Montejo A I, Llorca G, Izquierdo J A, Ledesma A, Bousoño M, Calcedo A, Carrasco J L, Daniel E, de Dios A, de la Gándara J, Derecho J, Franco M, Gómez M J, Macías J A, Martín T, Pérez V, Sánchez J M, Sánchez S, Vicens E
Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1996 Nov-Dec;24(6):311-21.
The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses.
There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.
作者分析了不同选择性5-羟色胺再摄取抑制剂（SSRI，包括氟西汀、氟伏沙明、帕罗西汀和舍曲林）引起性功能障碍（SD）的发生率，以及SD随时间的定性和定量变化。对308例接受SSRI治疗的门诊患者（169例女性，139例男性；平均年龄±标准差=41±7岁）进行了访谈，使用作者为此设计的SD问卷，其中包括以下项目的问题：性欲减退、性高潮延迟或无高潮、射精延迟、无法射精、阳痿和总体性满意度。纳入标准如下：服用SSRI前性功能正常，仅接受SSRI治疗或与苯二氮卓类药物联合使用，既往有异性恋或自我手淫的当前性行为。排除既往有性功能障碍、SSRI与抗精神病药物联合使用、近期服用激素和患有重大疾病的患者。
当医生直接询问患者时，SD的发生率显著增加（55.29%），而自发报告的SD发生率为（14.2%）。不同SSRI之间存在一些显著差异，帕罗西汀比氟伏沙明、氟西汀和舍曲林引起更多的性高潮/射精延迟和阳痿（卡方检验p<0.05）。只有22.6%的患者对其性功能障碍耐受性良好。SD与剂量呈正相关。当剂量减少或停药时，患者的性功能有显著改善。男性性功能障碍的发生率高于女性，但女性的性功能障碍比男性更严重。9例患者中有7例（77.7%）在改用吗氯贝胺（450毫克/天）治疗后完全改善，4例患者中有2例（50%）在改用安非他明治疗后改善。
