Preeti S, Jayaram S D, Chittaranjan A
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Pharmacology, Kasturba Medical College, Manipal, Karnataka, India.
East Asian Arch Psychiatry. 2018 Mar;28(1):9-16.
To investigate early evolution, tolerability, and predictors of antidepressant-emergent sexual dysfunction in patients with anxiety or depressive disorder.
Patients with anxiety or depressive disorders who were prescribed antidepressant monotherapy (mirtazapine, sertraline, desvenlafaxine, escitalopram, or fluoxetine) at the discretion of the treating clinician were recruited from July 2012 to June 2014 from a hospital outpatient service. All were free of psychotropic medication for least 1 month. Sexual function was assessed at baseline, week 2, and week 6 using the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). A PRSexDQ score of ≥2 was considered to indicate sexual dysfunction. Sexual function was dichotomised to 'favourable' or 'impaired'.
Of 230 patients recruited, 209 were assessed at baseline of whom 184 were assessed at week 2; of these, 154 were also assessed at week 6. At baseline, 138 (66%) of the 209 patients were diagnosed with depressive disorder and 71 (34%) with anxiety disorder; 29% of patients had sexual dysfunction (in any domain of PRSexDQ). By week 6, the percentage had increased to 41%, although the change in the mean PRSexDQ score was only marginal (from 1.04 at baseline to 1.55 at week 6). With regard to individual questionnaire items, by week 6, sexual desire improved, but erectile and ejaculatory function in men and orgasmic function in women worsened. Fluoxetine and sertraline were associated with impaired sexual function, whereas mirtazapine was associated with favourable sexual function. In a logistic regression analysis, at week 2, mirtazapine and desvenlafaxine were predictors of favourable sexual outcome, whereas fluoxetine and higher baseline PRSexDQ score were predictors of impaired sexual outcome. At week 6, mirtazapine remained a predictor of favourable sexual outcome, whereas fluoxetine, higher 2-week PRSexDQ score, and adequate dose were predictors of impaired sexual outcome.
In patients with anxiety or depressive disorder, the risk of antidepressant-emergent sexual dysfunction at 6 weeks is low when drug doses are initially low with gradual up-titration. Baseline sexual dysfunction was independently associated with impaired sexual outcome. Men may be more likely than women to experience impaired sexual outcome. In patients with baseline sexual dysfunction, prescription of mirtazapine might be preferable to fluoxetine.
探讨焦虑或抑郁障碍患者中抗抑郁药引发性功能障碍的早期演变、耐受性及预测因素。
2012年7月至2014年6月期间，从一家医院门诊招募由治疗医生酌情给予抗抑郁药单药治疗（米氮平、舍曲林、去甲文拉法辛、艾司西酞普兰或氟西汀）的焦虑或抑郁障碍患者。所有患者至少1个月未服用精神类药物。在基线、第2周和第6周使用精神药物相关性性功能障碍问卷（PRSexDQ）评估性功能。PRSexDQ评分≥2被认为表明存在性功能障碍。性功能被分为“良好”或“受损”。
在招募的230例患者中，209例在基线时接受评估，其中184例在第2周接受评估；在这些患者中，154例在第6周也接受了评估。基线时，209例患者中有138例（66%）被诊断为抑郁症，71例（34%）被诊断为焦虑症；29%的患者存在性功能障碍（在PRSexDQ的任何领域）。到第6周时，这一比例增至41%，尽管PRSexDQ平均评分的变化仅微乎其微（从基线时 的1.04增至第6周时的1.55）。就个别问卷项目而言，到第6周时，性欲有所改善，但男性的勃起和射精功能以及女性的性高潮功能恶化。氟西汀和舍曲林与性功能受损相关，而米氮平与良好的性功能相关。在逻辑回归分析中，在第2周时米氮平和去甲文拉法辛是良好性结局的预测因素，而氟西汀和较高的基线PRSexDQ评分是性结局受损的预测因素。在第6周时，米氮平仍然是良好性结局的预测因素，而氟西汀、较高的第2周PRSexDQ评分和足量剂量是性结局受损的预测因素。
在焦虑或抑郁障碍患者中，当药物剂量最初较低并逐渐滴定增加时，6周时抗抑郁药引发性功能障碍的风险较低。基线性功能障碍与性结局受损独立相关。男性比女性更可能出现性结局受损。在有基线性功能障碍的患者中，处方米氮平可能比氟西汀更可取。
