Fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients

Abstract

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

Serotonin 2A −1438 G/A and G-Protein Beta3 Subunit C825T Polymorphisms in Patients with Depression and SSRI-Associated Sexual Side-Effects

“…Arguably, a prospective analysis would be better suited to study sexual dysfunction as a treatment-emergent effect. This being said, sexual dysfunction is known to be one of the few persistent side-effects associated with SSRI treatment, with over 85-90% of persons who experience this side effect not having resolution after 6 months of treatment (Ashton and Rosen, 1998;Montejo-Gonzalez et al, 1997). In an attempt to minimize the confounding effects of residual depressive symptoms on sexual functioning, we enrolled subjects who had been on SSRIs for at least 6 weeks, in order for them to have had an adequate chance to respond to medication.…”

“…Despite clinical study reports summarized in prescriber information sheets indicating the emergence of sexual difficulties in o15% of subjects, most investigations of this topic show that the real incidence of sexual side-effects subsequent to SSRI initiation is between 20 and 70% (Clayton et al, 2002;Montejo-Gonzalez et al, 1997;Montejo et al, 1996Montejo et al, , 2001. Sexual side-effects from these medications are of significant clinical importance, particularly in young, sexually active patients.…”

Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions

“…[25][26][27] Bupropion, nefazodone and mirtazapine (as well as agents not available in the US, such as tianeptine, amineptine, meclobemide and reboxetine) have lower rates of sexual dysfunction than SSRIs; switching to and augmenting with such agents has been shown to be useful in several studies. [28][29][30][31][32] As the effect on orgasm may be dose-dependent, strategies that involve reducing the serum level of an SSRI below an individual's threshold for orgasmic dysfunction can be effective.…”

Cardiovascular Safety Profile of Dapoxetine during the Premarketing Evaluation

“…Dapoxetine demonstrates rapid absorption and elimination with minimal accumulation following daily dosing, and is extensively metabolized by multiple enzymes. [7][8][9] Other SSRI medications approved for the treatment of depression have been shown to delay ejaculation in patients being treated for depression [10,11] and are used as off-label treatment for PE. [12,13] In comparison with dapoxetine, other SSRI medications have relatively slower absorption, resulting in potentially longer periods of exposure and accumulation.…”

“…[1,2] Although sexual activity has been identified as a potential cardiac risk factor in patients with pre-existing cardiovascular disease, [3] PE has CURRENT OPINION Drugs R D 2011; 11 (1): [1][2][3][4][5][6][7][8][9][10][11] 1179-6901/11/0001-0001 not been associated with any cardiovascular comorbidities or health risks. [4] Dapoxetine is a novel selective serotonin reuptake inhibitor (SSRI) developed as an ondemand oral treatment for PE and has been granted marketing authorization for the treatment of PE in men aged 18-64 years in 15 countries (as of August 2010).…”