Ben-Sheetrit Joseph, Hermon Yehonathan, Birkenfeld Shlomo, Gutman Yehiel, Csoka Antonei B, Toren Paz
Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel.
Geha Mental Health Center, Petah Tikva, Israel.
Ann Gen Psychiatry. 2023 Apr 21;22(1):15. doi: 10.1186/s12991-023-00447-0.
Sexual dysfunction is a common side effect of Serotonergic antidepressants (SA) treatment, and persists in some patients despite drug discontinuation, a condition termed post-SSRI sexual dysfunction (PSSD). The risk for PSSD is unknown but is thought to be rare and difficult to assess. This study aims to estimate the risk of erectile dysfunction (ED) and PSSD in males treated with SAs.
A 19-year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase-5 inhibitors prescriptions. 12,302 males aged 21-49 met the following criteria: non-smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or substance use. Logistic regression was used for estimation of ED risk in SA-treated subjects compared to non-SA-treated controls, assessed with and without the effects of age, body mass index (BMI), socioeconomic status (SES), depression and anxiety, yielding crude and adjusted odds ratios (cOR and aOR, respectively).
SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8-4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3-4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000.
This work offers a first assessment of the small but significant risk of irreversible ED associated with the most commonly prescribed class of antidepressants which should enhance the process of receiving adequate informed consent for therapy.
性功能障碍是5-羟色胺能抗抑郁药（SA）治疗常见的副作用，并且在一些患者中即使停药后仍持续存在，这种情况被称为选择性5-羟色胺再摄取抑制剂后性功能障碍（PSSD）。PSSD的风险未知，但被认为很罕见且难以评估。本研究旨在估计接受SA治疗的男性发生勃起功能障碍（ED）和PSSD的风险。
使用以色列最大的健康维护组织的计算机化数据库进行了一项为期19年的回顾性队列分析。ED通过磷酸二酯酶-5抑制剂处方来定义。12302名年龄在21至49岁的男性符合以下标准：不吸烟者，无医学或精神疾病合并症或与ED相关的药物，无酒精或物质使用。与未接受SA治疗的对照组相比，采用逻辑回归估计接受SA治疗的受试者发生ED的风险，评估时考虑和不考虑年龄、体重指数（BMI）、社会经济地位（SES）、抑郁和焦虑的影响，分别得出粗比值比和调整后比值比（分别为cOR和aOR）。
SA与ED风险增加相关（cOR = 3.6，p < 0.000001，95% CI 2.8 - 4.8），在调整年龄、SES、BMI、抑郁和焦虑后仍具有显著性（aOR = 3.2，p < 0.000001，95% CI 2.3 - 4.4）。接受SA治疗的患者中PSSD的风险为216分之一（0.46%）。PSSD的患病率为每10万人中有4.3例。
这项研究首次评估了与最常用的一类抗抑郁药相关的不可逆ED的小但显著的风险，这应该会加强在治疗中获得充分知情同意的过程。
