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Introduction:
Depression is one of the more prevalent mental disorders in the United States, with estimates as high as 6.7% of Americans affected annually. Consequently, antidepressant use in the United States is also widespread. Both depression and its treatments are associated with sexual dysfunction (SD) in men and women, including orgasm and a...
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Context 1
... in the mechanisms of action of various antidepressants and antidepressant classes help to explain the variation in their likelihood of inducing SD (Figure 1). Neurotransmitters, such as serotonin (5-hydroxytryptophan), dopamine, and norepinephrine, are involved in the physiology of sexual functioning as well as in governing mood; anti- depressants may increase or decrease the function of these neurotransmitters in various end organs. ...
Citations
... Typical side effects include erectile dysfunction, lower sex drive, difficulties with ejaculation, and difficulties with orgasm. Estimation of rates of sexual side effects may be impacted by studies relying on patients spontaneously disclosing adverse effects on sexuality, as compared to specific assessment instruments (Clayton et al. 2014). Prevalence of sexual dysfunction with antidepressant use has been estimated to occur in up to 70% of patients taking selective serotonin reuptake inhibitors (SSRIs; Clayton et al. 2014). ...
... Estimation of rates of sexual side effects may be impacted by studies relying on patients spontaneously disclosing adverse effects on sexuality, as compared to specific assessment instruments (Clayton et al. 2014). Prevalence of sexual dysfunction with antidepressant use has been estimated to occur in up to 70% of patients taking selective serotonin reuptake inhibitors (SSRIs; Clayton et al. 2014). The antipsychotics quetiapine, ziprasidone, perphenazine, and aripiprazole are associated with relatively lower rates of sexual dysfunction (16-27%) compared to atypical antipsychotics (40-60%) such as olanzapine, risperidone, clozapine, thioridazine, and haloperidol (Serretti and Chiesa 2011). ...
... Less is known about the possible impacts of lithium on sexual function (Elnazer et al. 2015). The association between medication and sexuality should be openly discussed with patients: sexual side effects may be a factor impacting adherence to medication (Montejo et al. 2015), but reduction in mood symptoms may also improve sexual functioning and therefore engagement with treatment (Clayton et al. 2014). ...
... Lower rates of sexual dysfunction were reported with antidepressants like Mirtazapine, Reboxetine, Bupropion, and Moclobemide (range 0% -24%) [33]. In a cohort study, Sexual problems of some type were found in 26% of normal subjects, 45% of non-treated depressed patients, and 63% of treated depressed patients [34]. ...
Introduction: Major depressive disorder has the highest lifetime prevalence of any psychiatric disorder and negatively impacts sexual functioning in many patients. Females hesitate to discuss sexual problems due to cultural barriers. So sexual dysfunctions are under-reported and under-studied. Method: This is a cross-sectional study to evaluate the pattern of sexual dysfunction in 18 to 40-year-old married females having major depressive disorder attending psychiatry OPD in a tertiary care hospital in Delhi, India. The severity of depression was assessed by the Hamilton Depression Rating Scale (HAM-D), and sexual functioning was assessed by the Arizona Sexual Experience Scale (ASEX) and Female Sexual Function Index (FSFI) scales. Data was analysed using SPSS. Mean and standard deviation (±SD) were used to describe quantitative data meeting normal distribution. As appropriate, the chi-square or Fisher’s exact test was used to compare categorical data amongst independent groups. Results: 64% and 56% of participants in drug naïve and on-treatment groups respectively had sexual dysfunction as per ASEX scale as compared to 10% of controls. As per the FSFI scale, 84% and 76% of participants of drug naïve and on-treatment groups had sexual dysfunction compared to 20% of the control group. Of all domains of sexual functioning, domains of desire, arousal, and orgasm were most commonly affected. Conclusion: This study showed a high prevalence of sexual dysfunction in depressed females emphasizing the need for direct inquiry about sexual problems by the treatment provider and appropriate management for the benefit of patients.
... The physio pathogenic mechanisms of these phenomena appear to be multifactorial and complex [7]. One mechanism is the increase in circulating serotonin and the activation of serotonin 5-HT2A receptors that c o u l d affect orgasmic function and sexual interest. ...
... Previous antidepressants were simultaneously gradually tapered down by halving the dose for the first week before complete withdrawal. 7 ...
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15%-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD at naturalistic settings. Study objectives: To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting. Methodology: observational pragmatic and naturalistic study to determinate the effectiveness of the switch to vortioxetine (mean dosage 13.11±4.03) in 74 patients aged 43.1 ± 12.65 ( 54% males) at risk of discontinuing treatment due to sexual dysfunction. The SALSEX Scale was applied at two moments: baseline visit and after 3 months of follow-up. Results. The global Sexual Dysfunction (SD) measured with the SALSEX Scale, decreased significantly from baseline visit (10.32; SD 2.73) to follow-up visit (3.78; SD 3.68) p<0.001. There was a significant improvement ( p<0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to Vortioxetine, 83.81% of patients experienced sexual function improvement (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. 58.1% of patients showed an improvement in depressive symptoms from baseline visit. Conclusion. Switching to vortioxetine is an effective and reliable strategy to treat patients with poor tolerated previous antidepressant -related sexual dysfunction in the real-life clinical settings.
... It can also affect sexual function and desire. High levels of norepinephrine can lead to decreased sexual desire and position, while low levels can increase sexual desire and function [19]. ...
Understanding the intricate interplay between the brain and sexual behaviour is fundamental to human sexuality research. This review provides a comprehensive overview of the current understanding of the sexual brain, encompassing the neurobiological mechanisms that underlie sexual arousal, desire, and pleasure. The review begins by exploring the critical brain regions involved in sexual response, including the hypothalamus, limbic system, prefrontal cortex, nucleus accumbens, and the Hypothalamic-Pituitary -Adrenal (HPA) axis. These regions regulate sexual behaviour, process emotional and sensory information, and coordinate hormonal release crucial for sexual functioning. Furthermore, the review delves into the neural correlates of sexual arousal, elucidating the role of various brain regions in the perception and processing of sexual stimuli. It highlights studies employing neuroimaging techniques that have shed light on the brain's response to sexual stimuli, both in males and females. It explores potential sex differences in neural activation patterns. Moreover, the review examines the influence of sexual orientation on the neu-ral processing of sexual stimuli, emphasizing the differentiation between romantic love and sexual desire in the brain. It explores how the brain's reward system is implicated in sexual experiences and discusses the impact of chronic stress on sexual function through the modulation of the HPA axis. Additionally, the review addresses the relationship between sexual behaviour and other cognitive processes, such as decision-making, impulse control, and memory. It explores the cognitive and attentional mechanisms involved in the appraisal of sexual stimuli and discusses the discrepancies between self-reported and physiological measures of sexual arousal. Finally, the review acknowledges the importance of societal and cultural factors in shaping sexual behaviour and the brain's response to sexual stimuli. It emphasizes the need for further research to elucidate the complex interactions between biological, psychological, and sociocultural factors in the context of human sexuality. Overall, this comprehensive review provides a valuable synthesis of current knowledge on the sexual brain, offering insights into the neurobiological mechanisms underlying human sexual response. It serves as a foundation for future research and underscores the significance of interdisciplinary approaches in unravelling the complexities of human sexuality.
... Making the diagnosis of PSSD is often challenging (Box 4) -it is usually misdiagnosed as a psychological issue rather than being related to the use of SSRIs, as depression itself also can cause sexual dysfunction and decreased arousal, most likely through direct or indirect effects on neurotransmitters such as serotonin, dopamine and norepinephrine 108,109 . When a patient experiences sexual side effects while on medication, they might stop taking their SSRI; however, these effects can be persistent, leading to confusion about whether the persistent sexual dysfunction is caused by the SSRI per se or by an underlying psychological disease 89 . ...
Conditions referred to as 'male sexual dysfunctions' usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse effects on individuals' sexual health and relationships. Such conditions include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard-flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case-control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defined, and the available options cannot, therefore, adequately address patients' sexual problems and implement appropriate treatment. Thus, larger-scale studies - including prospective trials and comprehensive case registries - are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.
... At this moment there is a sharp release of serotonin into the CNS, which leads to the suppression of dopamine and noradrenaline actions and, therefore, a rapid decline of sexual excitement and detumescence, respectively [23]. At the periphery, however, serotonin suppresses adrenergic effects causing sexual excitement and blood stasis in the vessels of the genitals [24]. The selective serotonin reuptake inhibitor (SSRI), dapoxetine, prolongs serotonin 5HT-receptor activation, resulting in a decrease in noradrenaline excitatory mechanisms, a decrease in genital sensitivity, and thus, a delay in ejaculation [25]. ...
Since time immemorial, people have been trying to influence different aspects of their sexuality. They seek ways to increase sexual activity or sexual desire in themselves and their partners. In addition to resorting to all sorts of mystical rituals, people were looking for various effects from the use of natural raw materials. Some plant, animal, or fungal products have been shown to affect libido, sexual arousal, erectile function, orgasm or erogenous zone sensitivity. Such substances have been called "aphrodisiacs" in honor of the ancient Greek goddess of love - Aphrodite. Most often, aphrodisiacs were taken orally, but some were smoked while others applied to the genitals. In modern clinical practice, phosphodiesterase type 5 inhibitors are used. These are substances, which enhance erection and prevent detumescence in the presence of sexual arousal. Another group of drugs is selective serotonin reuptake inhibitors, which reduce sexual arousal and sexual afferent from the genitals, thus preventing the premature onset of orgasm in men and prolonging sexual intercourse. However, drugs from other pharmacological groups have not found widespread clinical application. Another issue now is a trend among people taking drugs of natural origin, therefore, all kinds of traditional aphrodisiacs are actively used to the present day. Very little is known about almost all of them. Clinical trials are in most cases limited to a few, often not randomized, studies. In this regard, it is very difficult to evaluate the adequate therapeutic and toxic doses of remedies. The situation is complicated by the fact that those few clinical studies were based on questionnaires, that is, the indicators taken into statistical calculations were extremely subjective. Moreover, it was uncertain whether all patients could adequately assess their dynamics in terms of parameters such as sexual satisfaction, or clearly distinguish between libido and sexual arousal. Since the majority of the studies were not blinded, a psychogenic influence on the results of the investigations could not be eliminated, which in the sexual area may be huge. It is worth emphasizing the toxicity of many traditional aphrodisiacs. Of course, there is a serious deficit in the spectrum of pharmacotherapy for sexual disorders. Perhaps further large, randomized, placebo-controlled trials would add some of the traditional aphrodisiacs or their modifications to the arsenal of the clinical specialist.
... Antidepressants are widely accepted as first-line medications for the treatment of major depressive disorder and other diseases such as clinical depression, anxiety [1], obsessive-compulsive disorder (OCD) [2,3], some chronic pains [4], persistent depressive disorder (dysthymia) [5], premenstrual syndrome (PMS) [6], preventive treatment of migraines [7], attention-deficit/hyperactivity disorder (ADHD) [8], post-traumatic stress disorder (PTSD) [9], and therapeutic management of some addictions and drug-seeking behaviors [10], in some cases. However, it has been affirmed that the consumption of antidepressants is commonly comorbid with some side effects, including discontinuation syndrome [11], nausea, constipation, dizziness, headaches, dry mouth followed by drowsiness, palpitations, and sweating [12], weight gain [13], increased risk of suicidal behavior [14], and sexual dysfunction [15]. Amitriptyline, nortriptyline, imipramine, desipramine, maprotiline, and sertraline are known as the most conventional class of tricyclic antidepressants (TCAs). ...
In the present study, on-chip electromembrane surrounded solid phase microextraction (EM-SPME) was employed in the determination of tricyclic antidepressants (TCAs), including amitriptyline, nortriptyline, imipramine, desipramine, maprotiline, and sertraline, from various biological fluids. In this regard, poly(3,4-ethylenedioxythiophene)–graphene oxide (PEDOT-GO) was electrodeposited on an SPME fiber as a conductive coating, then the fiber played the acceptor-electrode role during the extraction. Thus, the immigration of the analytes under the influence of an electric field and their absorption onto the fiber coating were accomplished simultaneously. Under the optimized conditions, the limits of detection for the target analytes were acquired in the range of 0.005–0.025 µg L−1 using gas chromatography–mass spectrometry. The linearity of the method was 0.010–500 µg L−1 for the imipramine and sertraline, 0.025–500 µg L−1 for the amitriptyline, nortriptyline, and desipramine, and 1.000–250 µg L−1 for the maprotiline (R2 ≥ 0.9984). Moreover, this method provided suitable precision and fiber-to-fiber reproducibility, with RSDs ≤ 8.4%. The applicability of the proposed setup was eventually investigated for extraction of the drugs from human bone marrow aspirate, urine, plasma, and well water samples, in which satisfactory relative recoveries, from 93–105%, were obtained.
... Apart from body weight concerns, the medications used to treat depression have various side effects that tailor their management. For example, SSRI and SNRIs are associated with sexual dysfunction [95], SNRI with hypertension [96], and mirtazapine with hypersomnia [97]. Hence, the selection of antidepressants must be a critical and individualized process that is unique to each patient. ...
Background
Depression and chronic pain are two major chronic non-communicable diseases (CNCD). Considering the bidirectional relationship between obesity and CNCD, it is of the utmost importance to understand the effect of medications utilized to treat these diseases on body weight.
Methods
This is a clinical review on the effect of medications for depression and chronic pain on body weight. We searched PubMed, Scopus, MEDLINE, and Google Scholar databases for studies on the topic from January 1, 1950 to April 1, 2022 in English language. Additionally, we present expert opinions in the fields of obesity, depression and chronic pain, providing a weight-centric approach to treat depression and chronic pain.
Results
Several antidepressant and chronic pain medications are associated with weight gain. Selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidases, mirtazapine and trazodone are common antidepressants that can increase body weight while bupropion is significantly associated with weight loss. Gabapentin and pregabalin are common chronic pain medications that are linked to weight gain. On the other hand, topiramate is associated with significant weight loss. Obesity, depression and chronic pain experts recommend avoiding medications that can increase body weight if another effective alternative is available.
Conclusion
By shifting prescribing practices toward a weight-conscious approach (i.e., switching from weight gain medications to weight loss/neutral), it is possible to mitigate the incidence of drug-induced weight gain.
... Even ejaculation quality in terms of sperm count is diminished when sexual arousal and orgasm quality are diminished [230]. Additionally, of course, orgasm quality can be diminished by relationship stress, anhedonia, and depression [231][232][233][234], and conversely with the use of selective serotonin reuptake inhibitors (SSRIs) used to treat depression [235][236][237][238][239][240][241][242]. This is not to say that sex cannot be pleasurable without orgasm, but only to differentiate the appetitive pleasure driven by the neural mechanisms of arousal and desire from the consummatory pleasure and satisfaction driven by orgasm (see Figure 9). ...
Although mechanisms of mate preference are thought to be relatively hard-wired, experience with appetitive and consummatory sexual reward has been shown to condition preferences for partner related cues and even objects that predict sexual reward. Here, we reviewed evidence from laboratory species and humans on sexually conditioned place, partner, and ejaculatory preferences in males and females, as well as the neurochemical, molecular, and epigenetic mechanisms putatively responsible. From a comprehensive review of the available data, we concluded that opioid transmission at μ opioid receptors forms the basis of sexual pleasure and reward, which then sensitizes dopamine, oxytocin, and vasopressin systems responsible for attention, arousal, and bonding, leading to cortical activation that creates awareness of attraction and desire. First experiences with sexual reward states follow a pattern of sexual imprinting, during which partner- and/or object-related cues become crystallized by conditioning into idiosyncratic “types” that are found sexually attractive and arousing. These mechanisms tie reward and reproduction together, blending proximate and ultimate causality in the maintenance of variability within a species.
... Selective serotonin reuptake inhibitors (SSRIs) are one of the most used psychiatric drugs, either due to an onlabel or to an off-label application [1]. However, sexual dysfunction, with a prevalence up to 80%, is a well-known side effect of SSRIs, causing many patients to drop out their therapies [2,3]. ...
Background: Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual disorders, that may arise during the administration of antidepressant Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitor (SNRIs) and may persist after their discontinuation. PSSD is commonly associated with sexual problems with marked distress and poor quality of life. To date, however, no effective treatment is available. The study describes the clinical experience with a newly introduced systems sexology approach involving bio-psycho-social interventions.
Methods: In this study we retrospectively analyzed (from July 2019 to July 2020) twelve PSSD male patients (mean age 31.3 ± 6.21 years old) treated according to a recently introduced approach involving system sexology and bio-psycho-social interventions. The protocol was based on a combination of lifestyle changes, nutritional supplementation, pharmacological and behavioral interventions.
Results: 12 patients with high probability of PSSD were selected. Patients reported a significant improvement in all International Index of Erectile Function-15 (IIEF) domains and Orgasmometer scores from the baseline at 6 months of follow-up.
Conclusions: This study described for the first time a feasible and handy treatment procedure for PSSD, framework to improve patients complains, sexual function and satisfaction, and quality of life. Future randomized, placebo-controlled clinical studies with bigger cohorts will be needed in order to better assess this efficacy and confirm our results.
