Antidepressant drugs and sexual dysfunction

Abstract

This thesis describes a series of investigations that examined the relationships between depressive illness, antidepressant treatment, and sexual dysfunction, conducted between 1997 and 2003, involving over 1100 patients. A point prevalence study in 83 secondary care patients taking antidepressant drugs found that sexual dysfunction was reported by 75% of the sample.

A double-blind randomised controlled trial comparing the selective serotonin  re-uptake inhibitor (SSRI) paroxetine with the 5-HT₂ antagonist nefazodone, in the acute and continuation treatment of patients with DSM-III-R major depression (n=108) showed the two antidepressants had similar overall efficacy, but nefazodone was associated with significantly greater improvements in genital symptoms.

A second double-blind randomised controlled trial comparing paroxetine with a serotonin-noradrenaline re-uptake inhibitor in the acute treatment of patients with DSM-IV major depression (n=303) showed the two antidepressants had similar overall efficacy, but had significantly different effects on genital symptoms and on particular items on the sexual function questionnaire, developed for use in the point prevalence study.

A third double-blind randomised controlled trial comparing paroxetine with the selective noradrenaline re-uptake inhibitor reboxetine in the acute treatment of patients with DSM-IV major depression (n=70) again found that the two antidepressants had similar efficacy, but with significantly different effects on sexual function, as assessed by the visual analogue items of the Rush Sexual Inventory.

A fourth double-blind randomised controlled trial comparing paroxetine with the more selective SSRI escitalopram in the acute continuation treatment of patients with DSM-IV major depression (n=323) found no difference in overall efficacy, or effects on sexual function, assessed by the Arizona Sexual Experiences Scale (ASEX).

A five-year follow-up study in patients who participated in the point prevalence study (n=48) found that sexual dysfunction persisted in most patients, emphasizing the need for further research into the development of treatment approaches to sexual dysfunction in this patient group.

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