Resolution of sexual dysfunction during double-blind treatment of major depression with reboxetine or paroxetine

Abstract

The selective noradrenaline re-uptake inhibitor reboxetine may have advantages over the selective serotonin re-uptake inhibitors fluoxetine and citalopram, in effects on sexual function and satisfaction. The effects of reboxetine and paroxetine on sexual function were compared by examining data from the UK centres in an international double-blind flexible-dose parallel-group multi-centre randomized controlled trial of acute treatment of patients with DSM-IV major depression. Patients were randomly assigned to receive reboxetine (4 mg b.d.) or paroxetine (20 mg mane) using a double-dummy technique to preserve the blind. The dosage could be increased at day 28 (to reboxetine 4 mg mane, 6 mg nocte; or paroxetine 20 mg b.d.). Antidepressant efficacy was assessed by the 21-item Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impression Scale for Severity (CGI-S) at all study visits, and the Clinical Global Impression of Improvement (CGI-I) at each visit after randomization. Sexual function and satisfaction was assessed by visual analogue scale (VAS) items of the Rush Sexual Inventory completed at baseline and days 28 and 56. There were no significant differences between groups in demographic or clinical features at baseline. There was a gradual reduction in severity of depressive symptoms (reboxetine, 14.3; paroxetine, 12.0: observed case analysis), with no significant differences between groups. There were significant differences (p 0.05), with advantages for reboxetine, at Week 4 and Week 8 on the VAS item assessing ability to become sexually excited, and non-significant trends with advantages for reboxetine, in frequency of sexual thoughts at Week 4 (p 0.05) and Week 8 (p 0.08); and in desire to initiate sexual activity at Week 4 (p 0.09). Exclusion of patients who had ever experienced sexual dysfunction with any medication prior to participation in this study (n 10) reduced the statistical significance of the findings, although there were still numerical advantages for reboxetine. Sexual function and satisfaction in depressed patients improves during double-blind acute treatment with reboxetine or paroxetine, but this improvement is greater and more rapid with reboxetine.

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

“…A systematic review of randomized placebo-controlled trials with trazodone (which has partial agonist effects at 5-HT1A receptors and antagonist effects at 5-HT2A and alpha-1 adrenergic receptors) indicates that it can be efficacious in reducing "psychogenic" erectile dysfunction, when prescribed at higher daily dosage (150-200 mg) 90 . Many patients experience treatment-emergent sexual dysfunction whilst taking an antidepressant 68 , but in others the reduction of depressive symptoms through successful treatment can be accompanied by reported improvements in sexual desire and satisfaction 91,92 . Improvement in sexual function appears more common among patients who respond to antidepressant treatment 93 .…”

Involvement of norepinephrine and serotonin system in antidepressant-like effects of hederagenin in the rat model of unpredictable chronic mild stress-induced depression

“…Despite the prevalence and societal burden of depression, the treatments currently available and their clinical efficacy remain unsatisfactory (Malberg & Blendy, 2005). Various classes of antidepressant drugs, including monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and selective noradrenaline reuptake inhibitors (SNRIs), may induce serious side effects, such as cardiac toxicity, hypopiesia, sexual dysfunction, body weight gain, and sleep disorders (Antai-Otong, 2004;Baldwin et al, 2006;Khurana & Baudendistel, 2003;Park et al, 2005). Thus, the identification of affordable drugs with few side effects among traditional Chinese medicines has recently gained considerable interest for Chinese investigators.…”

Strategies for managing antidepressant-induced sexual dysfunction: A review

“…Clayton et al [12] performed a large RCT with 450 participants with major depressive disorder in which treatment with reboxetine was similar to placebo and better than fluoxetine in regard to overall sexual functioning assessed using the Rush Sexual Inventory (see Table 1) over an 8-week period. Similarly, Baldwin et al [13] reported benefits for reboxetine over paroxetine on sexual functioning during treatment for major depression in a smaller trial (70 participants). Those receiving reboxetine reported greater improvement in sexual excitement over the 8-week study [13].…”

“…Similarly, Baldwin et al [13] reported benefits for reboxetine over paroxetine on sexual functioning during treatment for major depression in a smaller trial (70 participants). Those receiving reboxetine reported greater improvement in sexual excitement over the 8-week study [13]. Most recently, a third RCT with 357 participants reported benefits of reboxetine over citalopram with regard to sexual function over a longer period of 24 weeks [14].…”