Ferguson J M, Shrivastava R K, Stahl S M, Hartford J T, Borian F, Ieni J, McQuade R D, Jody D
Pharmacology Research Corporation, Salt Lake City, Utah, USA.
J Clin Psychiatry. 2001 Jan;62(1):24-9. doi: 10.4088/jcp.v62n0106.
Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored.
One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks.
Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction.
In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.
几种不同类型的抗抑郁药都与性功能不良反应有关。这项双盲随机试验比较了奈法唑酮和舍曲林对因舍曲林治疗而出现性功能障碍的抑郁症患者性功能障碍复发的影响。同时也对抑郁症状进行了监测。
筛选出105例患有DSM-III-R重度抑郁发作且因舍曲林（100毫克/天）导致性功能障碍的患者进入研究。符合条件的患者进入为期1周的洗脱期，随后是7至10天的单盲安慰剂阶段。在单盲安慰剂阶段结束时没有性功能障碍症状的患者被随机分配接受为期8周的双盲治疗，分别服用奈法唑酮（400毫克/天）或舍曲林（100毫克/天）。
与接受奈法唑酮治疗的患者（26%；10/39）相比，接受舍曲林治疗的患者出现性功能障碍（射精和/或性高潮困难）复发的比例几乎是其三倍（76%；25/33）（p<0.001）。此外，接受奈法唑酮治疗的患者对其性功能的满意度高于接受舍曲林治疗的患者。两个治疗组在抑郁症状方面都表现出相似且持续的改善。两种药物耐受性良好，两个治疗组不良反应的总体发生率相似；然而，9例接受舍曲林治疗的患者（26%）因不良事件停药，而接受奈法唑酮治疗的患者有5例（12%）停药。在因不良事件停药的患者中，5例接受舍曲林治疗的患者是因为性功能障碍被报告为不良事件而停药，而接受奈法唑酮治疗的患者中只有1例因性功能障碍而停药。
在这个从舍曲林治疗引起的性功能障碍中恢复的重度抑郁症患者样本中，奈法唑酮治疗导致性功能障碍复发的情况明显少于再次使用舍曲林治疗，并且具有持续的抗抑郁活性。
