Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark.
J Sex Med. 2023 Feb 14;20(2):161-169. doi: 10.1093/jsxmed/qdac016.
Major depressive disorder (MDD) is closely associated with sexual dysfunction, which may worsen during treatment with selective serotonin reuptake inhibitors (SSRIs) due to the side effects of pharmacologic treatment.
To examine the association between sexual function and severity of MDD in drug-naïve patients as compared with healthy controls and how treatment with SSRIs affects sexual function over time in individuals with MDD. Interaction with gender and treatment response was examined.
In 92 patients with MDD, we measured MDD severity with 6- and 17-item versions of the Hamilton Depression Rating Scale (HDRS6 and HDRS17) and the level of sexual function with the Changes in Sexual Functioning Questionnaire at baseline and 4, 8, and 12 weeks after initiating treatment with escitalopram. Baseline sexual function was compared with the sexual function of 73 healthy controls. Linear regression models were used to assess differences in sexual function between healthy controls and patients and change in sexual function from baseline to week 12. Linear mixed models were used to assess differences in change in sexual function between treatment response groups.
Outcomes included total scores on the HDRS6, HDRS17, and Changes in Sexual Functioning Questionnaire and changes in total scores from baseline to week 12.
Unmedicated patients with MDD reported impaired sexual function as compared with healthy controls. Level of sexual function was not associated with severity of MDD at baseline. Patients' sexual function improved significantly during treatment, which was coupled with amelioration of depressive symptoms. Treatment response groups (remitters, intermediate responders, nonresponders) did not predict change in sexual function. Gender had no effect on sexual dysfunction symptoms during treatment.
Major depression is a risk factor for sexual problems, and improvement in sexual function was coupled with amelioration of depressive symptoms.
Among its strengths, this was a naturalistic study reflecting real-world settings in clinical practice. It additionally included a baseline measurement of sexual function and MDD severity on drug-naïve patients prior to the initiation of treatment. Finally, the follow-up of 12 weeks extends beyond the acute phase of treatment in which previous research has observed a peak in sexual side effects. In terms of limitations, there was no placebo arm; thus, the study cannot attribute the effects on sexual function to treatment with antidepressants per se. Also, the patients were young, which may have served as a protective factor against sexual side effects.
Sexual dysfunction was strongly associated with MDD and improved in parallel with overall symptoms of depression across a standard 12-week treatment with SSRI antidepressants.
NCT02869035 (https://clinicaltrials.gov/ct2/show/NCT02869035).
重度抑郁症（MDD）与性功能障碍密切相关，由于药物治疗的副作用，在使用选择性 5-羟色胺再摄取抑制剂（SSRIs）治疗期间，性功能障碍可能会恶化。
在未经药物治疗的患者中，与健康对照组相比，评估性功能与 MDD 严重程度之间的关系，并研究 SSRIs 治疗如何随着时间的推移影响 MDD 患者的性功能。还检验了性别和治疗反应的交互作用。
在 92 名 MDD 患者中，我们使用 6 项和 17 项汉密尔顿抑郁量表（HDRS6 和 HDRS17）来衡量 MDD 的严重程度，以及使用性功能变化问卷来衡量性功能，在开始使用依西酞普兰治疗前以及治疗后 4、8 和 12 周进行评估。将基线时的性功能与 73 名健康对照组的性功能进行比较。使用线性回归模型评估健康对照组和患者之间性功能的差异，以及从基线到第 12 周性功能的变化。使用线性混合模型评估治疗反应组之间性功能变化的差异。
与健康对照组相比，未经药物治疗的 MDD 患者报告性功能受损。基线时，性功能与 MDD 的严重程度无关。患者的性功能在治疗期间显著改善，同时抑郁症状也得到改善。治疗反应组（缓解者、中度反应者、无反应者）并不能预测性功能的变化。性别对治疗期间的性功能障碍症状没有影响。
重度抑郁症是性功能问题的一个危险因素，性功能的改善与抑郁症状的改善相关。
该研究的优势在于，这是一项自然主义研究，反映了临床实践中的实际情况。它还包括了未经药物治疗的患者在开始治疗前的基线性功能和 MDD 严重程度的测量。最后，12 周的随访时间超过了急性治疗阶段，在此之前的研究观察到了性功能副作用的峰值。该研究的局限性在于没有安慰剂组，因此不能将性功能的改善归因于抗抑郁药物本身的治疗效果。此外，患者年龄较轻，这可能是性功能副作用的一个保护因素。
性功能障碍与 MDD 密切相关，在接受标准的 12 周 SSRI 抗抑郁药物治疗期间，与抑郁的总体症状一起改善。
NCT02869035（https://clinicaltrials.gov/ct2/show/NCT02869035）。
