Chokka Pratap R, Hankey Jeffrey R
Chokka Center for Integrative Health, Edmonton, AB, Canada.
Ther Adv Psychopharmacol. 2018 Jan;8(1):13-23. doi: 10.1177/2045125317720642. Epub 2017 Jul 31.
Sexual dysfunction (SD) is pervasive and underreported, and its effects on quality of life are underestimated. Due in part to its bidirectional relationship with depression, SD can be difficult to diagnose; it is also a common side effect of many antidepressants, leading to treatment noncompliance. While physicians often count on patients to spontaneously report SD, treatment is optimized when the clinician instead performs a thorough assessment of sexual functioning before and during drug therapy using a standardized questionnaire such as the Arizona Sexual Experiences Scale (ASEX). Separating the effects of the disorder from those of medications is challenging; we present a concise, evidence-based schematic to assist physicians in minimizing treatment-emergent sexual dysfunction (TESD) while treating depression. Vascular, hormonal, neurogenic, and pharmacological factors should be considered when a patient presents with SD. We also recommend that physicians obtain patient information about baseline and historical sexual functioning before prescribing a drug that may lead to SD and follow up accordingly. When the goal is to treat depression while attenuating the risk of sexual symptoms, physicians may wish to consider agomelatine, bupropion, desvenlafaxine, moclobemide, trazodone, vilazodone, and vortioxetine.
性功能障碍（SD）普遍存在且报告不足，其对生活质量的影响被低估。部分由于它与抑郁症的双向关系，SD可能难以诊断；它也是许多抗抑郁药的常见副作用，导致治疗依从性差。虽然医生通常指望患者自发报告SD，但当临床医生使用标准化问卷（如亚利桑那性体验量表[ASEX]）在药物治疗前和治疗期间对性功能进行全面评估时，治疗效果会得到优化。区分疾病影响和药物影响具有挑战性；我们提供一个简洁的、基于证据的示意图，以帮助医生在治疗抑郁症时尽量减少治疗引发的性功能障碍（TESD）。当患者出现SD时，应考虑血管、激素、神经源性和药理学因素。我们还建议医生在开可能导致SD的药物之前获取患者关于基线和既往性功能的信息，并相应地进行随访。当目标是治疗抑郁症同时减轻性症状风险时，医生可能希望考虑阿戈美拉汀、安非他酮、去甲文拉法辛、吗氯贝胺、曲唑酮、维拉唑酮和伏硫西汀。
