Sexual dysfunctions, depression and antidepressants

Abstract

Normal sexual function is a biopsychosocial process; sexual problems almost always has organic and psychological components and requires multidisciplinary evaluation and treatment. Factors such as relationship conflicts, stresfull events, poor sexual education, aging, declining testosterone levels, medical illness, certain medications, and depressive disorder can contribute to sexual dysfunctions. Depression is one of the most prevalent medical disorders and has been recognised as a distinct pathologic entity from early Egyptian times. The character of depressive symptoms such as depressed mood,diminished interest or pleasure, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, diminished ability to think or concentrate; indecisiveness, recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide depends to a large extent on the severity of the disorder. Sexual dysfunction is often implicated in depression, but current nosology of sexual dysfunction and depression does not adequately address this relationship. Although decreased sexual desire is most often reported, difficulties with arousal, resulting in vaginal dryness in women and erectile dysfunction in men, and absent or delayed orgasm are also prevalent in depressive individuals. Sexual dysfunction is also a frequent undesirable effect of treatment with antidepressants and is one of the major reasons for early medication discontinuation. Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants and have significant effects on arousal and orgasm compared with antidepressants that target norepinefrine, dopamine, and melatonin system. The aim of this paper was to review the phenomenology of sexual dysfunction and to focus on the clinical assessment and therapeutic interventions used for sexual dysfunction in depressed patients.

Keywords

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Cinsel işlev bozuklukları, depresyon ve antidepresanlar

Abstract

Normal cinsel işlev biyopsikososyal bir süreçtir: Cinsel sorunların hemen daima organik ve psikolojik bileşenleri vardır ve çok disiplinli değerlendirmeyi gerektirirler. İlişki çatışmaları, stresli yaşam olayları, yetersiz cinsel eğitim, yaşlanma, azalmış testosteron düzeyleri, tıbbi hastalıklar, bazı ilaçlar ve depresif bozukluklar gibi etmenler cinsel işlev bozukluğu oluşmasında rol alabilir. Depresyon eski Mısır çağlarından beri ayrı bir patoloji olarak tanımlanmıştır ve en sık görülen tıbbi hastalıklardan biridir. Depresif mizaç, azalmış istek veya haz, anlamlı miktarda kilo kaybı veya kilo alma, uykusuzluk veya aşırı uyuma, psikomotor ajitasyon veya retardasyon, halsizlik veya enerji kaybı, değersizlik hissi, düşünme ve odaklanma yetisinde azalma, kararsızlık, yineleyici ölüm düşünceleri, intihar düşüncesi, intihar girişimi veya özgül intihar planları gibi depresif belirtilerin karakteri büyük oranda hastalığın şiddetine bağlıdır. Cinsel işlev bozuklukları sıklıkla depresyonda bulunur ama günümüzdeki sınıflandırma sistemleri depresyon ve cinsel işlev bozuklukları arasındaki ilişkiyi yeterince ele almaz. Depresif bireylerde azalmış cinsel istek en çok bildirilen bozukluk olmasına karşın, kadında vajinal kuruluk ve erkekte sertleşme bozukluğu ile sonuçlanan uyarılma zorlukları ve orgazm yokluğu veya gecikmesi de yaygın rastlanan sorunlardır. Cinsel işlev bozuklukları aynı zamanda antidepresan ilaç tedavisinin sık görülen istenmeyen yan etkisidir ve ilaçların erken kesilmesinin ana nedenlerindendir. Seçici serotonin geri alım engelleyiciler en yaygın kullanılan ve norepinefrin, dopamin ve melatonin sistemlerini etkileyen antidepresanlarla kıyaslandığında uyarılma ve orgazm üzerine anlamlı etkileri olan antidepresan ilaçlardır. Bu yazının amacı depresif hastalarda cinsel işlev bozukluklarını gözden geçirmek ve bu hastalarda cinsel işlev bozukluklarının klinik olarak değerlendirilmesi ve tedavisine odaklanmaktır.

Keywords

• Cinsellik, cinsel işlev bozukluğu, depresif bozukluk, antidepresanlar, SSGÖ

References

1. 1. Seidman SN, Roose SP. Sexual dysfunction and depression. Curr Psychiatry Rep. 2001;3:202-208.
2. 2. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281:537-544.
3. 3. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009;29:157- 64.
4. 4. Kennedy S, Dickens S, Eisfeld B, et al. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56:201-208.
5. 5. Araujo AB, Durante R, Feldman HA, et al.: The relationship between depressive symptoms and male erectile dysfunction: Cross sectional results from the Massachusetts Male Aging Study. Psychosom Med. 1998;60:458–465.
6. 6. Moreira ED, Glasser DB, Nicolosi A, et al. Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe. BJU Int. 2008;101:1005-1011.
7. 7. Yılmaz E. Cinsel sorunlar ve tutumlar uzerine bir epidemiyolojik arastirma. First National Congress of Association of Cognitive and Behavioral Therapy Abstract Book, 2007, Istanbul. s80.
8. 8. Angst J. Sexual problems in healthy and depressed persons. Int Clin Pharmacol. 1998;13:S1-S4.

9. 9. Casper R, Redmond D, Katz M, et al. Somatic symptoms in primary affective disorder. Presence and relationship to the classification of depression. Arch Gen Psychiatry. 1985;42:1098-1104.
10. 10. Hayes RD, Dennerstein L, Bennett CM, et al. What is the “true” prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? J Sex Med. 2008;5: 777- 787.
11. 11. Bonierbale M, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin. 2003;19:114-124.
12. 12. Mathew R, Weinman M. Sexual dysfunctions in depression. Arch Sex Behav. 1982;1:323-328.
13. 13. Cyranowski JM, Bromberger J, Youk A, et al. Lifetime depression history and sexual function in women at midlife. Arch Sex Behav. 2004;33:539-548.
14. 14. Chen KC, Yang YK, Lee IH, et al. Sexual dysfunction and physicians’ perception in medicated patients with major depression in Taiwan. Depress Anxiety. 2008;25:56-62.
15. 15. Amerikan Psikiyatri Birliği (2000) DSM-IV-TR Ruhsal bozuklukların tanısal ve sayımsal elkitabı, 2. Cilt, dördüncü baskı, (Çev Ed. E Köroğlu) Hekimler Yayın Birliği, Ankara, 2007. S.777-842.
16. 16. Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19:67–85
17. 17. Kennedy S, Fulton K, Bagby R, et al. Sexual function during bupropion or paroxetine treatment. Can J Psychiatry. 2006;51: 45-52.
18. 18. Montejo A, Llorca G, Izquierdo J, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry. 2001;62:10-21.
19. 19. Akpafflong MJ, Wilson-Lawson M, Kunik ME. Antidepressantassociated side effects in older adult depressed patients. Geriatrics. 2008;63:18-23.
20. 20. Baldwin D, Bridgman K, Buis C. Resolution of sexual dysfunction during double-blind treatment of major depression with reboxetine or paroxetine. J Psychopharmacol. 2006;20:91-96.
21. 21. Baldwin D, Cooper J, Huusom A, et al. A double-blind, randomized, parallel-group, flexible-dose study to evaluate the tolerability, efficacy and effects of treatment discontinuation with escitalopram and paroxetine in patients with major depressive disorder. Int Clin Psychopharmacol. 2006;21:159-169.
22. 22. Clayton A, Keller A, McGarvey E. Burden of phase-specific sexual dysfunction with SSRIs. J Affect Disord. 2006;91:27-32.
23. 23. Delgado P, Brannan S, Mallinckrodt C, et al. Sexual functioning assessed in 4 double-blind placebo- and paroxetine-controlled trials of duloxetine for major depressive disorder. J Clin Psychiatry. 2005;66:686-692
24. 24. Dunn JA, Arakawa R, Greist JH, et al. Assessing the onset of antidepressant-induced sexual dysfunction using interactive voice response technology. J Clin Psychiatry. 2007;68:525-532.
25. 25. Landen M, Hogberg P, Thase M. Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. J Clin Psychiatry. 2005;66:100-106.
26. 26. Michelson D, Schmidt M, Lee J, et al. Changes in sexual function during acute and six-month fluoxetine therapy: a prospective assessment. J Sex Marital Ther. 2001;27:289Y302.
27. 27. Papakostas GI. Tolerability of modern antidepressants. J Clin Psychiatry. 2008;69:8-13.
28. 28. Waldinger M,Zwinderman A, OlivierB. Antidepressants and ejaculation: a double-blind, randomized, fixed-dose study with mirtazapine and paroxetine. J Clin Psychopharmacol. 2003;23:467- 470.
29. 29. Balon R: Sexual functioning with selective serotonin reuptake inhibitors. Am J Psychiatry. 1999;156:807–808.
30. 30. Ashton AK, Rosen RC: Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther. 1998;24:191–192.
31. 31. Ozmenler NK, Karlidere T, Bozkurt A, et al. Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors. Hum sychopharmacol. 2008;23:321-326.
32. 32. Balon R: Sildenafil and sexual dysfunction associated with antidepressants. J Sex Marital Ther. 1999;25:259–264.
33. 33. Ashton AK, Rosen RC: Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 1998;59:112–115.