Kennedy S H, Eisfeld B S, Dickens S E, Bacchiochi J R, Bagby R M
Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Ontario, Canada.
J Clin Psychiatry. 2000 Apr;61(4):276-81. doi: 10.4088/jcp.v61n0406.
Recent reports suggest that adverse effects on sexual function occur in up to 50% of patients who are treated with selective serotonin reuptake inhibitor (SSRI) antidepressants. Previously cited low rates were more likely a function of underreporting than underoccurrence. There is less evidence about rates of dysfunction with serotonin-norepinephrine reuptake inhibitor (SNRI) and reversible inhibitor of monoamine oxidase A (RIMA) antidepressants. The purpose of this report is to evaluate disturbances in sexual drive/desire and arousal/orgasm in 107 patients who met criteria for major depressive disorder and received treatment with either moclobemide, paroxetine, sertraline, or venlafaxine.
All consenting eligible patients who met DSM-IV criteria for major depressive disorder completed the Sexual Functioning Questionnaire, version 1 (SFQ) and were assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D) prior to and after 8 or 14 weeks of antidepressant therapy. Analyses were carried out to examine the effect of gender, drug type, pretreatment level of sexual dysfunction, and drug response on reported sexual dysfunction.
Compared with women, men experienced a significantly greater level of drug-related impairment in drive/desire (p < .05), whereas there were no statistically significant differences in levels of arousal/orgasm impairment between men and women. The reported impairment in drive/desire items for men ranged from 38% to 50% and from 26% to 32% for women. No differences were found across the 4 antidepressants in men, whereas in women, rates of dysfunction were generally higher with sertraline and paroxetine, but only significantly so in comparison with moclobemide on some measures (p < .03). Rates of sexual dysfunction with venlafaxine tended to fall between those of SSRIs and the RIMA agent. An unexpected relationship was found between favorable drug response and a decreased level of drug-induced sexual dysfunction.
Antidepressant-induced sexual dysfunction occurs in approximately 30% to 70% of patients who are treated with sertraline or paroxetine. Lower rates are reported with moclobemide and venlafaxine. Clinicians should evaluate the various aspects of sexual dysfunction before and during antidepressant therapy.
近期报告显示，接受选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药治疗的患者中，高达50%出现性功能不良反应。此前报道的低发生率更可能是漏报而非实际发生率低的结果。关于5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）和单胺氧化酶A可逆抑制剂（RIMA）抗抑郁药导致性功能障碍的发生率，证据较少。本报告旨在评估107例符合重度抑郁症标准并接受吗氯贝胺、帕罗西汀、舍曲林或文拉法辛治疗的患者的性欲/性冲动及性唤起/性高潮障碍情况。
所有符合《精神疾病诊断与统计手册》第四版（DSM-IV）重度抑郁症标准且同意参与的合格患者，完成了性功能问卷第1版（SFQ），并在抗抑郁治疗8周或14周前后使用17项汉密尔顿抑郁评定量表（HAM-D）进行评估。进行分析以检验性别、药物类型、性功能障碍的治疗前水平以及药物反应对报告的性功能障碍的影响。
与女性相比，男性在性欲/性冲动方面的药物相关损害程度显著更高（p <.05），而男性和女性在性唤起/性高潮损害水平上无统计学显著差异。男性报告的性欲/性冲动项目损害率为38%至50%，女性为26%至32%。男性中4种抗抑郁药之间未发现差异，而在女性中，舍曲林和帕罗西汀的性功能障碍发生率通常较高，但仅在某些指标上与吗氯贝胺相比有显著差异（p <.03）。文拉法辛导致性功能障碍的发生率往往介于SSRI和RIMA药物之间。发现药物反应良好与药物引起的性功能障碍水平降低之间存在意外关系。
接受舍曲林或帕罗西汀治疗的患者中，约30%至70%会出现抗抑郁药引起的性功能障碍。吗氯贝胺和文拉法辛报告的发生率较低。临床医生应在抗抑郁治疗前和治疗期间评估性功能障碍的各个方面。
