抗抑郁药相关性性功能障碍的发生率：一项针对1022名门诊患者的前瞻性多中心研究。西班牙精神药物相关性性功能障碍研究工作组

Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.

作者信息

Montejo A L, Llorca G, Izquierdo J A, Rico-Villademoros F

机构信息

University Hospital of Salamanca, Psychiatric Teaching Area, University of Salamanca, School of Medicine, Spain.

出版信息

J Clin Psychiatry. 2001;62 Suppl 3:10-21.

PMID:11229449

Abstract

BACKGROUND

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed.

METHOD

The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction.

RESULTS

The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction.

CONCLUSION

The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.

摘要

背景

抗抑郁药，尤其是选择性5-羟色胺再摄取抑制剂（SSRI）、文拉法辛和氯米帕明，常与性功能障碍有关。其他作用机制不同的抗抑郁药（奈法唑酮、米氮平、安非他酮、阿密替林和吗氯贝胺）似乎有较少的性副作用。性功能障碍的发生率被低估，需要使用特定问卷进行评估。

方法

作者在一项由西班牙精神药物相关性性功能障碍研究工作组开展的多中心、前瞻性、开放标签研究中，分析了抗抑郁药相关性性功能障碍的发生率。该研究组收集了1995年4月至2000年2月期间，性功能此前正常、正在单独接受抗抑郁药治疗或抗抑郁药加苯二氮䓬类药物治疗的患者的数据。使用精神药物相关性性功能障碍问卷对1022名门诊患者（610名女性，412名男性；平均年龄 = 39.8±11.3岁）进行了访谈，该问卷包括有关性欲、性高潮、射精、勃起功能和总体性满意度的问题。

结果

将所有抗抑郁药整体考虑时，性功能障碍的总发生率为59.1%（604/1022）。当比较不同药物间任何类型性功能障碍的发生率时，存在显著差异：氟西汀为57.7%（161/279）；舍曲林为62.9%（100/159）；氟伏沙明为62.3%（48/77）；帕罗西汀为70.7%（147/208）；西酞普兰为72.7%（48/66）；文拉法辛为67.3%（37/55）；米氮平为24.4%（12/49）；奈法唑酮为8%（4/50）；阿密替林为6.9%（2/29）；吗氯贝胺为3.9%（1/26）。男性性功能障碍的发生率（62.4%）高于女性（56.9%），尽管女性性功能障碍的严重程度更高。约40%的患者对其性功能障碍耐受性较低。