% when all patients were considered, and 88.2% and 95.6% when only depressed patients were examined. The PDSQ's anxiety disorder subscales have high sensitivity and negative predictive value thereby indicating that the scale could function well as a screening instrument in depressed patients.     

米氮平与文拉法辛治疗抑郁症引起性功能障碍Meta分析

目的评价国内米氮平与文拉法辛治疗抑郁症对照研究引发性功能障碍的差异。方法应用循证医学的Meta分析，采用Peto固定效应模型法，对符合准的12篇对照研究文献性功能障碍的差异进行Meta分析。结果5项研究共313例纳入研究，米氮平治疗组共159例，发生性功能障碍1例，文拉法辛治疗组154例，发生性功能障碍15例，两组性功能障碍的发生率分别是0．63％和9．74％，综合检验两组差异有统计学意义（Z=2．96，P〈0．01；OR=0．10，959，6CI：0．06～0．56）。结论在治疗抑郁症中，文拉法辛比米氮平更容易引发性功能障碍，应特别加以关注。     

Severity of depressive symptoms and response to antidepressants and placebo in antidepressant trials

Although increased pre-treatment severity of depressive symptoms is thought to suggest better outcome with tricyclic antidepressants, it is unclear if such a pattern exists among those depressed patients treated with newer antidepressants. If such a pattern with newer antidepressants were observed, it would have implications for the design and conduct of future antidepressant trials. We reviewed the data from 329 depressed adult patients that were part of 15 multi-center, randomized, double blind, placebo-controlled antidepressant clinical trials at our center. Based on patients' pre-treatment scores on the 17-item Hamilton Depression Rating Scale (HAM-D), patients were sub-grouped to one of four severity of depression groups: low moderate, high moderate, moderately severe, and severe. The effect size was 0.51 in the low moderate group, 0.54 in the high moderate group, 0.77 in the moderately severe group and 1.09 in the severe group. An analysis of variance revealed a statistically significant interaction between treatment and severity of depressive symptoms. A correlational analysis revealed that in the group of depressed patients assigned to antidepressants, higher levels of pre-treatment depressive symptoms were significantly associated with greater changes in response to antidepressant treatment. Although a similar pattern was seen among the depressed patients assigned to placebo, it did not reach statistical significance. The results of this study suggest that antidepressant-placebo differences may be larger among those depressed outpatients with higher pre-treatment HAM-D scores compared to those depressed outpatients with lower pre-treatment scores. These findings may help in the design of future antidepressant clinical trials.     

Alterations of serum levels of brain-derived neurotrophic factor (BDNF) in depressed patients with or without antidepressants.

BACKGROUND: Because researchers have reported that antidepressants increase the expression of brain-derived neurotrophic factor (BDNF) in the rat hippocampus, we investigated whether serum BDNF levels may be used as a putative biological marker for major depressive disorders (MDD). METHODS: We measured serum BDNF in the following three groups: antidepressant-naive patients with MDD (n = 16), antidepressant-treated patients with MDD (n = 17), and normal control subjects (n = 50). Patients were evaluated using the Hamilton Rating Scale for Depression (HAM-D). Serum BDNF was assayed with the sandwich ELISA method. RESULTS: We found that serum BDNF was significantly lower in the antidepressant-naive group (mean, 17.6 ng/mL; SD, 9.6) than in the treated (mean, 30.6 ng/mL; SD, 12.3; p =.001) or in the control group (mean, 27.7 ng/mL; SD, 11.4; p =.002). There was a significant negative correlation (r = -.350, z = -2.003, p =.045) between serum BDNF and HAM-D scores in all patients. In a preliminary examination, reduced BDNF values of three drug-naive patients recovered to basal levels after antidepressant treatment. CONCLUSIONS: Our study suggests that low BDNF levels may play a pivotal role in the pathophysiology of MDD and that antidepressants may increase BDNF in depressed patients.     

Neuroleptic malignant syndrome under treatment with antidepressants? A critical review

Neuroleptic malignant syndrome (NMS) is a rare complication of treatment with neuroleptics. The pathophysiology is not fully known. A dopaminergic transmission block in the basal ganglia and hypothalamus is thought to be the pathophysiological mechanism of NMS. Several cases of NMS have been reported, precipitated by medication without a direct effect on the dopaminergic system. This Medline analysis concerns 23 cases of antidepressant-induced NMS reported in the literature with the differing pathophysiological hypotheses on the precipitation of NMS. The results indicate no hard evidence of an antidepressant-evoked NMS. However, various hypotheses assuming an disturbed balance of the dopaminergic and non-dopaminergic system may be relevant in animal studies, but are without clinically relevant proof presently. An antidepressant-induced NMS is a very rare complication on the basis of pretreatment with neuroleptics causing chronic dopamine blockade and elevated plasma level of neuroleptics due to comedicated antidepressants. Received: 7 August 1997 / Accepted: 5 May 1998     

Trajectories of suicidal ideation in depressed older adults undergoing antidepressant treatment

Suicide is a public health concern in older adults. Recent cross sectional studies suggest that impairments in executive functioning, memory and attention are associated with suicidal ideation in older adults. It is unknown whether these neuropsychological features predict persistent suicidal ideation. We analyzed data from 468 individuals ≥ age 60 with major depression who received venlafaxine XR monotherapy for up to 16 weeks. We used latent class growth modeling to classify groups of individuals based on trajectories of suicidal ideation. We also examined whether cognitive dysfunction predicted suicidal ideation while controlling for time-dependent variables including depression severity, and age and education. The optimal model using a zero inflated Poisson link classified individuals into four groups, each with a distinct temporal trajectory of suicidal ideation: those with ‘minimal suicidal ideation’ across time points; those with ‘low suicidal ideation’; those with ‘rapidly decreasing suicidal ideation’; and those with ‘high and persistent suicidal ideation’. Participants in the ‘high and persistent suicidal ideation’ group had worse scores relative to those in the “rapidly decreasing suicidal ideation” group on the Color-Word ‘inhibition/switching’ subtest from the Delis–Kaplan Executive Function Scale, worse attention index scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and worse total RBANS index scores. These findings suggest that individuals with poorer ability to switch between inhibitory and non-inhibitory responses as well as worse attention and worse overall cognitive status are more likely to have persistently higher levels of suicidal ideation.Clinicaltrial.gov numberNCT00892047.     

抑郁障碍病人药物治疗的流行病学调查

目的　了解中国目前抑郁障碍病人药物治疗的处方方式及影响因素。方法　按国家统计局发布的中国 2 0 0 0年人均生产总值 (人均GDP)划分的 5个经济发展等级 ,根据一定的抽样比例选择北京等 10个省市的医院 ,自制调查问卷 ,经预调查和讨论修订 ,于 2 0 0 2年 5月 2 0～ 2 4日进行抑郁障碍药物治疗的流行病学调查。结果　共收集调查住院和门诊抑郁障碍病人 735例。 72 9%的就诊者属于自费病人 ,女性占 6 1 6 %。按使用频率前 10位药物依次为氟西汀 (含进口和国产制剂 )、阿米替林、文拉法新 (包括国产制剂和进口缓释剂 )、多虑平、帕罗西汀、氯丙咪嗪、麦普替林、曲唑酮、丙咪嗪和米氮平。三环类药物 (TCAs)使用频率为 4 1 9% ,五羟色胺再摄取抑制剂 (SSRIs)治疗者占全部病人的 4 4 5 % ,其他新型抗抑郁药占 2 1 6 %。抗抑郁药治疗患者中 ,90 3%的病人接受单一药物治疗 ,合并治疗药物主要是苯二氮 艹卓 类药 (5 3 3% )、抗精神病药 (17 1% )、β 受体阻断剂 (7 1% )和心境稳定剂(4 9% )。影响药物选择的因素主要是患者的症状和经济状况。结论　国内抑郁障碍药物处方方式逐渐以新型抗抑郁药物占主流 ,经济负担和病人的症状表现影响抗抑郁药物的处方方式     

Pain is associated with prospective memory dysfunction in multiple sclerosis

Prospective memory (PM) pertains to the execution of a future goal or behavior. Initial research implies that people with multiple sclerosis (MS) are apt to show impaired prospective memory for activities of daily living. Yet, PM impairment does not occur in all people with MS. Thus, some other variable besides disease status alone may contribute to PM dysfunction in people with MS. Chronic pain may be such a variable. Approximately 50–70% of people with MS experience significant pain, and such pain has been thought to diminish memory function. To investigate this possibility, 96 patients with MS and 29 healthy subjects were administered the Memory for Intentions Screening Test (MIST; Woods, S. P., Iudicello, J. E., Moran, L. M, Carey, C. L., Dawson, M. S., & Grant, I. (2008). HIV-associated prospective memory impairment increases risk of dependence in everyday functioning. Neuropsychology, 22, 110–117.), a well-validated measure of prospective memory, and the Medical Outcomes Study Pain Effects Scale (PES; Fischer, J. S., Rudick, R. A., Cutter, G. R., & Reingold, S. C. (1999). The multiple sclerosis functional composite measure (MSFC): An integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. Multiple Sclerosis, 5, 244–250.) to assess chronic pain. After controlling for demographic variables and disability severity, subjective pain accounted for significant variance in PM, particularly for time-based intentions over sustained delay periods. These data accord well with assertions that pain may degrade ability to remember new intentions and suggests that pain is associated with PM dysfunction in people with MS.     

Tricyclic antidepressants in depressed patients with cardiac conduction disease

The observation that fatalities from tricyclic antidepressant (TCA) overdose are associated with heart block and/or arrhythmias has led to concern about the cardiovascular effects of TCAs. Contrary to expectations, studies have shown TCAs to be relatively safe in patients without heart disease. However, it is unclear whether these drugs are also safe in patients with heart disease. This prospective study compared the risk of cardiovascular complication at therapeutic plasma concentrations of TCAs in 196 depressed patients, 155 with normal electrocardiograms and 41 with either prolonged PR interval and/or bundle-branch block. The prevalence of second-degree atrioventricular block was significantly greater in patients with preexisting bundle-branch block (9%) than in patients with normal electrocardiograms (0.7%). Orthostatic hypotension occurred significantly more frequently with imipramine than with nortriptyline, and in patients with heart disease.     

抗抑郁治疗在脑卒中功能恢复中的作用

目的 探讨脑血管意外伴抑郁症状患者应用抗抑郁药物治疗对其病程及预后的影响。方法 经CES-D筛选出伴抑郁症状的125例脑血管意外患者,随机分为两组。治疗组65名,非治疗组62名,两组在年龄,性别,神经功能缺损及CES-D评分等项目上无明显差异。治疗组予抗抑郁药物PROZAC20mgqd治疗,平均治疗时间为175±43.8天,一月及一年后再对两组进行CES-D及神经功能缺损的评定及比较。结果治疗组一月及一年后CES-D评分均有明显下降(p<0.001),神经功能恢复也明显好于非治疗组(P<0.01)。结论 脑血管意外伴抑郁症状者给予抗抑郁治疗对其病情改善和预后均有好处。     

Sexual dysfunction after treatment for testicular cancer: A systematic review

Objectives: We aimed to assess the nature and risk of sexual dysfunction in men after treatment for testicular cancer. Method: Systematic review of sexual dysfunction in men treated for testicular cancer. The odds ratio or proportions of subjects with reduced sexual drive, erectile dysfunction or orgasmic/ejaculatory dysfunction was calculated. Results: A detailed review of 79 of the 227 citations was conducted. The highest level of evidence found, were controlled studies. Six controlled studies examined sexual function in 709 patients after they had received treatment. Seven uncontrolled studies examined sexual function in 337 subjects before and after treatment for testicular cancer. Most studies were limited by low response rates, use of unvalidated questionnaires and inclusion of a variety of treatment modalities. Few assessed psychological function and none examined its possible interaction with sexual dysfunction. Meta-analysis of the controlled studies indicated significantly reduced or absent orgasm (OR=4.62, 95% CI=2.47–8.63) together with erectile (OR=2.47, 95% CI=1.54–3.96) and ejaculatory dysfunction (OR=28.57, 95% CI=1.75–464.78) up to 2 years after treatment. Effects on sexual function were less consistent in the uncontrolled studies. Conclusions: The controlled studies indicate that sexual dysfunction persists for up to 2 years after treatment. However, better evidence is needed in studies that control for the impact of the testicular cancer, the treatment modality and psychological reactions to both.