Sexual dysfunction in patients with MDD treated with SSRIs - causes, measurement and prevention
DOI:
https://doi.org/10.12775/JEHS.2021.11.09.046Keywords
Sexual dysfunction, Depression, MDD, SSRIAbstract
Major Depressive Disorder(MDD) is serious psychiatric condition and they affect one in five people during their lifetime, the annual prevalence rates for the US population are 7.1% among adults, slightly more common among women (8.7%) than men (5.3%). Selective serotonin reuptake inhibitors are among the pharmacological agents most commonly used in the treatment of MDD.
The mechanism of action of antidepressants is not yet fully understood. Currently, it is believed that the mechanism of the so-called down-regulation, i.e. reducing the density of receptors in the postsynaptic membrane, in this case mainly 5HT2 receptors. All of the antidepressants in use today have some common side effects. The side effect that will be discussed in the broadest possible way in this paper are sexual dysfunctions appearing during the therapy. Measuring the degree to which a given substance affects the sexual function of a patient diagnosed with MDD encounters many difficulties on its way. There are currently several questionnaires enabling such an assessment, the most common are CSFQ, ASEX and SexFX. Also the major problem is Post SSRI Sexual Disfunction. A number of animal studies have proven that prolonged exposure to SSRIs leave permanent changes in the CNS, but unfortunately, similar studies have not yet been conducted in humans. The aim of this study is to present the problem of sexual dysfunction as a side effect of SSRI therapy, to present the causes and to propose a strategy to combat SSRI-induced sexual dysfunctions.
References
S. Pużyński, J. Wciórka: Psychiatria. T. 2. Wrocław: Elsevier Urban & Partner, 2010, s. 305–375. ISBN 978-83-7609-102-0.
Benjamin James Sadock, Virginia Alcott Sadock, Pedro Ruiz: Kaplan & Sadock’s Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. Wydanie 11. Philadelphia: Wolters Kluwer, 2015. ISBN 978-1609139711.
Massart R, Mongeau R, Lanfumey L. Beyond the monoaminergic hypothesis: neuroplasticity and epigenetic changes in a transgenic mouse model of depression. Philos Trans R Soc Lond B Biol Sci. 2012;367(1601)4. National Institute of Mental Health: Major Depression Among Adults
Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, McGrath PJ, Rosenbaum JF, Sackeim HA, Kupfer DJ, Luther J, Fava M. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006
Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR, Nemeroff CB, Bremner JD, Carney RM, Coyne JC, Delong MR, Frasure-Smith N, Glassman AH, Gold PW, Grant I, Mood disorders in the medically ill: scientific review and recommendations. BiolPsychiatry. 2005;58:175–189.
Elena Dalea BennyBang-Andersen ConnieSánchezEmerging mechanisms and treatments for depression beyond SSRIs and SNRIs J Clin Psychiatry 1999;60(suppl 4):4-11© Copyright 1999 Physicians Postgraduate Press, Inc.
„Farmakologia” Mutschler
NIMH- National Insitute of Mental Health – statistics
Rosenberg KP, Bleiberg KL, Koscis J, Gross C. A survey of sexual side effects among severely mentally ill patients taking psychotropic medications: impact on compliance. J Sex Marital Ther.
Gartlehner G, Hansen RA, Morgan LC, et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med. 2011;155(11):772–785
Bonierbale M, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin. 2003;19(2):114–124.
Enzlin P, Rosen R, Wiegel M, et al.; DCCT/EDIC Research Group. Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/EDIC study cohort. Diabetes Care. 2009;32(5):780–785.
Althof SE, Leiblum SR, Chevret-Measson M, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2005;2(6):793–800
A. McGahuey, Alan J. Gelenberg, Cin, C. (2000). The Arizona Sexual Experience Scale (ASEX): Reliability and Validity.
The association of serotonin transporter genotypes and selective serotonin reuptake inhibitor (SSRI)-associated sexual side effects: possible relationship to oral contraceptives. Bishop JR, Ellingrod VL, Akroush M, Moline J Hum Psychopharmacol. 2009
Serretti A, Kato M, De Ronchi D, Kinoshita T Meta-analysis of serotonin transporter gene promoter polymorphism (5-HTTLPR) association with selective serotonin reuptake inhibitor efficacy in depressed patients. Mol Psychiatry. 2007 Mar; 12
Michael J. Bly, Jeffrey R. Bishop, Kelan L. H. Thomas, And Vicki L. Ellingrod P-glycoprotein (PGP) Polymorphisms and Sexual Dysfunction in Female Patients With Depression and SSRI-Associated Sexual Side Effects
Hashimoto K, Sawa A, Iyo M Increased levels of glutamate in brains from patients with mood disorders. Biol Psychiatry. 2007 Dec 1; 62(11):1310-6.
Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry 2006;163:1504-1509; quiz 1664.
Rayen I, Steinbusch HW, Charlier TD, et al. Developmental fluoxetine exposure and prenatal stress alter sexual differentiation of the brain and reproductive behavior in male rat offspring.
Hogan C, Le Noury J, Healy D, et al. One hundred and twenty cases of enduring sexual dysfunction following treatment. Int J Risk Saf Med 2014;26:109-116.
Waldinger MD, van Coevorden RS, Schweitzer DH, et al. Penile anesthesia in post SSRI sexual dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels. Eur J Pharmacol 2015;753:263-268.
Csoka AB, Bahrick A, Mehtonen OP. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med 2008;5:227-233.
Fooladi E, Bell RJ, Jane F, Robinson PJ, Kulkarni J, Davis SR. Testosterone improves antidepressant-emergent loss of libido in women: findings from a randomized, double-blind, placebo-controlled trial. J Sex Med. 2014;11(3):831–839
Atmaca M, Korkmaz S, Topuz M, Mermi Mirtazapine augmentation for selective serotonin reuptake inhibitor-induced sexual dysfunction: a retropective investigation. O Psychiatry Investig. 2011 Mar; 8(1):55-7.
Keltner NL, McAfee KM, Taylor CL Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspect Psychiatr Care.2017 (11) 3-5
Goodman WK, Bose A, Wang Q. Treatment of generalized anxiety disorder with escitalopram: pooled results from double-blind, placebo-controlled trials. J Affect Disord. 2005;87:161–167
Stahl SM, Gergel I, Li D. Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2003;64:1322–132
Oosting RS, Chan JS, Olivier B, Banerjee P, Choi YK, Tarazi F Differential effects of vilazodone versus citalopram and paroxetine on sexual behaviors and serotonin transporter and receptors in male rats. Psychopharmacology
Benjamin James Sadock, Virginia Alcott Sadock, Pedro Ruiz:Kaplan & Sadock’s Synopsis of Psychiatry Behavioral Sciences/Clinical Psychiatry. Wydanie 11. Philadelphia: Wolters Kluwer, 2015. ISBN 978-1609139711.
Bull SA, Hunkeler EM, Lee JY. Discontinuing or switching serotonin reuptake inhibitors. Ann Pharmacother. 2002;36:578–84.
Hu XH, Bull SA, Hunkeler EM. Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry. 2004;65:959–6.
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