Sexual Dysfunction associated with Second-Generation Antidepressants in Patients with Major Depressive Disorder: Results from a Systematic Review with Network Meta-Analysis
Abstract:BACKGROUND: Sexual dysfunction (SD) is prevalent in patients with major depressive disorder (MDD) and is also associated with second-generation antidepressants (SGAD) which are commonly used to treat the condition. Evidence indicates underreporting of SD in efficacy studies. SD associated with antidepressant treatment is a serious side effect that may lead to early termination of treatment and worsening of quality of life. OBJECTIVES: To systematically assess the harms of SD associated with SGAD in adult patie… Show more
“…A second meta-analysis, of 58 randomized controlled trials and five observational studies, found only minor differences between most antidepressants, although there were relative disadvantages for paroxetine and venlafaxine, and relative advantages for bupropion 70 . A systematic review of the relative efficacy and tolerability of mirtazapine and comparator antidepressants found the former to be less likely than other antidepressants to cause adverse sexual effects 71 , possibly reflecting its antagonist effects at alpha-2 adrenergic and 5-HT2C receptors 72 .…”
Section: Influence Of Treatment Of Depression On Sexualitymentioning
Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.
“…A second meta-analysis, of 58 randomized controlled trials and five observational studies, found only minor differences between most antidepressants, although there were relative disadvantages for paroxetine and venlafaxine, and relative advantages for bupropion 70 . A systematic review of the relative efficacy and tolerability of mirtazapine and comparator antidepressants found the former to be less likely than other antidepressants to cause adverse sexual effects 71 , possibly reflecting its antagonist effects at alpha-2 adrenergic and 5-HT2C receptors 72 .…”
Section: Influence Of Treatment Of Depression On Sexualitymentioning
Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.
“…If an antidepressant is prescribed, then clinicians should discuss potential adverse sexual side effects and drug-drug interactions [Dauchy et al 2013]. There is evidence that some psychotropic medications, such as selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants, are associated with decreased libido [Reichenpfader et al 2014], delayed orgasm [Montejo et al 2001], continence and flow dysfunction [Pollack et al 1992]. Furthermore, antidepressants that are strong CYP2D6 (cytochrome P450 2D6) inhibitors may decrease the efficacy of TAM and are relatively contraindicated [Sideras et al 2010].…”
Section: Control Of Underlying Medical Conditionsmentioning
There is increasing attention and concern about managing the adverse effects of adjuvant endocrine therapy for women with early breast cancer as the side effects of therapy influence compliance and can impair quality of life (QoL). Most side effects associated with tamoxifen (TAM) and aromatase inhibitors (AIs) are directly related to estrogen deprivation, and the symptoms are similar to those experienced during natural menopause but appear to be more severe than that seen in the general population. Prolonged estrogen deprivation may lead to atrophy of the vulva, vagina, lower urinary tract and supporting pelvic structures, resulting in a range of genitourinary symptoms that can in turn lead to pain, discomfort, impairment of sexual function and negatively impact on multiple domains of QoL. The genitourinary side effects may be prevented, reduced and managed in most cases but this requires early recognition and appropriate treatment. We provide an overview of practical clinical approaches to understanding the pathophysiology and the management of genitourinary symptoms in postmenopausal women receiving adjuvant endocrine therapy for breast cancer.
“…1 Whereas 26% of nondepressed people report some sexual dysfunction, this number increases to 45% in people with untreated depression, and to 63% in medically treated patients with depression. 2 In addition to high levels of baseline SD in patients with depression, many antidepressant medications independently cause SD in any or all phases of the sexual response cycle, including libido, arousal, orgasm, and ejaculation.…”
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confidence: 99%
“…2 In addition to high levels of baseline SD in patients with depression, many antidepressant medications independently cause SD in any or all phases of the sexual response cycle, including libido, arousal, orgasm, and ejaculation. 1 …”
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