Cedars-Sinai Medical Center and UCLA, 8730 Alden Drive, Thalians W-157, Los Angeles, CA 90048, USA.
J Clin Psychiatry. 2013 Mar;74(3):256-61. doi: 10.4088/JCP.12m07933.
Major depressive disorder (MDD) patients often experience impaired sexual satisfaction (ISS) and poor quality of life (QOL). Selective serotonin reuptake inhibitors (SSRIs), the first-line treatment for MDD, can cause sexual dysfunction, potentially worsening ISS and QOL. This study examined the impact of MDD and the SSRI citalopram on sexual satisfaction and QOL in level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial (July 2001-September 2006).
A retrospective analysis was conducted of the change in sexual satisfaction, as measured by item 9 of the Quality of Life Enjoyment and Satisfaction Questionnaire, the primary outcome measure, in 2,280 patients with DSM-IV-TR-defined MDD who were treated with citalopram for 12 weeks. The Quick Inventory of Depressive Symptomatology-Self Report was used to evaluate the impact of depression ratings on impaired sexual satisfaction and on QOL.
Impaired sexual satisfaction was present in 64.3% of MDD patients at pretreatment, but that percentage declined to 47.1% at posttreatment with citalopram (P < .0001). Those who achieved remission had less ISS and better QOL. The prevalence of ISS in remitters was 21.2% versus 61.3% in nonremitters (P < 10(-8)). The mean ± standard deviation score for remitters increased from 2.32 ± 1.16 to 3.44 ± 1.23 (P < 10(-8); Cohen d = 0.81 [large effect size]), whereas in nonremitters it increased only from 1.99 ± 1.08 to 2.19 ± 1.19 (P < 10(-8); Cohen d = 0.16). The difference between remitters and nonremitters was highly significant (P < 10(-8)). Regression analyses at pretreatment and posttreatment demonstrated significant associations between depressive symptoms and ISS (P < .0001) and between ISS and lower QOL (P < .0001) as well as an association between citalopram and increased probability of ISS and a poorer QOL in patients who continue to have moderate-to-severe depression.
A majority of MDD patients have impaired sexual satisfaction, a symptom associated with poor QOL. Despite the sexual side effects of the SSR citalopram, treating depression to full remission was associated with improvements in sexual satisfaction and QOL.
ClinicalTrials.gov identifier: NCT00021528.
重度抑郁症（MDD）患者常经历性满意度（ISS）受损和生活质量（QOL）下降。选择性 5-羟色胺再摄取抑制剂（SSRIs）是治疗 MDD 的一线药物，但会引起性功能障碍，可能会使 ISS 和 QOL 进一步恶化。本研究旨在评估 MDD 及 SSRIs 西酞普兰对 STAR*D 试验（2001 年 7 月至 2006 年 9 月）一级治疗中 ISS 和 QOL 的影响。
采用 DSM-IV-TR 定义的 MDD 患者 2280 例，以自评问卷 9 项（主要结局指标）评估西酞普兰治疗 12 周时性满意度的变化。采用贝克抑郁自评量表评估抑郁严重程度对 ISS 和 QOL 的影响。
治疗前，64.3%的 MDD 患者存在 ISS，而西酞普兰治疗后 ISS 下降至 47.1%（P＜0.0001）。缓解患者 ISS 发生率更低，QOL 更高。缓解患者 ISS 发生率为 21.2%，未缓解患者 ISS 发生率为 61.3%（P＜10（-8））。缓解患者的 ISS 评分均值从 2.32±1.16 增加至 3.44±1.23（P＜10（-8）；Cohen d=0.81[大效应量]），而非缓解患者仅从 1.99±1.08 增加至 2.19±1.19（P＜10（-8）；Cohen d=0.16）。缓解组与非缓解组差异显著（P＜10（-8））。治疗前和治疗后回归分析显示，抑郁症状与 ISS 显著相关（P＜0.0001），ISS 与 QOL 显著相关（P＜0.0001），西酞普兰与 ISS 发生率增加及 QOL 下降显著相关，在持续中重度抑郁患者中更为明显。
大多数 MDD 患者存在 ISS，ISS 是与 QOL 差相关的症状。尽管 SSRIs 西酞普兰有副作用，但将抑郁治疗至完全缓解与 ISS 和 QOL 的改善相关。
ClinicalTrials.gov 标识符：NCT00021528。
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