Kurt Kaya Simge N, Safak Yasir, Ozdemir Seyda
Department of Psychiatry, 29 Mayıs State Hospital, Ankara, 06105, Turkey.
Department of Psychiatry, Etlik City Hospital, Ankara, 06170, Turkey.
Sex Med. 2024 Dec 20;12(6):qfae085. doi: 10.1093/sexmed/qfae085. eCollection 2024 Dec.
Sexual dysfunction (SD) due to Selective Serotonin Reuptake Inhibitors (SSRI) use is a common condition encountered by psychiatrists and its etiology has not been fully elucidated.
To determine the relationship between alpha Melanocyte Stimulating Hormone (α-MSH) and Melanocortin-4 receptor (MCR4) levels and sexual function levels of patients with and without SSRI related SD and control group and to examine whether α-MSH and MCR4 play a role in the etiology of SSRI related SD.
A total of 92 patients and 49 healthy volunteers who applied to psychiatry outpatient clinic were included in the study. Sociodemographic form, sexual history form, Structured Clinical Interview for DSM 5, Psychotropic Related Sexual Dysfunction-Turkish version (PreSexDQ-T), Arizona Sexual Experiences Scale, Beck Depression and Anxiety Inventory were used in the evaluation interview with the referred patients. Patient groups were formed according to whether there was SSRI related SD according to the sexual history and PreSexDQ-T scale.
The α-MSH and MCR4 levels were significantly lower in patients with SD due to SSRI use.
α-MSH and MCR4 levels were lower in the SSRI related SD (SSRI-SD (+)) group than in the not experiencing SD with SSRIs (SSRI-SD (-)) and control groups. The mean α-MSH and MCR4 value of the control group was found to be significantly higher than the SSRI-SD (+) patient group, the mean MCR4 value of the control group was found to be significantly higher than the mean MCR4 value of the SSRI-SD (-) patient group. The mean MCR4 and a-MSH values of the SSRI-SD(+) group using SSRI with fluoxetine were significantly lower than the SSRI-SD (-) group using SSRI with fluoxetine.
There is a role for α-MSH and MCR4 in SSRI related SD.
Its strength is that it is the first human study in this field. Limitations include small sample size and unknown baseline levels of α-MSH and MCR4.
The fact that α-MSH and MCR4 play a role in the etiology of SD due to SSRI use in woman and that there was a significant difference between SSRI-SD (+) and SSRI-SD (-) groups when α-MSH and MCR4 levels were compared in fluoxetine users supports the hypothesis that serotonin may mediate SD via α-MSH and MCR4 through 5-hydroxytryptamine-2C (5-HT) antagonism.
使用选择性5-羟色胺再摄取抑制剂（SSRI）导致的性功能障碍（SD）是精神科医生常遇到的情况，其病因尚未完全阐明。
确定有无SSRI相关性SD的患者以及对照组的α-黑素细胞刺激素（α-MSH）和黑皮质素-4受体（MCR4）水平与性功能水平之间的关系，并研究α-MSH和MCR4是否在SSRI相关性SD的病因中起作用。
本研究共纳入92例患者和49名申请精神科门诊的健康志愿者。在对转诊患者的评估访谈中，使用了社会人口学表格、性病史表格、《精神疾病诊断与统计手册》第5版的结构化临床访谈、精神药物相关性性功能障碍-土耳其语版（PreSexDQ-T）、亚利桑那性体验量表、贝克抑郁和焦虑量表。根据性病史和PreSexDQ-T量表中是否存在SSRI相关性SD来组建患者组。
使用SSRI导致SD的患者中，α-MSH和MCR4水平显著较低。
与未使用SSRI出现SD（SSRI-SD（-））的患者组及对照组相比，SSRI相关性SD（SSRI-SD（+））组的α-MSH和MCR4水平较低。发现对照组的α-MSH和MCR4平均值得显著高于SSRI-SD（+）患者组，对照组的MCR4平均值得显著高于SSRI-SD（-）患者组的MCR4平均值。使用氟西汀的SSRI-SD（+）组的MCR4和α-MSH平均值显著低于使用氟西汀的SSRI-SD（-）组。
α-MSH和MCR4在SSRI相关性SD中起作用。
其优点是这是该领域的第一项人体研究。局限性包括样本量小以及α-MSH和MCR4的基线水平未知。
α-MSH和MCR4在女性因使用SSRI导致的SD病因中起作用，并且在比较氟西汀使用者的α-MSH和MCR4水平时，SSRI-SD（+）组和SSRI-SD（-）组之间存在显著差异，这支持了5-羟色胺可能通过α-MSH和MCR4，经由5-羟色胺-2C（5-HT）拮抗作用介导SD的假说。
