Graf Heiko, Wiegers Maike, Metzger Coraline D, Walter Martin, Grön Georg, Abler Birgit
Department of Psychiatry III, Ulm University, Ulm, Germany (Drs Graf, Wiegers, Grön, and Abler); Department of Psychiatry, Otto von Guericke University, Magdeburg, Germany (Drs Metzger and Walter); Leibniz Institute for Neurobiology, Magdeburg, Germany (Drs Metzger and Walter).
Int J Neuropsychopharmacol. 2014 Oct 31;18(2):pyu004. doi: 10.1093/ijnp/pyu004.
Impaired sexual function is increasingly recognized as a side effect of psychopharmacological treatment. However, underlying mechanisms of action of the different drugs on sexual processing are still to be explored. Using functional magnetic resonance imaging, we previously investigated effects of serotonergic (paroxetine) and dopaminergic (bupropion) antidepressants on sexual functioning (Abler et al., 2011). Here, we studied the impact of noradrenergic and antidopaminergic medication on neural correlates of visual sexual stimulation in a new sample of subjects.
Nineteen healthy heterosexual males (mean age 24 years, SD 3.1) under subchronic intake (7 days) of the noradrenergic agent reboxetine (4 mg/d), the antidopaminergic agent amisulpride (200mg/d), and placebo were included and studied with functional magnetic resonance imaging within a randomized, double-blind, placebo-controlled, within-subjects design during an established erotic video-clip task. Subjective sexual functioning was assessed using the Massachusetts General Hospital-Sexual Functioning Questionnaire.
Relative to placebo, subjective sexual functioning was attenuated under reboxetine along with diminished neural activations within the caudate nucleus. Altered neural activations correlated with decreased sexual interest. Under amisulpride, neural activations and subjective sexual functioning remained unchanged.
In line with previous interpretations of the role of the caudate nucleus in the context of primary reward processing, attenuated caudate activation may reflect detrimental effects on motivational aspects of erotic stimulus processing under noradrenergic agents.
性功能障碍日益被认为是精神药物治疗的一种副作用。然而，不同药物对性反应过程的潜在作用机制仍有待探索。我们之前利用功能磁共振成像研究了血清素能（帕罗西汀）和多巴胺能（安非他酮）抗抑郁药对性功能的影响（阿布莱尔等人，2011年）。在此，我们在一组新的受试者中研究了去甲肾上腺素能和抗多巴胺能药物对视觉性刺激神经关联的影响。
纳入19名健康异性恋男性（平均年龄24岁，标准差3.1），他们在亚慢性摄入（7天）去甲肾上腺素能药物瑞波西汀（4毫克/天）、抗多巴胺能药物氨磺必利（200毫克/天）和安慰剂的情况下，在一项既定的色情视频片段任务中，采用随机、双盲、安慰剂对照、受试者内设计，通过功能磁共振成像进行研究。使用马萨诸塞州总医院性功能问卷评估主观性功能。
与安慰剂相比，瑞波西汀治疗下主观性功能减弱，同时尾状核内神经激活减少。神经激活的改变与性兴趣降低相关。在氨磺必利治疗下，神经激活和主观性功能保持不变。
与之前对尾状核在初级奖赏处理中的作用的解释一致，尾状核激活减弱可能反映出去甲肾上腺素能药物对色情刺激处理动机方面的有害影响。
