Hindmarch I
Human Psychopharmacology Research Unit, University of Surrey, Milford Hospital, Godalming, UK.
Int Clin Psychopharmacol. 1998 Jul;13 Suppl 6:S5-8.
The cognitive system is structured from sets of schema, patterns of neural activity that allow the assimilation or accommodation of new experiences and so, by a process of consolidation, the gradual development of knowledge and understanding. As well as schema for purely cognitive processes, there are similar structures that enable individuals to deal with sexual behaviour and affectual relationships (e.g. hedonia, self-esteem, personal preferences and body image). In depression, there is a well established disruption of cognitive function that results in anhedonia and a loss of pleasure, including that from sexual activities. Many antidepressants also have a direct pharmacological action on the central nervous system and disrupt cognitive function, so increasing anhedonia and impairing sexual function. Drug actions on cognitive structures, which in turn increase anhedonia and reduce sexual libido, are over and above any direct pharmacological effects on the more overt behavioural activities associated with sex, including orgasm, erectile function, potency and ejaculation. The tricyclic antidepressants, for example, destroy the cognitive structures that are vital to maintain normal libido as well as disturbing overt sexual behaviours. Some selective serotonin reuptake inhibitors (SSRIs; paroxetine and sertraline) are associated with behavioural activation that is also responsible for an impairment of sexual function. However, there are clear differences between the SSRIs, and fluvoxamine (relative to the other SSRIs) has little effect on objective measures of cognition or on cerebral and behavioural components of sexual function.
认知系统由图式集构建而成，即神经活动模式，它允许新体验的同化或顺应，从而通过巩固过程逐渐发展知识和理解。除了用于纯认知过程的图式外，还有类似的结构使个体能够处理性行为和情感关系（例如享乐主义、自尊、个人偏好和身体形象）。在抑郁症中，认知功能存在既定的破坏，导致快感缺失和愉悦感丧失，包括性活动带来的愉悦感。许多抗抑郁药也对中枢神经系统有直接药理作用，会破坏认知功能，从而加剧快感缺失并损害性功能。药物对认知结构的作用，进而增加快感缺失并降低性 Libido，这超出了对与性相关的更明显行为活动（包括性高潮、勃起功能、性能力和射精）的任何直接药理作用。例如，三环类抗抑郁药会破坏对维持正常性欲至关重要的认知结构，同时扰乱明显的性行为。一些选择性 5-羟色胺再摄取抑制剂（SSRIs；帕罗西汀和舍曲林）与行为激活有关，这也会导致性功能受损。然而，SSRIs 之间存在明显差异，氟伏沙明（相对于其他 SSRIs）对认知的客观测量或性功能的大脑和行为成分影响很小。
