Clayton Anita H, Pradko James F, Croft Harry A, Montano C Brendan, Leadbetter Robert A, Bolden-Watson Carolyn, Bass Kristin I, Donahue Rafe M J, Jamerson Brenda D, Metz Alan
Department of Psychiatric Medicine, University of Virginia, Charlottesville 22903, USA.
J Clin Psychiatry. 2002 Apr;63(4):357-66. doi: 10.4088/jcp.v63n0414.
Sexual dysfunction commonly occurs during antidepressant treatment. However, the reported rates of sexual dysfunction vary across antidepressants and are typically underreported in product literature. The objectives of this study were (1) to estimate the prevalence of sexual dysfunction among patients taking newer antidepressants (bupropion immediate release [IR], bupropion sustained release [SR], citalopram, fluoxetine, mirtazapine, nefazodone, paroxetine, sertraline, venlafaxine, and venlafaxine extended release [XR]) and (2) to compare physician-perceived with patient-reported prevalence rates of antidepressant-associated sexual dysfunction.
This cross-sectional, observational study was conducted in 1101 U.S. primary care clinics. Adult outpatients (4534 women and 1763 men) receiving antidepressant monotherapy were enrolled. The prevalence of sexual dysfunction was measured using the Changes in Sexual Functioning Questionnaire.
In the overall population, bupropion IR (22%) and SR (25%) and nefazodone (28%) were associated with the lowest risk for sexual dysfunction, whereas selective serotonin reuptake inhibitor (SSRI) antidepressants, mirtazapine, and venlafaxine XR were associated with higher rates (36%-43%). In a prospectively defined subpopulation unlikely to have predisposing factors for sexual dysfunction, the prevalence of sexual dysfunction ranged from 7% to 30%, with the odds of having sexual dysfunction 4 to 6 times greater with SSRIs or venlafaxine XR than with bupropion SR. Physicians consistently underestimated the prevalence of antidepressant-associated sexual dysfunction.
Ours is the first study to assess sexual dysfunction across the newer antidepressants using consistent methodology and a validated rating scale. Overall, SSRIs and venlafaxine XR were associated with higher rates of sexual dysfunction than bupropion or nefazodone. Because antidepressant-associated sexual dysfunction is considerably underestimated by physicians, greater recognition and education are imperative when prescribing antidepressant treatment.
性功能障碍在抗抑郁治疗期间较为常见。然而，所报道的性功能障碍发生率在不同抗抑郁药物之间存在差异，且在产品说明书中通常报告不足。本研究的目的是：（1）估计服用新型抗抑郁药物（速释安非他酮、缓释安非他酮、西酞普兰、氟西汀、米氮平、奈法唑酮、帕罗西汀、舍曲林、文拉法辛和缓释文拉法辛）的患者中性功能障碍的患病率；（2）比较医生感知的与患者报告的抗抑郁药物相关性性功能障碍的患病率。
这项横断面观察性研究在美国1101家初级保健诊所进行。纳入接受抗抑郁药物单药治疗的成年门诊患者（4534名女性和1763名男性）。使用性功能问卷变化情况来测量性功能障碍的患病率。
在总体人群中，速释安非他酮（22%）、缓释安非他酮（25%）和奈法唑酮（28%）与性功能障碍的最低风险相关，而选择性5-羟色胺再摄取抑制剂（SSRI）类抗抑郁药物、米氮平和缓释文拉法辛与较高的发生率相关（36% - 43%）。在一个前瞻性定义的不太可能有性功能障碍易感因素的亚组中，性功能障碍的患病率在7%至30%之间，使用SSRI类药物或缓释文拉法辛出现性功能障碍的几率比使用缓释安非他酮大4至6倍。医生一直低估了抗抑郁药物相关性性功能障碍的患病率。
我们的研究是第一项使用一致方法和经过验证的评分量表评估新型抗抑郁药物性功能障碍情况的研究。总体而言，SSRI类药物和缓释文拉法辛与性功能障碍的发生率高于安非他酮或奈法唑酮。由于医生对抗抑郁药物相关性性功能障碍的情况严重低估，在开具抗抑郁药物治疗处方时，提高认识和加强教育势在必行。
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