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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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