Sexual dysfunction is an underdiscussed adverse effect to selective serotonin reuptake inhibitors SSRIs and may increase the risk for discontinuation...
Erectile function, arousal, ejaculation, orgasm, and overall satisfaction domain measures improved significantly in sildenafil compared with placebo patients.
These improvements may allow patients to maintain adherence with effective antidepressant treatment. Depression is a public health problem that adversely affects patients, their partners and families, the workplace, and general health care. Discontinuation may in turn lead to increased relapse, recurrence, morbidity, or mortality rates associated with depression. Selective serotonin reuptake inhibitors SSRIs replaced tricyclic antidepressants as first-line agents by demonstrating comparable efficacy, simpler titration, improved tolerability, and greater safety in an event of overdose.
Recognizing that further improvements in antidepressant treatment remained, pharmacological refinements were introduced that, in addition to blocking serotonin reuptake, block serotonin receptor function modulators , provide dual norepinephrine-serotonin reuptake inhibition, or are without serotonin reuptake inhibition. However, most antidepressants, with or without serotonin reuptake inhibition, can adversely affect sexual function.
The sexual response consists of 4 stages: Associations between depression, medication, and sexual dysfunction are prevalent and multidirectional. Sildenafil citrate is a selective and competitive inhibitor of phosphodiesterase type 5, the predominant catabolic isozyme for cyclic guanosine monophosphate in the corpus cavernosum. This prospective, randomized, double-blind, placebo-controlled investigation specifically examined sildenafil treatment for patients with MDD in remission, who were taking selective and nonselective serotonin reuptake inhibitors, and who were experiencing AASD.
The following specific objectives were addressed:
Developing strategies to predict who may be at the highest imperil for adverse changes in their sexual well-being is an mattering much step in improving the status of life and treatment of patients who require antidepressant treatment. The results of studies investigating genetic variations in drug metabolism enzymes and their relationships to antidepressant-associated adverse effects have dinosaur mixed.
Continued efforts to delineate the relationships between genetic markers and antidepressant outcomes, and to translate this knowledge to resigned care, have the potential to significantly improve the empiric series of antidepressant agents and to minimize the risk for intolerable side effects.
Approximately 19 million Americans suffer from depression occasionally year, with estimates that Selective serotonin reuptake inhibitors SSRIs such as citalopram, fluoxetine, fluvoxamine, escitalopram, paroxetine, and sertraline are common choices as first-line antidepressants. The efficacy of these drugs is superior to placebo and comparable to other classes of antidepressants in treating patients with major depression [ 2 Precise, 3 ].
Side effects and medication non-adherence to therapies are two reasons for inadequate responses to antidepressant agents. These sensual side effects are particularly discomfiting to patients because they are persistent and generally do not abate like headache, nausea, insomnia, diarrhea, and other early onslaught side effects, which generally disappear after the first few weeks of therapy.
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Krieger CA expert opinion. Scores for each item range from 1 to 6, and scale totals range from 5 to 30 higher scores indicating greater sexual dysfunction. The high prevalence of SSRI-associated sexual side effects and the negative impact they may have on drug therapy underscores the importance of conducting investigations to identify and characterize variables associated with these undesirable outcomes.
J Am Coll Cardiol. Recognizing that further improvements in antidepressant treatment remained, pharmacological refinements were introduced that, in addition to blocking serotonin reuptake, block serotonin receptor function modulators , provide dual norepinephrine-serotonin reuptake inhibition, or are without serotonin reuptake inhibition. An intronic polymorphic domain often associated with susceptibility to affective disorders has allele dependent differential enhancer activity in embryonic stem cells.
The primary outcome variable of this study was a global measure of SD, defined as exceeding predefined sex-specific thresholds on CSFQ total scores. Orgasm and global sexual functioning also improved in both groups, but it was nonsignificant. Patients were excluded for any of the following: Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: Sildenafil citrate is a selective and competitive inhibitor of phosphodiesterase type 5, the predominant catabolic isozyme for cyclic guanosine monophosphate in the corpus cavernosum.
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