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Exercise improves sexual function in women taking antidepressants: Results from a randomized crossover trial
Depression and Anxiety
Abstract
Background
In laboratory studies, exercise immediately before sexual stimuli improved sexual arousal of women taking antidepressants [1]. We evaluated if exercise improves sexual desire, orgasm, and global sexual functioning in women experiencing antidepressant-induced sexual side effects. Methods
Fifty-two women who were reporting antidepressant sexual side effects were followed for 3 weeks of sexual activity only. They were randomized to complete either three weeks of exercise immediately before sexual activity (3×/week) or 3 weeks of exercise separate from sexual activity (3×/week). At the end of the first exercise arm, participants crossed to the other. We measured sexual functioning, sexual satisfaction, depression, and physical health. ResultsExercise immediately prior to sexual activity significantly improved sexual desire and, for women with sexual dysfunction at baseline, global sexual function. Scheduling regular sexual activity significantly improved orgasm function; exercise did not increase this benefit. Neither regular sexual activity nor exercise significantly changed sexual satisfaction. Conclusions
Scheduling regular sexual activity and exercise may be an effective tool for the behavioral management of sexual side effects of antidepressants.
... Our search yielded 12 randomized controlled trials included in this systematic review [20][21][22][23][24][25][26][27][28][29][30][31], with the majority of studies (10 studies) employed an RCT design to investigate interventions for erectile dysfunction in male adults. Among the included RCTs, six were two-armed trials [20][21][22][23]30,31], one was a two-arm parallel-group design [26], one was a randomized double-blind independent group design [25], and one utilized an RCT with an assessor-blinded design [21]. ...
... Our search yielded 12 randomized controlled trials included in this systematic review [20][21][22][23][24][25][26][27][28][29][30][31], with the majority of studies (10 studies) employed an RCT design to investigate interventions for erectile dysfunction in male adults. Among the included RCTs, six were two-armed trials [20][21][22][23]30,31], one was a two-arm parallel-group design [26], one was a randomized double-blind independent group design [25], and one utilized an RCT with an assessor-blinded design [21]. These studies were conducted in diverse locations, including Brazil [20], Australia [21], Singapore [24], and Nigeria [25]. ...
... In the other study conducted in Austin, Texas, a randomized controlled trial involved women aged 18 or older. The nine-week study included 52 participants, with the control group engaging in PA without subsequent sexual activity, and the exercise group following a 30-minute exercise video immediately followed by sexual activity [31]. The findings indicated a significant time effect on sexual desire, with higher desire observed during the experimental exercise arm compared to pre-trial and post-baseline assessments. ...
Sexual function is a vital component of overall well-being and quality of life. Physical activity is known to have a profound influence on various aspects of health, but its impact on sexual function in the general population remains an under-explored area. This systematic review seeks to thoroughly examine existing evidence, aiming to establish the correlation between physical activity and sexual function in both male and female adults. We conducted a comprehensive search of electronic databases and relevant sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were those that investigated the effects of physical activity on sexual function using the International Index of Erectile Dysfunction (IIEF-5) questionnaire and the Female Sexual Function Index (FSFI). Quality assessment was performed on the included studies, and the findings were synthesized through qualitative analysis. The review identified 12 randomized controlled trials, primarily focusing on males, with interventions ranging from home-based walking to structured exercise training. Only two studies were conducted among females. The most recommended exercise was aerobic exercise. Consistent aerobic exercise proves to be a hopeful and efficient non-drug intervention for enhancing erectile function in men. However, when considering the effects of physical exercise programs on sexual function and the quality of sexual life of females, the results present challenges in drawing clear conclusions. Health policymakers play an important role in providing guidelines and recommendations to healthcare professionals, encouraging them to prescribe exercise as a preferable alternative to pharmacological treatments for enhancing sexual functions in both men and women.
... Sexual function, sexual satisfaction, depression, and physical health were measured. The results showed that exercise immediately before sexual activity significantly improved the libido of women with sexual dysfunction and improved overall sexual function for women who had sexual dysfunction at the beginning of the study [29]. ...
... The duration of exercise and the number of exercise session was more than that in our study times and also the type of exercise in Gerbild et al. study was aerobic exercise which is active, while in our study the participants received passive pedaling. Lorenz and Meston showed that sexual desire in women treated with antidepressants immediately increased after exercise but did not affect orgasm function and satisfaction in depressed women with sexual dysfunction [29]. In this study, participants performed stretching exercises three times a week for 3 weeks and each time for 30 min. ...
... In this study, participants performed stretching exercises three times a week for 3 weeks and each time for 30 min. Although, the duration of exercise sessions was less than that in our study, patients in Lorenz and Meston study [29] received active and progressive increasing exercise sessions. Furthermore, Lamina et al. demonstrated that exercising with a bicycle for 8 weeks between 45 and 60 min significantly affected erectile function in patients with hypertension [39]. ...
Purpose
To investigate the effect of passive pedaling with mini bike on sexual function in patients under hemodialysis.
Methods
This study was a randomized clinical trial. Thirty-seven patients undergoing hemodialysis were assigned to the intervention (n = 20) and control (n = 17) groups by the stratified block randomization method. The intervention group exercised with a mini bike that was automatic and tuned for patients during the first two hours of dialysis, twice a week for 20 minutes each time, for 3 months. The International Index of Erectile Function and Female Sexual Function Index were used to assess the sexual function in the first, second, and third months during the intervention and one month after the intervention. A higher score indicates a better sexual function. Repeated measure ANOVA, Chi square and Fisher exact tests, independent t and Mann–Whitney U tests were used for data analysis.
Results
The SPSS software version 22 was used for data analysis. Sexual function scores of the intervention group were 35.9 at the beginning of the study, 34.1 in the first month, 37.4 in the second month, 34.8 in the third month, and 31.7 one month after the study. There was no significant difference in the scores of sexual function in the intervention group during the study. The mean scores of sexual function in the control group were 34.5, 34.4, 34.9, 33.8, and 33.9 at the beginning of the study, in the first month, in the second month, in the third month, and one month after the study, respectively (P > 0.05). There was no significant difference between the two groups in terms of sexual function scores during and after the intervention (P > 0.05).
Conclusion
Passive pedaling with mini-bike had no effect on sexual function of hemodialysis patients.
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... As regards the influence of regular physical activity on sexual function in women with major depressive disorders (note: not in women with MS), Lorenz and Meston (2014) randomly assigned 52 women who were reporting antidepressant sexual side effects. They were randomized to complete either three weeks of exercise immediately before sexual activity (3×/week) or 3 weeks of exercise separate from sexual activity (3×/week). ...
... Neither regular sexual activity nor exercise significantly changed sexual satisfaction. Lorenz and Meston (2014) concluded that scheduling regular sexual activity and exercise may be an effective tool for the behavioral management of sexual side effects of antidepressants. In a further attempt to summarize the influence of regular physical activity on sexual dysfunction, Stanton et al. (2018) described in their review that improvements in physiological sexual arousal following acute exercise appeared to be driven by increases in sympathetic nervous system activity and endocrine factors. ...
... First, following Najafidoulatabad et al. (2014), Lorenz and Meston (2014), and Stanton et al. (2018) we expected that aquatic exercise training (2x/week; 3x/week) would improve sexual function in female PwMS, compared with an ACC. Second, following others, we expected that aquatic exercise training would improve depression, fatigue (Razazian et al. 2016, and sleep complaints (Sadeghi Bahmani et al. 2018), compared with an ACC. ...
Abstract
Background: Persons with multiple sclerosis (PwMS) report impaired sexual function, and this is particularly prevalent and burdensome for females with MS. The present study included a randomized controlled trial (RCT) design and examined the effect of aquatic exercise training on sexual function among females with MS.
Methods: The sample consisted of 60 married female PwMS (mean age: 37.68 years; median EDSS: 1.75) who were randomly assigned into one of the following conditions: aquatic exercise twice a week (2x/w); aquatic exercise three times a week (3x/w); active control condition (ACC). Participants completed questionnaires regarding sexual function (desire, arousal, lubrication, orgasm, satisfaction, pain), symptoms, and couple satisfaction before and after the 8-week study period.
Results: The interventions had significant and positive effects on the overall score of sexual function (p <.001, ηρ2 =.35), all subscales (desire (p =.002, ηρ 2 =.20), arousal (p =.01, ηρ 2 =.15), lubrication(p =.011, ηρ 2 =.15), orgasm (p =.007, ηρ 2 =.16), satisfaction(p =.023, ηρ 2 =.13), pain (p =.02, ηρ2 =.13)) and depression (p =.002, ηρ 2 =.20).
The interventions had no significant and positive effects on fatigue (p =.31, ηρ 2 =.04) sleep complaints (p =.079, ηρ 2 =.087), and couple satisfaction (p =.69, ηρ 2 =.01) compared with the active control condition.
Conclusions: Aquatic exercise training may improve sexual function among female PwMS, but this requires further examination using a large sample pre-screened for sexual dysfunction. If confirmed, the present findings are of clinical and practical importance for females with MS.
... 10 In addition, a longitudinal study showed that physical exercise improved sexual function in women using antidepressants in a follow-up of 3 weeks. 25 In longitudinal studies, good health behavior has shown an association with good sexual function, especially for men. In addition, positive changes in health behavior interventions have shown a positive effect on sexual function in men and women. ...
... This now verified long-term relationship may further act as a positive motivator for individuals to engage in healthy behavior. As shown in previous studies, good health behavior and lifestyle interventions associate with improved sexual functioning, [15][16][17][18][19][20][21][22]25 which might be one of the major pathways to explain how health behavior associates with satisfaction with sex life. Our results support these findings, as sexual functioning and satisfaction are associated. ...
Background
Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied.
Aim
The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years.
Methods
This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0–4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012.
Outcomes
The outcome in the study was satisfaction with sex life in the year 2012.
Results
Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (β = −0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life.
Clinical Implications
The results could serve as a motivator for a healthy lifestyle.
Strengths and Limitations
The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today’s diversity of gender, since the options for gender at the time of survey were only male and female.
Conclusion
These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.
... Z uwagi na wysoki odsetek pacjentów odstawiających leki z powodu dysfunkcji seksualnych ważne jest monitorowanie funkcji seksualnych u pacjentów przed i w trakcie leczenia lekami z grupy SSRI [19,20]. W przypadku pojawienia się dysfunkcji, lub ich nasilenia, możemy podjąć szereg działań mających na celu przywrócenie funkcji seksualnych u pacjentów. ...
... Terapia poznawczo-behawioralna (cognitive-behavioral therapy, CBT) lub terapia par również mogą przynieść efekt [26]. Pojedyncze badanie wskazuje, że ćwiczenia fizyczne przed aktywnością seksualną również mogą być skuteczne w zakresie poprawy pożądania seksualnego oraz ogólnych funkcji seksualnych, jednocześnie nie wywierając żadnego wpływu na poprawę orgazmu lub satysfakcji [20]. ...
Introduction: Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly used drugs. One of the most common side effects are those related to sexual function. We can divide them into sexual dysfunction occurring during the use of SRRIs and those occurring and persisting after discontinuation of SSRIs.Purpose: To review available PubMed data on SSRI-related sexual dysfunction, epidemiology, symptoms and treatment.Current state of knowledge: SSRIs are first-line drugs for depression and other mental disorders. Their use can cause sexual dysfunction. SSRI-induced sexual disorders are more common but easier to treat. Post-SSRI sexual dysfunction is less common and harder to treat. There are several hypotheses regarding its pathomechanism, such as epigenetic changes, serotonin neurotoxicity, endocrine disruption, and downregulation of serotonin receptors.Conclusions: Sexual dysfunction after SSRIs left without treatment increases the chances of self-discontinuation of drugs by patients and contributes to significant suffering. In the case of SSRIs induced sexual dysfunction, there are several possible interventions that can effectively eliminate sexual dysfunction and restore the patient's comfort. There are no effective treatments for post-SSRI sexual dysfunction syndrome. In addition, the diagnosis of PSSD is difficult as there are no specific diagnostic criteria. More research is needed to determine how to diagnose and treat patients who develop PSSD.
... What these acute and chronic treatments have in common is the activation of autonomic arousal. Consistent with this, a regimen of regular cardiovascular exercise immediately before sexual activity significantly improved sexual desire and global sexual functioning in women that experienced sexual side effects of various antidepressants (Lorenz and Meston, 2014). Lorenz and Meston also found that having sex regularly improved orgasm ratings, suggesting that tolerance may accrue to the delayed orgasm effects. ...
... The idea for testing acute CAF came from studies in which activation of sympathetic and/or central arousal with ephedrine, oxytocin, or cardiovascular exercise was able to reverse different sexual side effects of SSRI treatment (e.g., Cantor et al., 1999;IsHak et al., 2008;Lorenz and Meston, 2014;Meston, 2004). Indeed, acute CAF facilitates the initiation of copulatory behavior in sexually naïve male rats (Soulairac and Coppin-Monthillaud, 1951) and increases appetitive sexual behaviors, intromissions, and ejaculations in sexually experienced male rats (Pfaus et al., 2010;Zimbardo and Barry 3rd, 1958). ...
Rationale
Sexual side effects of chronic treatment with selective serotonin reuptake inhibitors (SSRIs) in humans include anorgasmia and loss of sexual desire and/or arousal which interferes with treatment compliance. There are few options at present to reduce these effects. Because orgasm and desire are mediated in part by activation of sympathetic arousal, we asked whether the sympathomimetic effects of acute caffeine treatment could reverse these effects.
Objective
The present study examined whether acute treatment with caffeine (CAF; 10 or 20 mg/kg, ip) versus vehicle could ameliorate the disruption of appetitive and consummatory measures of copulatory behavior produced by chronic fluoxetine (10 mg/kg, sc) in adult, sexually active female or male rats.
Methods
Sexually experienced female or male rats received daily injections of FLU over a 24-day period and were tested for sexual behaviors five times at 4-day intervals during this period in bilevel pacing chambers. Females had been ovariectomized and given hormone replacement with estradiol benzoate and progesterone prior to each test. Males were left gonadally intact. Four days after the final FLU test, rats were randomly assigned to one of the three doses of CAF and received ip injections of CAF or the saline vehicle 60 min before testing.
Results
Chronic FLU reduced solicitations and lordosis over time in females and reduced the number of ejaculations in males. Both doses of CAF restored solicitations and lordosis in females and ejaculations in males. On their own, both doses of CAF increased females’ pacing behavior and the number of mounts and intromissions in the males.
Conclusions
Stimulation of sympathetic outflow by CAF may constitute a readily accessible on-demand treatment for the sexual side-effects of SSRIs.
... Physical activity before intercourse significantly improves sexual desire. 34 Moreover, regular sexual activity considerably improves sexual orgasm; however, neither regular sexual activitys nor physical exercise resulted in major changes in sexual satisfaction. 34 Halis et al showed that Pilates improved sexual function in healthy women. ...
... 34 Moreover, regular sexual activity considerably improves sexual orgasm; however, neither regular sexual activitys nor physical exercise resulted in major changes in sexual satisfaction. 34 Halis et al showed that Pilates improved sexual function in healthy women. 35 Accordingly, it seems that walking can moderate behavioral and mood disorders caused by sexual dysfunction and improve some complications of sexual dysfunction, such as reduced sexual desire, orgasmic dysfunction, and reduced sexual satisfaction. ...
Introduction
Sexual dysfunction is a little-addressed condition in patients with rheumatoid arthritis. Aerobic exercises, including walking, can help alleviate this dysfunction. This study aimed to determine the effect of an 8-week aerobic walking program on sexual function ine patients with rheumatoid arthritis.
Methodology
This clinical trial was conducted on 51 patients with rheumatoid arthritis. At first, patients were selected through nonprobability sampling. They were then allocated into intervention and control groups using block randomization. The walking intervention was performed based on the frequency–intensity–time–type principle forg 8 consecutive weeks. Rosen’s Female Sexual Function Index was used for data collection before, immediately after, and 4 weeks after the intervention. Data collected were analyzed with SPSS 22 using descriptive and inferential statistics and 95% CI.
Findings
Mean sexual function scores before, after, and 4 weeks after intervention were 17.66±4, 22.88±4.7, and 24.39±5.1 in the intervention group and 17.60±4.24, 17.27±4.66, and 17.39±4.39 in the control group, respectively. Test results showed a significant intergroup difference in mean sexual function score (p<0.05).
Conclusion
Based on our results, an 8-week aerobic walking program is recommended as an effective way to improve sexual function in women with rheumatoid arthritis.
... The only study that has directly examined the impact of a longer exercise protocol on some domain of sexual function tested the effects of a 3-week exercise regimen on both arousal and desire. 45 It is unclear if 3 weeks of exercise (in this study, the exercise program was a combination of strength and endurance training, 3 times per week) was enough to catalyze the physiological adaptations that are associated with repeated exercise. The increases in muscle size that are associated with strength training do not occur until 8e10 weeks after the start of a new regimen. ...
... Although few studies have tested exercise protocols on women who meet clinical criteria for sexual dysfunction, there are some notable exceptions. In a series of studies, Meston and Lorenz 45,90,96 examined the effects of acute exercise on sexual desire and physiological sexual arousal in women with antidepressant-induced sexual dysfunction and women who have undergone hysterectomies. Results indicate that exercise is an effective treatment for these populations. ...
Background:
Acute exercise is associated with transient changes in metabolic rate, muscle activation, and blood flow, whereas chronic exercise facilitates long-lasting adaptations that ultimately improve physical performance. Exercise in general is known to improve both physical and psychological health, but the differential effects of brief bouts of exercise vs long-term exercise regimens on sexual function are less clear.
Aim:
The purpose of this review was to assess the direct and indirect effects of both acute and chronic exercise on multiple domains of sexual function in women.
Methods:
A literature review of published studies on exercise and sexual function was conducted. Terms including "acute exercise," "chronic exercise," "sexual function," "sexual arousal," "sexual desire," "lubrication," "sexual pain," and "sexual satisfaction" were used.
Outcomes:
This review identifies key relationships between form of exercise (ie, chronic or acute) and domain of sexual function.
Results:
Improvements in physiological sexual arousal following acute exercise appear to be driven by increases in sympathetic nervous system activity and endocrine factors. Chronic exercise likely enhances sexual satisfaction indirectly by preserving autonomic flexibility, which benefits cardiovascular health and mood. Positive body image due to chronic exercise also increases sexual well-being. Though few studies have examined the efficacy of month-long exercise programs for the treatment of sexual dysfunction, exercise interventions have alleviated sexual concerns in 2 specific clinical populations: women with anti-depressant-induced sexual dysfunction and women who have undergone hysterectomies.
Conclusions:
This review highlights the positive effects of acute and chronic exercise on sexual function in women. Directions for future research are discussed, and clinicians are encouraged to tailor specific exercise prescriptions to meet their patients' individual needs. Stanton AM, Handy AB, Meston CM, et al. The Effects of Exercise on Sexual Function in Women. Sex Med Rev 2018;XX:XXX-XXX.
... A significant part of each individual's personal well-being is sexual function and its health has been proposed as an ability to create common and mutual pleasure in couples that can help to adapt to the problems and tensions in marital life [1] Sexual function has a cycle with four stages: sexual desire, arousal, orgasm, and suppression, and any disorder in one of these stages leads to sexual dysfunction in the individuals. [2,3] Sexual dysfunction is a common problem among Iranian women. [1] This disorder in men and women will cause many individual and social problems in life, including a threat to physical and mental health, increased psychological and social stress, and decreased calmness and thinking power. ...
BACKGROUND
Women with perfect health are strong foundations of a healthy and prosperous family life and suppressing the natural needs of women will have adverse effects on the intimacy and vitality of family members, especially in the field of sexual function. This study aimed to determine the effect of GIM on the level of sexual function in women with sexual dysfunction.
MATERIALS AND METHODS
In this cluster randomized trial, which was conducted from 2018 to 2019 in the randomly selected comprehensive health centers of Isfahan, Iran, 72 women of reproductive age (two groups of 36 people) with sexual dysfunction were selected by convenience sampling method, and then, music-guided imagination was performed on the intervention group. No special intervention was performed in the control group. Data collection tools were demographic characteristics questionnaire and a standard questionnaire of the female sexual function index.
RESULTS
There was no statistically significant difference in sexual function and demographic characteristics before the intervention between the two groups ( P = 0/301). The results demonstrated that the overall score of sexual function in the intervention subjects was better than the control group ( P = 0/003). Improvement of sexual function dimensions (desire, arousal, orgasm) was also significant in the intervention group compared to the control group ( P < 0.05).
CONCLUSION
GIM can be effective in improving women's sexual function. Providing this technique as a low-cost and affordable method is recommended to health experts in private and government clinics. This method can improve the mental health of the family and society.
... More comfortable positions [41], pillows and muscle-relaxing activities [42], pelvic floor training and sex education [43], walking [44], yoga [45], and increasing exercise capacity and self-confidence are suggested [46]. Physical exercise, both strength training and aerobic/cardiovascular training, appears an effective treatment for many aspects of sexual life: body image and self-esteem [47], sexual de-sire [48], sexual activity [49,50], erectile dysfunction [51], premature ejaculation [52], and depression [53]. Therefore, physical activity seems to have a positive effect on sexual function and may be considered in patients with LBP-related sexual disability. ...
Background:
The literature shows a relationship between sexual activity and low back pain (LBP). The aim of this work is to provide a theoretical framework and practical proposal for the management of sexual disability in individuals with LBP.
Methods:
Based on a literature review, a team of specialized physical therapists developed a pattern for the management of LBP-related sexual disability.
Results:
A patient reporting LBP-related sexual disability may be included in one of four clinical decision-making pathways corresponding to one of the following: #1 standard physical therapy (PT); #2 psychologically informed physical therapy (PIPT); #3 PIPT with referral; or #4 immediate referral. Standard PT concerns the management of LBP-related sexual disability in the absence of psychosocial or pathological issues. It includes strategies for pain modulation, stiffness management, motor control, stabilization, functional training, pacing activities comprising education, and stay-active advice. PIPT refers to patients with yellow flags or concerns about their relationship with partners; this treatment is oriented towards a specific psychological approach. "PIPT with referral" and "Immediate referral" pathways concern patients needing to be referred to specialists in other fields due to relationship problems or conditions requiring medical management or pelvic floor or sexual rehabilitation.
Conclusions:
The proposed framework can help clinicians properly manage patients with LBP-related sexual disability.
... Several studies have also identified the positive effect of exercise on women's sexual health in the general population. The study of Lorenz et al. demonstrated that regular exercise improved sexual desire and global sexual function in women with antidepressant-induced sexual dysfunction [13] or another study showed that 12-week Pilates interventions have a significant positive effect on sexual function in healthy women [14]. It is also well known that pelvic floor muscle (PFM) training can improve female sexual function [15]. ...
Introduction:
Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM.
Methods:
In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6 years) and a control group (CG) (mean ± SD age 46.3 ± 8.5 years). IG underwent the 8-week program (1 h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test.
Results:
Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life.
Conclusion:
Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed.
Trial registration number:
ISRCTN91200867 (prospectively registered).
... Some studies have reported a significant increase in patients' libidos as a result of bupropion augmentation treatment. In addition, exercise has been shown to improve sexual function and desire due to the activation of sympathetic nervous system (14). Despite the use and practice of the various methods mentioned, most patients (80%) report little or no improvement after 6 months of treatment. ...
Objective
SSRIs are considered the first line in the medical treatment of depression and anxiety disorders. One of their most common side effects, sexual dysfunction, has led many patients to discontinuing their medication and treatment course. Alpinia galanga, a plant from the ginger family, has been shown to enhance androgenic activity and sexual function. This study aimed to assess whether the addition of Alpinia galanga extract to the treatment regimen of adult males consuming SSRIs can improve SSRI-induced erectile dysfunction.
Materials and methods
This triple-blind randomized clinical trial was conducted on 60 adult males who were being treated with SSRIs at the time of the study. The participants were divided into two groups, a group of 30 people receiving 500 mg of Alpinia galanga extract and a group of 30 subjects receiving placebo. The population were re-assessed on week 2 and week 4 of the study using the international index of erectile function (IIEF), the Beck Depression Inventory, and the Beck Anxiety Inventory. In all the tests, a p-value of 0.05 was considered as the cut-off for significance.
Results
At the beginning of the study, the IIEF scores of the placebo group and the intervention group were 10.6 ± 3.8 and 11.2 ± 4.8, respectively, which were not significantly different (p-value = 0.577). By week 4 of the study, the IIEF scores of the control group and the Alpinia galanga group had increased to 13.7 ± 4.3 and 17.4 ± 3.7 respectively, which demonstrates a remarkably larger increase in the group receiving Alpinia galanga extract in comparison to the placebo group (p-value < 0.001).
Conclusion
In this study, the effect of the addition of Alpinia galanga extract to the treatment regimen of male patients using SSRIs on the sexual dysfunction experienced by this group has been promising. Similar results, if proven, can aid both patients and clinicians in making and following better treatment plans with more pleasant outcomes.
Clinical trial registration
[https://clinicaltrials.gov/], identifier [IRCT20101130005280N41].
... In particular, in women experiencing antidepressant-induced FSD, a randomized, crossover trial showed that PA immediately prior to sex improved the FSFI desire domain. 17 Similarly, a 16-week resistance training enhanced FSFI total score through an improvement of desire, arousal and lubrication in young women with polycystic ovary syndrome. 18 Our results, obtained in a FSD clinical setting, corroborate these previous observations, while considering a larger study population and a prolonged (3-month) period. ...
Introduction
Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking.
Objective
To investigate the clinical, psychological, and sexual correlates of PA in women with FSD.
Methods
A non-selected series of n=322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1-3 hours/week: active, 4-6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question. FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Uneasiness Test (BUT), and Middlesex Hospital Questionnaire (MHQ).
Results
Mean age was 45.1±12.9, mean body mass index was 25.24±6.34 kg/m² and 46.3% (n=149) of women were post-menopausal. At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several FSFI domains - including desire, arousal and lubrication (see Table 1) - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed (see Table 1). In the same adjusted model, the association between PA and the vascular resistance of clitoral arteries, expressed by clitoral PI, retained statistical significance. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (BUT Global severity index), psychopathological symptoms (MHQ total score) and sexual distress (FSDS-R score). These latter two factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction – see Figure 1) and histrionic/hysterical symptoms), even compared to a sedentary lifestyle.
Conclusions
In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction. Women consulting for FSD may gain benefits from regular PA; however, physicians should remain alert to the downsides of excessive exercise.
Disclosure
Work supported by industry: no.
... In addition to being an effective treatment for depression, exercise can also be effective on antidepressant-induced sexual dysfunction [8]. The irisin molecule is a recently discovered myokine and adipokine that is released from skeletal muscle in response to exercise [9]. ...
Objective
It is known that selective serotonin reuptake inhibitors (SSRIs), represent an important and effective treatment of depression and other psychological disorders, these medications can increase prolactin levels mainly through activation of the serotonergic pathway. In this study, we aimed to determine the beneficial effects of irisin on paroxetine, a SSRI, induced hyperprolectinemia and in some other reproductive hormonal changes associated with hyperprolactinemia.
Methods
Thirty two male Spraque-Dawley rats were used and divided into four groups including sham-operated control (vehicle), irisin (100 ng/kg/day for 28 days with mini-osmotic pumps), paroxetine (treated with 20 mg/kg paroxetine by oral gavage), irisin and paroxetine+irisin groups (n = 8). Serum prolactin (PRL), kisspeptin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and 5-alpha reductase levels were determined with enzyme-linked immunosorbent analysis (ELISA).
Results
In animals treated with paroxetine, PRL level increased and testosterone level decreased significantly (p < 0.05). Serum LH level was significantly increased in the group, but no significant changes were observed in the FSH, kisspeptin and 5-alpha reductase levels. Serum prolactin levels was significantly decreased in the group treated with irisin. While no significant difference was observed in kisspeptin, FSH and 5-alpha reductase levels, an increase in serum LH and testosterone levels with irisin administration (p < 0.05).
Conclusion
In conclusion, chronic irisin exposure may reverse paroxetine-induced hyperprolactinemia. These results indicate that irisin may have the potential to be used as a therapeutic agent by primarily affecting paroxetine-induced increased prolactin and decreased testosterone levels.
... Women are relatively at higher risk for depression and anxiety as well as sexual dysfunction (SD) than men (Laumann et al., 1999;Lorenz and Meston, 2014). Depression may negatively affect sexual well-being as a result of reduced motivation for or rewarded from involving in pleasurable activities, disrupting intimate relationship or increased the risk of smoking or substance abuse (Althof et al., 2005;Shifren et al., 2008). ...
Objectives
We aimed in the current cross-sectional study to evaluate rates and patterns of SD among drug naïve women with mild to moderate depression against those receiving escitalopram.
Study design
Group (A) included 120 females diagnosed with mild to moderate depression. Group (B) served as controls included 60 age-matched volunteers.
Main outcome measures
Female participants were evaluated by the validated Arabic female sexual function index (ArFSFI), perceived stress situation scale (PSS), patient health questionnaire-9 scale (PHQ-9) and center for epidemiological studies-depression scale (CES-D).
Results
The study demonstrated that females with mild to moderate depression treated with escitalopram had better sexual function than those who were drug naïve. Additionally, treated females got better scores of PSS, CES-D and PHQ-9 compared to those who were drug naïve. The PSS and the CES-D and the PHQ-9 scales negatively correlated with the domains of desire, pain, arousal, lubrication, orgasm, satisfaction and total score of FSFI. Finally, a linear regression analysis after adjustment of FSFI as a dependent variable had revealed that the PSS scale, the PHQ-9 scale and the international index of erectile function-5 were significant independent predictors of the affected females’ sexual function.
Conclusion
Escitalopram is associated with lesser risk of SD in females with mild to moderate depression.
... In the second study, women with antidepressant-induced sexual dysfunction (N = 52) were followed for 9 weeks to assess the effects of scheduled sexual activity and exercise on sexual function. 62 During the first 3 weeks, patients were sexually active 3Â/wk without exercise. During the 3-week crossover phases, patients performed strength training and cardiovascular exercise for 30 minutes to achieve 70% to 85% of max heart rate 3Â/wk and then engaged in sexual activity immediately after exercise or waited >6 hours for sexual activity. ...
Background
Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.
Methods
To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
Results
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: −1.8, 95% credible interval [CrI]: [−3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: −1.2, 95% CrI [−2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
Conclusions
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.
... Other lifestyle approaches were found beneficial in improving sexual function in patients taking antidepressants, such as regular exercise (Lorenz et al., 2014). Overall, no psychological or pharmacological approach can be considered 'ideal' ). ...
Previous studies have revealed complex associations between sexual dysfunction, depressive symptoms, and treatment with antidepressant drugs, and provide evidence linking depression, neuroinflammation and hypothalamo-pituitary-axis (HPA) dysregulation. However, little is known about the prevalence of sexual dysfunction or incidence of treatment-emergent sexual dysfunction in patients with anxiety disorders. Published studies have found contrasting evidence of the association between anxiety symptoms and disrupted levels of inflammatory markers, and investigations of HPA function in anxiety disorders have produced inconsistent findings. Augmentation with COX-2 inhibitors in patients with depression can reduce depressive symptoms and improve quality of life, but the potential therapeutic benefit of COX-2 inhibitors in patients with anxiety disorders is uncertain. This thesis includes a systematic review of the utility of the Arizona Sexual Experiences scale (ASEX) and a series of investigations in patients with anxiety disorders (n=35), with exploration of sexual function, anxiety symptoms, neuroinflammation and HPA dysregulation, at baseline, after six weeks of treatment, and after six weeks of augmentation with the COX-2 inhibitor celecoxib. The ASEX appears reliable, valid, and sensitive to change, and acceptable in a broad range of clinical settings. Cross-sectional findings indicate a point prevalence of sexual dysfunction of 57.1% at Baseline, 75.1% at Week 6 and 39.3% at Week 12. Sexual dysfunction was significantly positively correlated with the severity of anxiety symptoms, and significantly negatively correlated with mental wellbeing at Baseline, Week 6 and Week 12. There were low levels of IL-12p70 and low IL-2 but a high level of TNF-α at Week 6. At Week 12, there were low levels of IL-1β, low IL-12p70 and IL-13, a high level of TNF-α (regardless of augmentation with celecoxib) but low IL-2 levels in the nonaugmentation group. At Baseline, patients with panic disorders with agoraphobia had a high hair cortisol concentration (HCC). Longitudinal analysis found worsening of sexual function at Week 6, but significant improvement in anxiety symptoms, wellbeing and sexual function at Week 12 in the celecoxib augmentation group. There was a significant reduction in IL-2 level from Week 6 to Week 12 in the augmentation group, a reduction of HCC from Baseline to Week 6, and a slight elevation at Week 12, although changes in HCC were not statistically significant. Investigating sexual dysfunction as part of the clinical assessment of patients with anxiety disorders, is important to facilitate better management and well-being. Augmentation with celecoxib can improve clinical outcomes, yet further research is needed to retest this. More research is needed to explore HCC in anxiety disorders in larger clinical samples.
... In association with this, female patients with antidepressantrelated sexual dysfunction including SSRIs were made an erotic movie watched for 5 or 15 minutes after exercise, or without exercise. 63 It was found that genital arousal was increased in females who do exercise but not in those who did not do any exercise by using vaginal photoplethysmograph method, without any influence on self-reported arousal perceptions. The beneficial effects of physical exercise on sexual dysfunction were also reported in some other studies. ...
Any type of sexual dysfunction is an important problem in half of the patients with depressive disorder. On the other hand, one to a quarter of people without any depressive disorder experience sexual dysfunction. Antidepressant agents can lead to all types of sexual side effects including arousal, libido, orgasm and ejaculation problems. Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of drugs which are prescribed for the treatment of a variety of disorders, including major depressive disorder, obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder, generalized anxiety disorder, and impulse control disorders. It has been reported that one in eight people have utilized one of the SSRIs in the past 10 years. Some studies reported up to 80% of SSRI-induced sexual side effects. Management of SSRI-induced sexual dysfunction seems to be complex and hard. In this paper, SSRI-induced sexual dysfunction and new perspectives in the management of this problem were reviewed.
... Previous studies using these exercise protocols mainly focused on improvements in maximum aerobic capacity (VO 2 max) and cardiocirculatory, respiratory, and metabolic parameters. 3e5, 50 Other studies evaluated the short-term effects of aerobic physical exercise on sexual function relative to other strategies, such as resistance training or viewing an explicit sex film, 51,52 or examined the correlation of physical activity with questionnaire scores that evaluate sexual function. 53 A cross-sectional study of healthy young women in Brazil reported a positive association between VO 2 max and pelvic floor muscle strength. ...
Background:
Polycystic ovary syndrome (PCOS) is a common condition characterized by hyperandrogenism, anthropometric changes (increased weight and waist-to-hip ratio [WHR]), behavioral changes (sexual dysfunction, anxiety, and depression), and reduced quality of life. Physical exercise may reduce many of the adverse effects of PCOS. However, no studies have yet evaluated the effects of aerobic exercise on the sexual function of women with PCOS.
Aim:
To compare the effects of continuous and intermittent aerobic physical training on the sexual function and mood of women with PCOS.
Methods:
This is a secondary analysis of a controlled clinical trial in which women with PCOS (18-39 years of age) were randomly allocated to 1 of 3 groups for 16 weeks: continuous aerobic training (CAT, n = 23), intermittent aerobic training (IAT, n = 22), or no training (control group, n = 24). The Female Sexual Function Index (FSFI) was used to assess sexual function, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression.
Main outcome measure:
The main outcome measure used was the FSFI.
Outcomes:
The primary outcomes were changes from baseline in total FSFI score and HAD scores at week 16 to prove the superiority of intermittent aerobic exercise compared with continuous aerobic exercise.
Results:
After 16 weeks, the CAT group had a significant increase in the total FSFI score, improvements in the FSFI domains of satisfaction and pain, and a reduction in the WHR. The CAT and IAT groups also had significantly lower levels of testosterone after 16 weeks. The IAT group had a significant increase in the total FSFI score and improvements in the desire, excitation, lubrication, orgasm, and satisfaction FSFI domains. The CAT and IAT groups both had significant reductions in anxiety and depression scores after 16 weeks.
Clinical implications:
Aerobic physical training protocols could be indicated to promote mental and sexual health in women with PCOS.
Strength & limitations:
This is one of the first studies to examine the effects of different physical training protocols on the sexual function of women with PCOS. The limitations of this study are that we did not consider diet or the frequency of sexual relations of participants with their partners. These factors could have interfered with the outcomes.
Conclusion:
The CAT and IAT protocols improved the sexual function and reduced the anxiety and depression of women with PCOS. Both protocols were similar to improve FSFI domain scores. Lopes IP, Ribeiro VB, Reis RM, et al. Comparison of the Effect of Intermittent and Continuous Aerobic Physical Training on Sexual Function of Women With Polycystic Ovary Syndrome: Randomized Controlled Trial. J Sex Med 2018;15:1609-1619.
... The SSS-W has been broadly used, as an overall measure assessing sexual satisfaction within personal and relational dimensions (Claudat & Warren, 2014;Giraldi et al., 2011;Lorenz & Meston, 2014), or as specific subscales, such as personal concern for assessing sexual distress (Stephenson, Hughan, & Meston, 2012). It has also been used in lab studies (Rellini & Meston, 2011), with women with sexual arousal difficulties (Frohlich & Meston, 2005), or in women with history of childhood maltreatment (Rellini, Vujanovic, Gilbert, & Zvolensky, 2012) or in women with history of childhood sexual abuse (Rellini & Meston, 2011). ...
Sexual satisfaction is considered a sexual health indicator, closely linked to sexual distress, and subsequently, to sexual problems, in women. The Sexual Satisfaction Scale for Women (SSS-W) was developed for assessing sexual satisfaction and distress in women, and principal component analysis support a five-factor structure (Contentment, Communication, Compatibility, Relational Concern, and Personal Concern). Our goal was to translate and validate the SSS-W for Portuguese women. For that purpose, participants completed the SSS-W, the Female Sexual Functioning Index (FSFI), and the Dyadic Adjustment Scale. A sample constituted by 329 women was collected through an online survey (56 women with sexual difficulties according to the FSFI cutoff score). According to con-firmatory factor analysis, a five-factor model fits the Portuguese version of the SSS-W, which supports the original factorial structure. Reliability, as well as concurrent, conver-gent, and discriminant validity have shown good to excellent values. In sum, Portuguese version of the SSS-W provides relevant clinical information on sexual satisfaction, namely communication , contentment, and compatibility dimensions, as well as concerns on personal and relational topics. Moreover, current findings suggested that the Portuguese version of the SSS-W presented adequate psychometric properties and its use as valid and reliable measure for assessing sexual satisfaction in women is recommended. ARTICLE HISTORY
Background
Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed agents to treat depression. Considering the growth in antidepressant prescription rates, SSRI-induced adverse events (AEs) need to be comprehensively clarified.
Objective
This study was to investigate safety profiles and potential AEs associated with SSRIs using the Food and Drug Administration Adverse Event Reporting System (FAERS).
Methods
A retrospective pharmacovigilance analysis was conducted using the FAERS database, with Open Vigil 2.1 used for data extraction. The study included cases from the marketing date of each SSRI (ie, citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, and sertraline) to April 30, 2023. We employed the reporting odds ratio and Bayesian confidence propagation neural network as analytical tools to assess the association between SSRIs and AEs. The Medical Dictionary for Regulatory Activities was used to standardize the definition of AEs. AE classification was achieved using system organ classes (SOCs).
Results
Overall, 427 655 AE reports were identified for the 6 SSRIs, primarily associated with 25 SOCs, including psychiatric, nervous system, congenital, familial, genetic, cardiac, and reproductive disorders. Notably, sertraline ( n = 967) and fluvoxamine ( n = 169) exhibited the highest and lowest signal frequencies, respectively. All SSRIs had relatively strong signals related to congenital, psychiatric, and nervous disorders.
Conclusions and relevance
Most of our findings are consistent with those reported previously, but some AEs were not previously identified. However, AEs attributed to SSRIs remain ambiguous, warranting further validation. Applying data-mining methods to the FAERS database can provide additional insights that can assist in appropriately utilizing SSRIs.
This chapter examines the relationship between acute exercise and physiological sexual arousal in women. The first section of the chapter provides foundational knowledge on the physiological sexual arousal response, which is characterized by increased blood flow to the genitals and subsequent vasocongestion, and then highlights the faciliatory effect of acute exercise on this response. Based on a series of studies that investigated autonomic nervous system influences on sexual arousal in women, the second section suggests that activation of the sympathetic nervous system is most likely the mechanism that facilitates the relationship between acute exercise and increased physiological sexual arousal. Finally, the chapter discusses key clinical implications of the relationship between acute exercise and physiological arousal, particularly for women who have a history of childhood sexual abuse, women who have undergone hysterectomies, and women who report sexual arousal problems due to antidepressant medication use.KeywordsFemale sexual functionSexual arousalAcute exerciseSympathetic nervous system
Background
Women with perfect health are strong foundations of a healthy and prosperous family life and suppressing the natural needs of women will have adverse effects on the intimacy and vitality of family members especially in the field of sexual function. This study aimed to determine the effect of guided imagery and music (GIM) on the level of sexual function in women with sexual dysfunction.
Methods
This study was performed as a clinical trial on 72 women of reproductive age with sexual dysfunction (two 36-individual groups) referred to comprehensive health centers in Isfahan, Iran. Sampling was conducted in a convenience way and by step-by-step stages of guided imagery and music. No special intervention was performed in the control group. Data collection tools were demographic characteristics questionnaire and standard questionnaire of female sexual function index. Data analysis was performed by SPSS software using descriptive and analytical statistics with 95% confidence level.
Result
There was no statistically significant difference in sexual function and demographic characteristics before the intervention between the two groups (Pvalue > 0.05). The results demonstrated that the overall score of sexual function in the intervention subjects was better than the control group. (Pvalue < 0.05) Improvement of sexual function dimensions (desire, arousal, orgasm) were also significant in the intervention group compared to the control group (Pvalue < 0.05).
Conclusion
Guided imagery and music (GIM) can be effective in improving women sexual function. This technique is recommended for reproductive age women with sexual dysfunction or women who want to enhance sexual function.
The aim of this study is to investigate the effect of planned behavior training on changing the lifestyle of women with a cold temper Quasi-experimental research method and its design of pre-test-post-test type with control and experimental group and statistical population including all cold-tempered women referring to family counseling centers in Hamadan with whit 809 people in the first half of 1400, of which 30 people were available by sampling method and were randomly replaced in two groups of control (15) and experimental group (15 people). To collect information from lifestyle questionnaires (LSQ), Halbert Marital Relationships (HISD), Behavioral training package was planned which was taught to the experimental group in 9 sessions of 60 minutes virtually. The results of the research hypotheses were analyzed using analysis of covariance and SPSS software version 25. Showed that planned behavior training has a positive and significant effect on changing the lifestyle of cold-tempered women. It is recommended to use this educational model to change and improve the lifestyle of cold-tempered women.
Introduction: Women with perfect health are strong foundations of a healthy and prosperous family life and suppressing the natural needs of women will have adverse effects on the intimacy and vitality of family members especially in the field of sexual function. This study aimed to determine the effect of guided imagery and music (GIM) on the level of sexual function in women with sexual dysfunction.
Method: This study was performed as a clinical trial on 72 women of reproductive age with sexual dysfunction (two 36-individual groups) referred to comprehensive health centers in Isfahan, Iran. Sampling was conducted in a convenience way and by step-by-step stages of guided imagery and music. No special intervention was performed in the control group. Data collection tools were demographic characteristics questionnaire and standard questionnaire of female sexual function index. Data analysis was performed by SPSS software using descriptive and analytical statistics with 95% confidence level.
Results: There was no statistically significant difference in sexual function and demographic characteristics before the intervention between the two groups (Pvalue >0.05). The results demonstrated that the overall score of sexual function in the intervention subjects was better than the control group. (Pvalue <0.05) Improvement of sexual function dimensions (desire, arousal, orgasm) were also significant in the intervention group compared to the control group (Pvalue <0.05).
Conclusion: Guided imagery and music (GIM) can be effective in improving women sexual function. This technique is recommended for reproductive age women with sexual dysfunction or women who want to enhance sexual function.
Introduction:
Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management.
Areas covered:
A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40 - 45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed.
Expert opinion:
MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.
Sexual dysfunction (SD) in patients with chronic kidney disease is common and negatively impacts quality of life. SD is often under-appreciated because of overall low awareness. Diagnosis of SD is subjective, and manifestations can be different among men and women. Causes of SD are multifactorial, including psychological disorders, hormonal imbalances, vascular disorders, neurological disorders, and medication side effects. Non-specific approaches to improving sexual function include addressing underlying psychological disorders, promoting lifestyle modifications, optimizing dialysis care, and facilitating successful kidney transplantation, whereas treatment with phosphodiesterase type 5 inhibitor, hormone replacement, and mechanical devices can be offered to patients with specific indications.
Background
Research on the relationship between physical activity (PA) and female sexual dysfunction (FSD) is lacking.
Aim
To investigate the clinical, psychological, and sexual correlates of PA in women with FSD.
Methods
A non-selected series of n = 322 pre- and post-menopausal patients consulting for FSD was retrospectively studied. Regular involvement in PA and its frequency (<1 hour/week: sedentary, 1–3 hours/week: active, 4–6 hours/week: very active, >6 hours/week: extremely active) were investigated with a specific question.
Outcomes
FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire.
Results
At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic/hysterical symptoms), even compared to a sedentary lifestyle.
Clinical Implications
Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise.
Strengths & Limitations
The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA.
Conclusion
In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction.
Maseroli E, Rastrelli G, Di Stasi V, et al. Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much. J Sex Med 2021;XXX:XXX–XXX.
Persons with depression often report impaired sexual functioning. Apart from being a part of depressive symptomatology, poor sexual functioning or sexual dysfunction in depressed individuals had been linked to antidepressants used for the management of depression. Sexual dysfunctions can add on to further distress to the depressed individual and can lead to prolongation of depression as well as can lead to poor treatment adherence. A detailed analysis of various concurrent risk factors is essential to rule out organic and other factors likely to contribute to sexual dysfunctions in subjects with depression. It is advisable to make it a strategy to evaluate premorbid sexual functioning in depressed subjects before initiating any antidepressant and to educate the subject about the likelihood of sexual dysfunction with antidepressants. While selecting antidepressant, premorbid sexual functioning, sexual dysfunction as part of depression and importance given to adequate sexual functioning must be considered. Management of sexual dysfunction, which is considered as a part of depression, involves reassurance of patients and use of appropriate antidepressant. However, management of antidepressant-induced sexual dysfunction is challenging and requires proper evaluation, proper education of the patient and trying multiple strategies.
Multiple sclerosis (MS) is a prevalent immune-mediated and neurodegenerative
disease of the central nervous system (CNS) among adults in the United States and
worldwide. This disease results in impairments of physical, psychological, and social
functions that compromise quality of life. This review focuses on sexual dysfunction,
including its prevalence, burden, and management, in persons with MS. Sexual dysfunction is
defined as sexual behaviors and experiences characterized as insufficient in quality, duration
and frequency. Sexual dysfunction occurs in 40-80% percent of women and 50-90% percent
of men with MS. The presence of sexual dysfunction is seemingly predicted by psychological
and psychiatric issues such as depression and anxiety; sociodemographic dimensions such as
older age, unemployment and lower socioeconomic status; and MS-related issues such as
fatigue, higher degree of disability and motor impairments. Sexual dysfunction in persons
with MS is further associated with decreased psychological and psychosocial wellbeing and
impaired quality of life. There is limited research supporting pharmacological and other
approaches for managing sexual dysfunction in MS, and we make the case for exercise
training based on recent evidence from randomized controlled trials in MS and putative
mechanisms of action targeted by exercise training in MS. This paper concludes by providing
a research agenda for a deeper and broader understanding of exercise training and sexual
function in MS.
Irisin is a novel myokine/adipokine that is released into the circulation in response to types of exercise and increases energy expenditure. Disorders in the endocrine system related to reproduction, which occur due to the chronic or excessive exercise, cause a decrease in women's sexual desire. However, the role of irisin hormone on sexual desire in women has not been elucidated. We hypothesized that chronic irisin exposure would decrease sexual incentive motivation for male partners by affecting the endocrine system in female rats. We tested this by quantifying and comparing of both sexual incentive motivation and active investigation for sexual partner, and also changes in the serum hormone levels in chronically irisin-treated female rats. As a result, chronic irisin exposure decreased the time spent near the male rat, male preference ratio, and male investigation preference ratio. Furthermore, serum testosterone and progesterone levels significantly decreased and estradiol levels increased while kisspeptin-1 levels were not changed by chronic irisin exposure in female rats. These data indicate that chronic irisin exposure may cause low sexual incentive motivation for opposite-sex partners in female rats via changes in reproductive hormones. The results suggest that irisin hormone may play a role in decreased sexual desire due to long-term exercise in women.
Sexual function is an important part of most women’s lives. Female sexual dysfunction (FSD), defined as a sexual problem that causes clinically significant distress, is common, but under-identified and undertreated. Clinicians should ask about sexual concerns in routine visits. Assessment of FSD should include a comprehensive history and physical examination utilizing a biopsychosocial approach. Providers should explore psychological, emotional, interpersonal, and sociocultural contributing factors. Medications should be reviewed as possible contributors. Antidepressants are a common cause of FSD. Treatment of FSD should focus on the underlying diagnosis. Given its complexity, FSD is best treated utilizing a multidisciplinary approach, including a medical provider, pelvic floor physical therapist, and sex therapist. General recommendations for all patients with FSD include increasing exposure to sexual stimuli such as erotic literature, scheduling sex, decreasing stressors, and improving overall general health through adequate sleep, exercise, and a healthy diet.
Purpose:
Sexual dysfunction in women with overactive bladder (OAB) syndrome has been an important topic, while the sexual satisfaction of partners has not been fully investigated. Our aim was to explore the association between the severity of OAB with female sexual dysfunction and sexual satisfaction of partners.
Methods:
A total of 323 patients with OAB recruited in our hospital were included in our study from September 2017 to March 2019. Data were collected by Overactive Bladder Symptom Score (OABSS) questionnaire, self-designed questionnaire for basic characteristics; Female Sexual Function Index (FSFI); and sexual satisfaction survey for sex partners of patients. χ2 test or 1-way ANOVA was used to compare the variables among groups. Logistic regression analysis was performed to analyze the severity of OAB with female sexual dysfunction and sexual satisfaction of partners. The correlations between different OABSS domains with female sexual dysfunction and sexual satisfaction of partners were assessed.
Results:
All the patients were classified into mild (n = 107), moderate (n = 98), severe (n = 118) OAB group based on OABSS. Most of the basic information were similar among groups, except for BMI, highest education, occupation, fertility, and history of pelvic floor surgery. After multiple factors correction, the severity of OAB, exercise frequency, and the history of pelvic floor surgery were statistically associated with the female sexual dysfunction and sexual satisfaction of partners. Urgency score was significantly correlated with female sexual dysfunction, and the urge incontinence was most significantly associated with the sexual satisfaction of partners.
Conclusion:
Severe OAB was closely associated with female sexual dysfunction and sexual satisfaction of partners. The urgency and urge incontinence should be focused for OAB management.
Female sexual dysfunction is both a symptom of depression and exacerbated by treatments for depression. Ketamine, a novel treatment for depression, has been shown to enhance, whereas fluoxetine has been shown to impair sexual motivation. Sexual experience leads to more robust partner preference and paced mating behavior in female rats. Whether acute ketamine and fluoxetine similarly affect sexual motivation and mating behavior in sexually experienced female rats is unknown. Sexually experienced female rats received 10 mg/kg i.p. of ketamine or saline vehicle (Experiment 1) or 10 mg/kg i.p. of fluoxetine or water vehicle (Experiment 2) 30 min before a 10-min No-Contact partner preference test followed immediately by a 15-intromission paced mating test. Partner preference and paced mating behavior did not differ between ketamine- and saline-treated rats. In contrast, rats treated with fluoxetine spent significantly less time with either stimulus animal and were less active during the partner preference test than water-treated rats. Additionally, contact-return latency to ejaculation was significantly longer in fluoxetine-treated rats and they spent less time with the male during paced mating in comparison to water-treated rats. Thus, even with sexual experience, fluoxetine disrupts sexual function whereas ketamine has no detrimental effects on sexual behavior in female rats. A growing body of evidence suggests that ketamine is an encouraging new approach to treat depression particularly because it is not associated with sexual dysfunction.
In the previous chapters, the complexities of sexual problems accompanying different mental disorders have been comprehensively described. This chapter deals with the impact of psychotropic medications on sexual functioning. It encompasses biochemical mechanisms that modulate both mental state and sexual response through neurotransmitters and neurohormones, as well as indirect influences through their impact on psychomotor and cardiometabolic profile. Treatment-emergent changes in body image and sexual functioning can have a profound effect on self-esteem and intimate relationships. Treatment-related sexual side effects are underreported and poorly recognized in clinical practice of mental health professionals; although, they have a great impact on poor adherence to medication and related clinical outcomes. As sexual satisfaction is one of the most important determinants influencing well-being and quality of life, clinicians should give more attention to it and actively ask their patients about sexual functioning and adapt the medication accordingly. A comprehensive overview and practical recommendations on clinical investigation and management of psychotropic medication-related sexual side effects are presented in the second part of the chapter.
Many studies on spinal cord injury and sexuality have been conducted over the years. However, to date, no one has studied the influence of exercise on sexuality for individuals with spinal cord injury. This project examined the impact of an 8-week exercise intervention on sexual interest and sexual satisfaction for individuals with SCI. Participants were surveyed prior to the exercise intervention (pre-test), after the 8-week intervention (post-test), and at 3 month follow up. There was little change between the three time-points which may indicate that exercise does not impact sexual interest and sexual satisfaction for individuals with SCI. Further research on the subject is needed.
Background
Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment.
Objective
The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life.
Methods
This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (6 months post primary cancer treatment, self-report
• Sexual dysfunction is a frequent, potentially distressing, adverse effect of antidepressants and a leading cause of medication non‐adherence.
• Sexual function should be actively assessed at baseline, at regular intervals during treatment, and after treatment cessation.
• Trials comparing the risk of sexual dysfunction with individual antidepressants are inadequate, but it is reasonable to conclude that the risk is greatest with selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs), less with tricyclic antidepressants (except clomipramine) and mirtazapine, and least with moclobemide, agomelatine, reboxetine and bupropion.
• Management of antidepressant‐induced sexual dysfunction requires an individualised approach (eg, considering other causes, dose reduction, addition of medication to treat the adverse effect, switching to a different antidepressant).
• Post‐SSRI sexual dysfunction has been recently identified as a potential, although rare, adverse effect of SSRIs and SNRIs. Consider the possibility of post‐SSRI sexual dysfunction in patients in whom sexual dysfunction was absent before starting antidepressants but develops during or soon after antidepressant treatment and still persists after remission from depression and discontinuation of the drug.
Ancient physicians such as Herodicus, Hippocrates and Galen recommended exercises as
panacea for healthy living in antiquity. Modern scholars such as Christos and Tipton have
variously demonstrated the importance of exercises and sports in ancient and modern European
societies citing exercises as treatments for some illnesses by the doctor in the Hippocratic
Corpus. This paper examined the importance of exercise in antiquity and modernity, even as
it serves as a catholicon for healthy living, with a view to identifying the values and relevance
of exercise in dealing with illnesses and promoting good health. Sallis and Owen behavioural
epidemiology was adopted as theoretical framework. The historical and comparative
methodologies were adopted as the study examined the historical trajectory and cross-cultural
variations of exercise in antiquity and today’s world. The discourse in this study demonstrated
that exercise has been functional as medicine and for healthy living in antiquity and modernity.
Medical practitioners, exercise physiologists, including laymen understand its importance and
further recommend exercise suitable for people of varying ages. Further studies may be designed to examine low to medium and medium to high intensity exercise and its health
implications.
Key Words: Exercises, Health, Antiquity, Modernity
Purpose of Review
The goal of this review was to evaluate recent developments in sexual dysfunction associated with psychotropic medications and its management.
Recent Findings
Sexual dysfunction associated with psychotropic medications is a serious clinical problem which occurs mostly with antidepressants, especially serotonergic ones, and antipsychotics, especially those causing hyperprolactinemia. Sexual dysfunction(s) seems to be associated to a significantly lesser degree with some newer psychotropic medications, e.g., vilazodone, vortioxetine, and agomelatine among antidepressants, and aripiprazole and lurasidone among antipsychotics. There have been no significant new developments in management of sexual dysfunction(s) associated with psychotropic medications with the exception of using newer medications or switching to them. A new clinical phenomenon—post serotonin reuptake inhibitors sexual dysfunction—has emerged as a difficult management issue.
Summary
Sexual dysfunction associated with psychotropic medications continues to be an important issue requiring further research to provide solid evidence for regulatory agencies and for clinicians.
Sexual desire is a state of motivation that can induce to participate in sexual
activity. Physical activity is related to the well-being in both social and sexual
relationships. The aim of this study was to analyze sexual desire in relation to
physical activity and its impact on sexual excitation and inhibition in a population of
young adults. The total sample consisted of 485 participants (327 women and 158
men), aged between 18 and 35 years. This study required the fulfillment of a
sociodemographic questionnaire, the Sexual Desire Inventory (dyadic and solitary),
the Physical Activity Questionnaire (IPAQ) and the Sexual Inhibition and Sexual
Excitation Scales (SES-SIS). The main results showed that there is a relationship
between desire and physical activity with excitement and sexual inhibition,
concluding that medium and high activity levels contribute positively in people's
sexual behavior. Future research could propose exercise as an intervention in
problems of desire.
Female sexual dysfunction can drastically diminish quality of life for many women. It is estimated that in the United States 40% of women have sexual complaints. These conditions are frequently underdiagnosed and undertreated. Terminology and classification systems of female sexual dysfunction can be confusing and complicated, which hampers the process of clinical diagnosis, making accurate diagnosis difficult. There are few treatment options available for female sexual dysfunctions, however, some interventions may be of benefit and are described. Additional treatments are in development. The development of clear clinical categories and diagnostic guidelines for female sexual dysfunction are of utmost importance and can be of great benefit for clinical and public health uses and disease-related research.
Erectile dysfunction is a major health problem that affects approximately 15–20% of the general population. Its prevalence is significantly higher (30–80%) in patients with cardiovascular (CV) risk factors or disease. Erectile dysfunction shares common pathophysiological mechanisms with CV disease which include a complex interaction between subclinical inflammation, endothelial dysfunction, atherosclerosis, and arterial structural damage. Roles of exercise and cardiorespiratory fitness (CRF) have been well established as first-line recommendations in the management of hypertension, diabetes, dyslipidemia, obesity, or overt CV disease. In the setting of erectile dysfunction, several observational studies have assessed the impact of exercise on sexual dysfunction, with various studies showing promising results. In addition, randomized trials in various subpopulations with sexual dysfunction suggest significant ameliorating effects of exercise on erectile function. However, these studies are few, and most are not adequately powered to strongly support these benefits. Nevertheless, international guidelines recommend lifestyle interventions – including exercise – as the first step in the management of all patients with sexual dysfunction. Larger well-designed trials are needed to prove the benefits observed in the few available studies.
Ancient physicians such as Herodicus, Hippocrates and Galen recommended exercises as panacea for healthy living in antiquity. Modern scholars such as Christos and Tipton have variously demonstrated the importance of exercises and sports in ancient and modern European societies citing exercises as treatments for some illnesses by the doctor in the Hippocratic Corpus. This paper examined the importance of exercise in antiquity and modernity, even as it serves as a catholicon for healthy living, with a view to identifying the values and relevance of exercise in dealing with illnesses and promoting good health. Sallis and Owen behavioural epidemiology was adopted as theoretical framework. The historical and comparative methodologies were adopted as the study examined the historical trajectory and cross-cultural variations of exercise in antiquity and today's world. The discourse in this study demonstrated that exercise has been functional as medicine and for healthy living in antiquity and modernity. Medical practitioners, exercise physiologists, including laymen understand its importance and further recommend exercise suitable for people of varying ages. Further studies may be
Orgasm frequently occurs from sexual and/or genital stimulation but has been documented outside these contexts and may be better conceptualized as a set of neuropsychological processes. Objective: To document a range of orgasm experiences. Methods: A content analysis of 687 anonymously posted online comments related to nonsexual orgasms. Results: Orgasm types include those related to exercise, sleep, drug use, riding in vehicles, breastfeeding, eating, auditory stimulation, and childbirth, among others. Conclusions: Orgasm is experienced in association with varied forms of sensory stimulation. This study provides information about the diversity of human orgasm, informing sex education, therapy, and practice.
Sexual functioning is complex, and sexual dysfunction may involve any component of the sexual response cycle including libido, arousal, or orgasm. The etiology of most forms of sexual dysfunction is multifactorial and may be physical or psychological. Those suffering from depression may note a change in sexual functioning secondary to their underlying psychiatric condition or quite often, to the antidepressants prescribed to treat their depression. In such situations, patients often become noncompliant with their antidepressant treatment, potentially increasing their risk for serious complications of untreated depression. It is therefore of great importance for clinicians to recognize this side effect and treat it appropriately.
There are a number of psychosocial, relational, and contextual factors that impact female sexual arousal. Although there are no studies that establish causality, numerous significant correlational relationships exist and it follows that addressing these variables in evaluation and psychological treatment can help improve sexual functioning in women. For example, treatment of a female patient whose dysfunction stems from changes related to aging should have a different focus than that of a survivor of abuse. This chapter offers an exploration of the factors that affect sexual desire and arousal disorders in women, as well as tools available for diagnosis and treatment of sexual dysfunction.
Two studies were conducted to further psychometric research on the recently developed Beck Anxiety Inventory (BAI). In Study 1 the test-retest reliability and internal consistency of the scale were examined with a sample of 40 outpatients having anxiety disorders. The BAI proved highly internally consistent (cronbach's alpha = .94) and acceptably reliable over an average time lapse of 11 days (r = .67). Study 2 was conducted to assess the convergent and discriminant validity of the BAI vis á vis anxiety and depression and in comparison to the widely used trait Anxiety measure from the State-Trait Anxiety Inventory. Seventy-one outpatients with anxiety disorders completed the revised State-Trait Anxiety Inventory, the Beck Depression Inventory, and daily diary ratings of anxiety and depression in addition to the BAI. The BAI fared better on tests of convergent and discriminant validity than did Trait Anxiety. The correlation between the BAI and Diary Anxiety was significantly higher than that between BAI and Diary Depression, and, compared to Trait Anxiety, the BAI was significantly less confounded with depression as measured by the BDI. Scores for STAI-Y Trait Anxiety were highly confounded with measures of depression, but results for the STAI-Y State scale were more positive.
Introduction. This article presents data based on the responses of over 800 women who contributed to the development of the Sexual Satisfaction Scale for Women (SSS-W).
Aim. The aim of this study was to develop a comprehensive, multifaceted, valid, and reliable self-report measure of women's sexual satisfaction and distress.
Methods. Phase I involved the initial selection of items based on past literature and on interviews of women diagnosed with sexual dysfunction and an exploratory factor analysis. Phase II involved an additional administration of the questionnaire, factor analyses, and refinement of the questionnaire items. Phase III involved administration of the final questionnaire to a sample of women with clinically diagnosed sexual dysfunction and controls.
Results. Psychometric evaluation of the SSS-W conducted in a sample of women meeting DSM-IV-TR criteria for female sexual dysfunction and in a control sample provided preliminary evidence of reliability and validity. The ability of the SSS-W to discriminate between sexually functional and dysfunctional women was demonstrated for each of the SSS-W domain scores and total score.
Conclusion. The SSS-W is a brief, 30-item measure of sexual satisfaction and sexual distress, composed of five domains supported by factor analyses: contentment, communication, compatibility, relational concern, and personal concern. It exhibits sound psychometric properties and has a demonstrated ability to discriminate between clinical and nonclinical samples.
Antidepressants can impair sexual arousal. Exercise increases genital arousal in healthy women, likely due to increasing sympathetic nervous system (SNS) activity.
Test if exercise increases genital arousal in women taking antidepressants, including selective serotonin reuptake inhibitors (SSRIs), which suppress SNS activity, and selective serotonin and norepinephrine reuptake inhibitors (SNRIs), which suppress the SNS less.
Women reporting antidepressant-related sexual arousal problems (N = 47) participated in three counterbalanced sessions where they watched an erotic film while we recorded genital and SNS arousal. In two sessions, women exercised for 20 min, either 5 or 15 min prior to the films.
During the no-exercise condition, women taking SSRIs showed significantly less genital response than women taking SNRIs. Exercise prior to sexual stimuli increased genital arousal in both groups. Women reporting greater sexual dysfunction had larger increases in genital arousal post-exercise. For women taking SSRIs, genital arousal was linked to SNS activity.
Exercise may improve antidepressant-related genital arousal problems.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
There is increasing evidence that women's physiological sexual arousal is facilitated by moderate sympathetic nervous system (SNS) activation. Literature also suggests that the level of SNS activation may play a role in the degree to which SNS activity affects sexual arousal. We provide the first empirical examination of a possible curvilinear relationship between SNS activity and women's genital arousal using a direct measure of SNS activation in 52 sexually functional women. The relationship between heart rate variability (HRV), a specific and sensitive marker of SNS activation, and vaginal pulse amplitude (VPA), a measure of genital arousal, was analyzed. Moderate increases in SNS activity were associated with higher genital arousal, while very low or very high SNS activation was associated with lower genital arousal. These findings imply that there is an optimal level of SNS activation for women's physiological sexual arousal.
The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
In a recent experiment, Meston and Gorzalka (1995) [Behaviour, Research and Therapy, 33, 651-664] demonstrated a facilitatory effect of sympathetic activation, via acute exercise, on female sexual arousal. The present investigation was designed to examine the time course of this effect. Thirty-six sexually functional women participated in two experimental sessions in which they viewed a neutral film followed by an erotic film. In one of these sessions, Ss were exposed to 20 min of intense exercise (stationary cycling) prior to viewing the films. Subjective (self-report) and physiological (photoplethysmograph) sexual arousal were measured at either 5 min, 15 min, or 30 min post-exercise. Acute exercise marginally decreased vaginal pulse amplitude (VPA) and had no effect on vaginal blood volume (VBV) responses to an erotic film when measured 5 min post-exercise. At 15 min post-exercise, exercise significantly increased VPA and marginally increased VBV responses. At 30 min post-exercise, both VPA and VBV responses to an erotic film were marginally increased. Acute exercise had no significant effect on subjective perceptions of sexual arousal in any of the experimental conditions.
The effects of sympathetic nervous system (SNS) activation, induced via acute exercise, on sexual arousal in women was studied. In 2 experimental sessions, 36 women viewed a neutral film followed by an erotic film. In 1 session, the women were exposed to 20 min of intense exercise before viewing the films. Twelve women were sexually functional, 12 experienced significant impairments in sexual desire, and 12 experienced primary or secondary anorgasmia. Acute exercise significantly increased vaginal pulse amplitude (VPA) and vaginal blood volume (VBV) responses to an erotic film among sexually functional women and those with low sexual desire. Among anorgasmic women, exercise significantly decreased VPA but had no effect on VBV responses to an erotic film. Acute exercise had no significant effect on the women's perceptions of sexual arousal. Results suggest that increased SNS arousal may affect physiological sexual responding in women.
Previous observational and interventional studies have suggested that regular physical exercise may be associated with reduced symptoms of depression. However, the extent to which exercise training may reduce depressive symptoms in older patients with major depressive disorder (MDD) has not been systematically evaluated.
To assess the effectiveness of an aerobic exercise program compared with standard medication (ie, antidepressants) for treatment of MDD in older patients, we conducted a 16-week randomized controlled trial.
One hundred fifty-six men and women with MDD (age, > or = 50 years) were assigned randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride), or combined exercise and medication. Subjects underwent comprehensive evaluations of depression, including the presence and severity of MDD using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and Hamilton Rating Scale for Depression (HAM-D) and Beck Depression Inventory (BDI) scores before and after treatment. Secondary outcome measures included aerobic capacity, life satisfaction, self-esteem, anxiety, and dysfunctional cognitions.
After 16 weeks of treatment, the groups did not differ statistically on HAM-D or BDI scores (P = .67); adjustment for baseline levels of depression yielded an essentially identical result. Growth curve models revealed that all groups exhibited statistically and clinically significant reductions on HAM-D and BDI scores. However, patients receiving medication alone exhibited the fastest initial response; among patients receiving combination therapy, those with less severe depressive symptoms initially showed a more rapid response than those with initially more severe depressive symptoms.
An exercise training program may be considered an alternative to antidepressants for treatment of depression in older persons. Although antidepressants may facilitate a more rapid initial therapeutic response than exercise, after 16 weeks of treatment exercise was equally effective in reducing depression among patients with MDD.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed.
The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction.
The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction.
The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.
Recent advances in pharmacotherapy and changing health care environments have focused increased attention on trends in outpatient treatment of depression.
To compare trends in outpatient treatment of depressive disorders in the United States in 1987 and 1997.
Analysis of service utilization data from 2 nationally representative surveys of the US general population, the 1987 National Medical Expenditure Survey (N = 34 459) and the 1997 Medical Expenditure Panel Survey (N = 32 636).
Respondents who reported making 1 or more outpatient visits for treatment of depression during that calendar year.
Rate of treatment, psychotropic medication use, psychotherapy, number of outpatient treatment visits, type of health care professional, and source of payment.
The rate of outpatient treatment for depression increased from 0.73 per 100 persons in 1987 to 2.33 in 1997 (P<.001). The proportion of treated individuals who used antidepressant medications increased from 37.3% to 74.5% (P<.001), whereas the proportion who received psychotherapy declined (71.1% vs 60.2%, P =.006). The mean number of depression treatment visits per user declined from 12.6 to 8.7 per year (P =.05). An increasingly large proportion of patients were treated by physicians for their condition (68.9% vs 87.3%, P<.001), and treatment costs were more often covered by third-party payers (39.3% to 55.2%, P<.001).
Between 1987 and 1997, there was a marked increase in the proportion of the population who received outpatient treatment for depression. Treatment became characterized by greater involvement of physicians, greater use of psychotropic medications, and expanding availability of third-party payment, but fewer outpatient visits and less use of psychotherapy. These changes coincided with the advent of better-tolerated antidepressants, increased penetration of managed care, and the development of rapid and efficient procedures for diagnosing depression in clinical practice.
Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%) failed to complete the program and were considered treatment "dropouts." At the end of 16 weeks, 83 patients (53%) were in remission; the remaining patients not in remission were considered treatment "failures." Baseline levels of self-reported anxiety and lift satisfaction were the best predictors of both patient dropout and treatment success or failure across all treatment conditions.
The Female Sexual Functioning Index (FSFI; Rosen et al., 2000) is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual arousal disorder. The present investigation extended the validation of the FSFI to include women with a primary clinical diagnosis of female orgasmic disorder (FOD; n = 71) or hypoactive sexual desire disorder (HSDD; n = 44). Internal consistency and divergent validity of the FSFI were within the acceptable range for these populations of women. Significant differences between women with FOD and controls and between women with HSDD and controls were noted for each of the FSFI domain and total scores.
The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.
Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by pelvic striated circumvaginal musculature and uterine/anal contractions and myotonia that resolves sexually-induced vasocongestion and induces well-being/contentment. In 1,749 randomly-sampled U.S. women, 24% reported an orgasmic dysfunction.
To provide recommendations/guidelines concerning state-of-the-art knowledge for management of orgasmic disorders in women.
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Orgasm in Women Committee, there were four experts from two countries.
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Female Orgasmic Disorder, the second most frequently reported women's sexual problem is considered to be the persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase that causes marked distress or interpersonal difficulty (DSM-IV). Empirical treatment outcome research is available for cognitive behavioral and pharmacological approaches. Cognitive-behavioral therapy for anorgasmia promotes attitude and sexually-relevant thought changes and anxiety reduction using behavioral exercises such as directed masturbation, sensate focus, and systematic desensitization treatments as well as sex education, communication skills training, and Kegel exercises. To date there are no pharmacological agents trials (i.e., bupropion, granisetron, and sildenafil) proven to be beneficial beyond placebo in enhancing orgasmic function in women diagnosed with Female Orgasmic Disorder.
More research is needed in understanding management of women with orgasmic dysfunction.
Antidepressant medication is considered the current standard for severe depression, and cognitive therapy is the most widely investigated psychosocial treatment for depression. However, not all patients want to take medication, and cognitive therapy has not demonstrated consistent efficacy across trials. Moreover, dismantling designs have suggested that behavioral components may account for the efficacy of cognitive therapy. The present study tested the efficacy of behavioral activation by comparing it with cognitive therapy and antidepressant medication in a randomized placebo-controlled design in adults with major depressive disorder (N = 241). In addition, it examined the importance of initial severity as a moderator of treatment outcome. Among more severely depressed patients, behavioral activation was comparable to antidepressant medication, and both significantly outperformed cognitive therapy. The implications of these findings for the evaluation of current treatment guidelines and dissemination are discussed.
Missing data present a challenge to many research projects. The problem is often pronounced in studies utilizing self-report scales, and literature addressing different strategies for dealing with missing data in such circumstances is scarce. The objective of this study was to compare six different imputation techniques for dealing with missing data in the Zung Self-reported Depression scale (SDS).
1580 participants from a surgical outcomes study completed the SDS. The SDS is a 20 question scale that respondents complete by circling a value of 1 to 4 for each question. The sum of the responses is calculated and respondents are classified as exhibiting depressive symptoms when their total score is over 40. Missing values were simulated by randomly selecting questions whose values were then deleted (a missing completely at random simulation). Additionally, a missing at random and missing not at random simulation were completed. Six imputation methods were then considered; 1) multiple imputation, 2) single regression, 3) individual mean, 4) overall mean, 5) participant's preceding response, and 6) random selection of a value from 1 to 4. For each method, the imputed mean SDS score and standard deviation were compared to the population statistics. The Spearman correlation coefficient, percent misclassified and the Kappa statistic were also calculated.
When 10% of values are missing, all the imputation methods except random selection produce Kappa statistics greater than 0.80 indicating 'near perfect' agreement. MI produces the most valid imputed values with a high Kappa statistic (0.89), although both single regression and individual mean imputation also produced favorable results. As the percent of missing information increased to 30%, or when unbalanced missing data were introduced, MI maintained a high Kappa statistic. The individual mean and single regression method produced Kappas in the 'substantial agreement' range (0.76 and 0.74 respectively).
Multiple imputation is the most accurate method for dealing with missing data in most of the missind data scenarios we assessed for the SDS. Imputing the individual's mean is also an appropriate and simple method for dealing with missing data that may be more interpretable to the majority of medical readers. Researchers should consider conducting methodological assessments such as this one when confronted with missing data. The optimal method should balance validity, ease of interpretability for readers, and analysis expertise of the research team.
Sexual dysfunction is a disturbing and often underrecognized problem associated with schizophrenia and its treatment. The Psychotropic-Related Sexual Dysfunction (PRSexDQ-SALSEX) is a brief and relatively nonintrusive questionnaire that has shown adequate psychometric properties in patients with depression. This study examined the psychometric properties of the PRSexDQ-SALSEX in a sample of patients with schizophrenia or other psychotic disorders who were experiencing anti-psychotic-induced sexual dysfunction and were switched to olanzapine. The PRSexDQ-SALSEX was very feasible and its internal reliability was satisfactory. In addition, this questionnaire showed a good convergent validity and sensitivity to tracking changes in sexual functioning.
Context Recent advances in pharmacotherapy and changing health care environments
have focused increased attention on trends in outpatient treatment of depression.Objective To compare trends in outpatient treatment of depressive disorders in
the United States in 1987 and 1997.Design and Setting Analysis of service utilization data from 2 nationally representative
surveys of the US general population, the 1987 National Medical Expenditure
Survey (N = 34 459) and the 1997 Medical Expenditure Panel Survey (N
= 32 636).Participants Respondents who reported making 1 or more outpatient visits for treatment
of depression during that calendar year.Main Outcome Measures Rate of treatment, psychotropic medication use, psychotherapy, number
of outpatient treatment visits, type of health care professional, and source
of payment.Results The rate of outpatient treatment for depression increased from 0.73
per 100 persons in 1987 to 2.33 in 1997 (P<.001).
The proportion of treated individuals who used antidepressant medications
increased from 37.3% to 74.5% (P<.001), whereas
the proportion who received psychotherapy declined (71.1% vs 60.2%, P = .006). The mean number of depression treatment visits
per user declined from 12.6 to 8.7 per year (P =
.05). An increasingly large proportion of patients were treated by physicians
for their condition (68.9% vs 87.3%, P<.001),
and treatment costs were more often covered by third-party payers (39.3% to
55.2%, P<.001).Conclusions Between 1987 and 1997, there was a marked increase in the proportion
of the population who received outpatient treatment for depression. Treatment
became characterized by greater involvement of physicians, greater use of
psychotropic medications, and expanding availability of third-party payment,
but fewer outpatient visits and less use of psychotherapy. These changes coincided
with the advent of better-tolerated antidepressants, increased penetration
of managed care, and the development of rapid and efficient procedures for
diagnosing depression in clinical practice.
Objective: Exercise appears to be generally comparable to antidepressant medication in reducing depressive symptoms. The current study examines the effects of aerobic exercise, compared to antidepressant medication and placebo pill, on sexual function among depressed adults. Methods: Two hundred clinically depressed adults, aged 40 years and over, who were sedentary and generally overweight, were randomized to 4 months of Aerobic Exercise, Sertraline (Zoloft), or Placebo pill, for the treatment of depression. Exercise condition participants engaged in walking, running, or biking, 30 min/day, 3 days/week, to 70-85% of their heart rate reserve, in either a supervised group setting or independently at home. Before and following treatment, participants completed the Arizona Sexual Experiences Questionnaire (ASEX) and the Hamilton Rating Scale for Depression (HAM-D). An ANCOVA was performed to test the effects of treatment on post-treatment sexual function, controlling for age, sex, body mass index, diabetes, hypertension, pretreatment HAM-D scores, and pretreatment ASEX scores. Results: The treatment group main effect was significant (p = .02); exercisers had better post-treatment ASEX scores (adjusted ASEX M = 16.6) compared to the placebo group (adjusted ASEX M = 18.3; p = .01). Exercisers had post-treatment ASEX scores that were marginally better compared to the sertraline group, but this difference did not reach statistical significance (adjusted ASEX M = 17.9; p = .05). Conclusion: Aerobic exercise, which has been associated with reduced symptoms of depression comparable to antidepressant medication, appears to result in greater improvement in sexual function compared to placebo pill. A nonsignificant trend towards better sexual function among exercisers compared to antidepressant medication may be attributable to medication-related sexual side effects.
Background
Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.
Methods
A literature search was conducted using MEDLINE, ISI Web of Knowledge, and references of selected articles. Selected studies performed on patients without previous SD were entered in the Cochrane Collaboration Review Manager (RevMan version 4.2). Our primary outcome measure was the rate of total treatment-emergent SD. Our secondary outcome measures were the rates of treatment-emergent desire, arousal, and orgasm dysfunction.
Results
Our analyses indicated a significantly higher rate of total and phase-specific treatment-emergent SD compared with placebo for the following drugs in decreasing order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine, with SD ranging from 25.8% to 80.3% of patients. No significant difference with placebo was found for the following antidepressants: agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone.
Discussion
Treatment-emergent SD caused by antidepressants is a considerable issue with a large variation across compounds. Some assumptions, such as the inclusion of open-label studies or differences in scales used to assess SD, could reduce the significance of our findings. However, treatment-emergent SD is a frequent adverse effect that should be considered in clinical activity for the choice of the prescribed drug.
The Ontario Exercise-Heart Collaborative Study was a multicenter randomized clinical trial of high intensity exercise for the prevention of recurrent myocardial infarction in 733 men. Of the 678 subjects who could have participated for at least 3 years, 315 (46.5%) dropped out. Stepwise multiple linear logistic regression analysis was carried out to examine the relation between subject characteristics and the probability of dropping out during the study. Analysis was performed on the entry group as a whole by considering those subjects who had reinfarction while complying with the program and also by excluding all subjects with reinfarctions. The consistent and statistically significant predictors of dropout in both analyses were smoking and a blue collar occupation. Angina was significantly associated with dropout only when reinfarctions were excluded. It may be important to consider these factors when investigating the potential for compliance-improving strategies in reducing dropout from exercise rehabilitation programs.
reviewed the theoretical and technical aspects of cognitive therapy with depressed children and adolescents / the cognitive model offers a useful paradigm for the study of depression in this age group (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It has been known for some time that the compliance with antidepressants in general practice is sub-optimal, but no new studies have been carried out since the 1970s, since which time training in general practice has improved and new classes of antidepressants have been introduced. In this study 46 patients commenced on an antidepressant for clinical reasons by their GP were interviewed 10-12 weeks later by a research worker. Thirty two percent of patients stopped medication within 6 weeks and 63% of these did not inform their GP of their decision. Side-effect burden was significantly associated with non-compliance. Selective serotonin re-uptake inhibitors showed a slight but non-significant compliance advantage in this small study but all patients treated with SSRIs were initially prescribed a dose for which there is evidence of superiority of effect over placebo, while only 30% of those on tricyclics were prescribed such a dose. Further work to establish accurate methods of determining compliance and effective ways of enhancing compliance with antidepressants in general practice is required.
Attendance and completion of weight loss intervention is associated with better weight loss outcomes; however, attrition is neither consistently reported nor comprehensively explored in the weight loss literature. A systematic review was undertaken to identify factors associated with attrition in weight loss interventions involving overweight or obese (body mass index ≥ 25) adults (18-65 years). Sixty-one studies published before May 2011 and addressing factors associated with weight loss programme attrition were identified. Conclusions were limited by the large number of variables explored, the small number of studies exploring each variable, the large variety of study settings and methodologies used, the inconsistent reporting of results, and the conflicting findings across studies. A consistent set of predictors has not yet been identified. The majority of studies relied on pre-treatment routinely collected data rather than variables selected because of their theoretical and/or empirical relationship with attrition. However, psychological and behavioural patient factors and processes associated with the treatment were more commonly associated with attrition than patient background characteristics. Future research should consider theoretically grounded social-psychological and behavioural processes as potential predictors of dropout. Identification of patients at risk of dropout will contribute to both the effectiveness and the cost-effectiveness of weight loss interventions.
To assess the 24-hour temporal-domain heart-rate variability correlates of treatment with fluoxetine or doxepin for depression.
A randomized evaluation of fluoxetine and doxepin measured a 50% change in the Hamilton Depression Rating Scale (HDRS) score as a response to therapy and was correlated with measures of standard deviation of the mean of all 5-minute segments of normal electrocardiographic R-R intervals (SDANN), standard deviation of all normal R-R intervals (SDNN), root mean square of successive differences in R-R intervals (r-MSSD), and percentage difference between adjacent normal R-R intervals that are greater than 50 msec (pNN50) from 24-hour electrocardiogram (ECG) tapes.
Ten out of 14 patients responded. Response was associated with an increase in SDANN of 17% (P < 0.05). Nonresponse was associated with a 17% decrease in SDANN and a 22% decrease in SDNN (both P < 0.05). No other measures correlated with therapeutic response. No heart-rate variability (HRV) differences between the 2 drug therapies were observed.
Twenty-four-hour HRV measures may be useful in assessing response to antidepressant therapy.
Previous measures of physical activity for epidemiologic studies were considered Inadequate to meet the needs of a community-based health education trial. Therefore, new methods of quantifying the physical activity habits of communities were developed which are practical for large health surveys, provide Information on the distribution of activity habits in the population, can detect changes in activity over time, and can be compared with other epidemiologic studies of physical activity. Independent sell-reports of vigorous activity (at least 6 metabolic equivalents (METs)), moderate activity (3–5 METs), and total energy expenditure (kilocalories per day) are described, and the physical activity practices of samples of California cities are presented. Relationships between physical activity measures and age, education, occupation, ethnicity, marital status, and body mass index are analyzed, and the reliabilities of the three activity indices are reported. The new assessment procedure is contrasted with nine other measures of physical activity used in community surveys.
Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.
A literature search was conducted using MEDLINE, ISI Web of Knowledge, and references of selected articles. Selected studies performed on patients without previous SD were entered in the Cochrane Collaboration Review Manager (RevMan version 4.2). Our primary outcome measure was the rate of total treatment-emergent SD. Our secondary outcome measures were the rates of treatment-emergent desire, arousal, and orgasm dysfunction.
Our analyses indicated a significantly higher rate of total and specific treatment-emergent SD and specific phases of dysfunction compared with placebo for the following drugs in decreasing order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram, and fluvoxamine, with SD ranging from 25.8% to 80.3% of patients. No significant difference with placebo was found for the following antidepressants: agomelatine, amineptine, bupropion, moclobemide, mirtazapine, and nefazodone.
Treatment-emergent SD caused by antidepressants is a considerable issue with a large variation across compounds. Some assumptions, such as the inclusion of open-label studies or differences in scales used to assess SD, could reduce the significance of our findings. However, treatment-emergent SD is a frequent adverse effect that should be considered in clinical activity for the choice of the prescribed drug.
Salivary testosterone concentrations were measured in male and female members of four heterosexual couples on a total of 11 evenings before and after sexual intercourse and 11 evenings on which there was no intercourse. Testosterone increased across the evening when there was intercourse and decreased when there was none. The pattern was the same for males and females. Early evening measured did not differ on the two kinds of days, suggesting that sexual activity affects testosterone more than initial testosterone affects sexual activity.
Side effects often complicate the use of antidepressants for treatment of patients with major depression. Aggressive minimization and management of antidepressant side effects may relieve discomfort and distress, improve quality of life, enable clinicians to use appropriate medications at therapeutic doses, improve compliance, and thus enhance overall outcome. In this article we present recommendations for the management of side effects associated with antidepressant medications. Specifically, strategies are provided for the management of anticholinergic, cardiovascular, sedative, and activating side effects. Strategies for the management of antidepressant-associated insomnia, hypomania and mania, sexual dysfunction, appetite stimulation and weight gain, cognitive impairment, and parathesias are also discussed.
We obtained Hamilton Rating Scale for Depression (HAM-D) scores and recorded 5 minutes of rhythm strip both before and after a therapeutic trial of antidepressant medications in 17 patients diagnosed with major depressive disorder (MDD). We calculated the standard deviation (SD) of interbeat intervals and the mean squared successive difference (MSSD) as measures of heart-rate variability (HRV). We then calculated Spearman rank-ordered correlation coefficients between the HRV measures and the HAM-D scores. Changes in SD and MSSD correlated with post-treatment HAM-D scores and with changes in HAM-D scores. These relationships were strongest in patients who responded positively to nontricyclic antidepressant medications. HRV before treatment was not predictive of treatment response, nor did HRV reliably reflect the severity of depressive symptoms. These findings indicate that pharmacologic treatment leading to improvement in MDD is associated with increased HRV. Hence, brief measures of HRV could be developed as a useful adjunctive, physiologic measure of treatment response to pharmacotherapy in clinical trials and other settings. Further, increased HRV associated with successful treatment of MDD may reflect improved autonomic function, decreasing the risk of cardiovascular mortality found in patients with MDD.
The prevalence of psychotropic medication consumption was assessed in the UK by surveying a representative sample of 4972 non-institutionalized individuals 15 years of age or older (participation rate, 79.6%). A questionnaire was administered over the telephone with the help of the Sleep-Eval Expert System. Topics covered included: type and name of medication, indication, dosage, duration of intake, and medical specialty of prescriber. Also collected were data pertaining to sociodemographics, physical illnesses, and DSM-IV mental disorders. Overall, 3.5% [95% CI: 3-4] of the sample reported current use of psychotropic medication. Consumption was higher among women [4.6% (3.8-5.4)] than men [2.3% (1.7-2.9)], and among the elderly (> or = 65 years of age). The distribution of psychotropics was: hypnotics 1.5%, antidepressants 1.1%, and anxiolytics 0.8%. The median duration of psychotropic intake was 52 weeks. General practitioners were the most common prescribers of psychotropics (over 80% for each class of drug). Nearly half the antidepressant users were diagnosed by the system with a DSM-IV anxiety disorder, and one-fifth the anxiolytic users with a depressive disorder. A marked improvement in sleep quality was reported by half the subjects using a psychotropic for sleep-enhancing purposes. Psychotropic users were more likely than non-users to report episodes of memory loss, vertigo, or anomia. Psychotropic medication consumption is lower and patterns of psychotropic prescription differ in the UK compared with other European and North American countries. Results suggest that physicians may not be sufficiently trained to deal with the overlap between general practice and psychiatry.
To identify reasons for dropout and factors that may predict dropout from an exercise intervention aimed at improving physical function in frail older persons.
An 18-month randomized controlled intervention in a community setting. The intervention comprised 2 groups: class-based and self-paced exercise.
155 community-dwelling older persons, mean age 77.4, with mildly to moderately compromised mobility.
The primary outcome measure was dropout. Dropouts were grouped as: D0, dropout between baseline and 3-month assessment, and D3, dropout after 3-month assessment.
Measurements of demographics, health, and physical performance included self-rated health, SF-36, disease burden, adverse events, PPT-8, MacArthur battery, 6-minute walk, and gait velocity.
There were 56 dropouts (36%), 31 in first 3 months. Compared with retained subjects (R), the D0 group had greater disease burden (P = .011), worse self-perceived physical health (P = .014), slower usual gait speed (P = .001), and walked a shorter distance over 6 minutes (P<.001). No differences were found between R and D3. Multinomial logistic regression showed 6-minute walk (P<.001) and usual gait velocity (P<.001) were the strongest independent predictors of dropout. Controlling for all other variables, adverse events after randomization and 6-minute walk distance were the strongest independent predictors of dropout, and self-paced exercise assignment increased the risk of dropout.
We observed baseline differences between early dropouts and retained subjects in disease burden, physical function, and endurance, suggesting that these factors at baseline may predict dropout. Improved understanding of factors that lead to and predict dropout could allow researchers to identify subjects at risk of dropout before randomization. Assigning targeted retention techniques in accordance with these factors could result in decreased attrition in future studies. Therefore, the results of selective attrition of frailer subjects, such as decreased heterogeneity, restricted generalizability of study findings, and limited understanding of exercise effects in this population, would be avoided.
Increased sympathetic nervous system (SNS) activity has been associated with stress, major depression, aging, and several medical conditions. This study assessed the effect of the selective serotonin reuptake inhibitor (SSRI), sertraline, on sympathetic nervous system (SNS) activity in healthy subjects. Twelve healthy volunteers participated in a double-blind, placebo-controlled, norepinephrine (NE) kinetic study, in which the effects of sertraline on SNS activity were ascertained by determining NE plasma concentrations and NE plasma appearance rates and clearance rates in sertraline or placebo conditions. Subjects received 50 mg of sertraline or placebo for two days and then one week later underwent the same protocol with the other drug. By single compartmental analysis, plasma NE appearance rates were significantly lower in the sertraline compared to the placebo condition (0.26+/-0.10 vs 0.40+/-0.23 microg/m(2)/min; P=0.04). Our study found that the net effect of short-term SSRI treatment is an apparent suppression of SNS activity as indicated by a decreased plasma NE appearance rate in the sertraline condition. If this preliminary finding can be extended to long-term treatment of patients, this could have significant therapeutic relevance for treating depression in elderly patients or those with cardiac disease, in which elevated SNS activity may exacerbate underlying medical conditions.
Brain serotonin is known to possess sympathoinhibitory properties. The aim of this clinical physiologic study was to determine whether sertraline, a selective serotonin reuptake inhibitor, facilitates the rate of recovery of cardiac autonomic function after an acute myocardial infarction (MI) in patients with depression.
Thirty-eight post-MI depressed patients were randomized to receive either sertraline 50 mg per day or placebo for 6 months. Depression was defined as a score >15 on the standardized Inventory to Diagnose Depression questionnaire taken at prehospital discharge and again within 2 weeks of the acute infarct. Eleven stable post-MI nondepressed patients served as a nonrandomized reference group during follow-up. Twenty-seven patients completed the randomization. All 3 groups were followed up closely in a multidisciplinary post-MI clinic where they underwent serial testing for both time and frequency domain heart rate variability (HRV) indices at baseline (1-2 weeks after MI) and at 6, 10, 14, 18, and 22 weeks. The rate of recovery of HRV was determined by use of a growth curve model based on repeated-measures analysis of variance. There was a linear rate of increase in the SD of 24-hour N-N intervals (SDNN) in the sertraline-treated group that paralleled that of the nondepressed reference group. This contrasted with a modest but significant decline in SDNN in the placebo group from 2 to 22 weeks (t = 2.10, P <.05). However, the short-term power spectral indices, while trending toward a more rapid rate of recovery in the treated group, did not reach statistical significance compared with the placebo group.
In depressed patients who have survived the acute phase of an MI sertraline facilitates the rate of recovery of SDNN, a recognized predictor of clinical outcome.
Despite the availability of effective antidepressants, recurrence and relapse rates for depression are high (up to 80%), treatment failures are common (40% to 60%), and as many as 20% of patients remain inadequately treated. Depression treatment guidelines are often not followed, and rates of nonadherence to treatment are high, with 28% of patients discontinuing antidepressant treatment within the first month and 44% discontinuing within 3 months of initiating therapy.
The aim of this article was to summarize research on antidepressant therapy nonadherence and examine the limitations of strategies used to minimize adverse events (AEs) and improve treatment duration.
A thorough search of the published literature from 1990 to the present was performed on MEDLINE and other search engines. The following search terms were used: tolerability, antidepressants, patient compliance, adherence, therapy, SSRIs, tricyclics, and other related terms focusing on specific agents.
Physician-specific issues represent some of the most important obstacles to adequate antidepressant therapy. Inadequate patient education, prescription of inappropriate medications or inadequate dosages, and lack of follow-up care are all issues the physician can control to improve patient adherence. Patient-specific issues include poor motivation (due to symptoms of depression) to continue therapy, failure to perceive a benefit, and concerns about cost of therapy. Medication-specific issues such as treatment-related AEs, delayed onset of action, complicated dosing or titration schedule, and subtherapeutic dosing also contribute to treatment discontinuation. Therapy with >/=I antidepressant and/or atypical antipsychotic may improve symptom control, but little evidence exists regarding efficacy and safety. Dosage reduction has been attempted to reduce events that may lead to patient discontinuation, but this may increase the risk of recurrent depressive episodes.
To maximize patient adherence to antidepressant therapy, it is necessary to combine adequate treatment duration, realistic patient expectations, and the right dose of an agent capable of treating the full range of symptoms while controlling for AEs.
This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication.
Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction.
Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo.
The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.
The Sexual Interest and Desire Inventory-Female (SIDI-F) is a 13-item scale developed as a clinician-administered assessment tool to quantify the severity of symptoms in women diagnosed with hypoactive sexual desire disorder (HSDD). The present investigation assessed the reliability and validity of the SIDI-F as a measure of HSDD severity. Results show that the SIDI-F exhibits excellent internal consistency, with Cronbach's alpha of 0.9. The validity of the SIDI-F as a measure of HSDD severity was confirmed by a number of observations. Women with a clinical diagnosis (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV-TR; American Psychiatric Association, 2000]) of HSDD had significantly lower SIDI-F scores than women not meeting diagnostic criteria for any subtype of female sexual dysfunction and women diagnosed with female orgasmic disorder. There was a high correlation between scores on the SIDI-F and scores on the Female Sexual Function Index (FSFI; Rosen et al., 2000) and an interactive voice response version of the Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvey, & Clavet, 1997; Clayton, McGarvey, Clavet, & Piazza, 1997), two validated measures that assess general female sexual dysfunction. In contrast, there was a poor correlation between SIDI-F scores and scores on a slightly modified Marital Adjustment Scale (Locke, Wallace, 1959; MAS), an assessment of general (nonsexual) relationship satisfaction. Taken together, the results of the present investigation indicate that the SIDI-F is a reliable and valid measure of HSDD severity, independent of relationship issues.
Depression and antidepressant therapy have been associated with sexual dysfunction in short-term and point-prevalence trials.
This report describes effects of duloxetine and escitalopram on sexual functioning during acute and long-term treatment of major depressive disorder (MDD).
In this 8-month, double-blind, placebo-controlled study, adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)-defined MDD were randomized to duloxetine 60 mg/day (N = 273; 173 female), escitalopram 10 mg/day (N = 274; 186 female), or placebo (N = 137; 87 female). After the first 8 weeks of treatment, dose increases were permitted to optimize treatment.
The 14-item Changes in Sexual Functioning Questionnaire (CSFQ) was used to assess sexual functioning.
Of the 114 patients who did not meet total CSFQ score criteria for global sexual dysfunction at baseline (duloxetine, N = 51; escitalopram, N = 39; placebo, N = 24), the incidence of treatment-emergent sexual dysfunction was significantly higher for escitalopram compared with placebo at 4 and 8 weeks, and significantly higher compared with duloxetine at 4 weeks. At 8 weeks, the incidence of treatment-emergent sexual dysfunction was 17/51 (33.3%) for duloxetine-treated patients; 19/39 (48.7%) for escitalopram-treated patients; and 4/24 (16.7%) for placebo-treated patients (P = 0.01 escitalopram vs. placebo; P = 0.13 duloxetine vs. placebo). After 12 weeks, no significant differences were observed between active drugs. At 8 months, the incidence of treatment-emergent sexual dysfunction was 33.3% for duloxetine, 43.6% for escitalopram, and 25.0% for placebo. Regardless of treatment, patients who achieved remission of MDD showed improvement in global sexual functioning, whereas worsening was observed for patients who did not achieve remission (P < 0.001). Discontinuation rates for sexual side effects did not differ between duloxetine (N = 2) and escitalopram (N = 7) (P = 0.07).
Short-term treatment demonstrated a higher incidence of treatment-emergent sexual dysfunction with escitalopram compared with duloxetine and placebo. After 12 weeks, there were no statistically significant differences between drugs; however, MDD outcome (regardless of treatment) had a significant impact on improvement in global sexual functioning.
Evidence exists linking major depressive disorder (MDD) with clinical cardiovascular events. The importance of the sympathetic nervous system in the generation of cardiac risk in other contexts is established.
To examine the importance of the sympathetic nervous system in the generation of cardiac risk in patients with major depressive disorder (MDD).
Studies were performed in 39 patients meeting the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for MDD and in 76 healthy subjects. Treatment for patients consisted of selective serotonin reuptake inhibition (SSRI) for 12 weeks. Whole body and cardiac sympathetic activity were examined using noradrenaline isotope dilution methodology and sympathetic nerve recording techniques. Measurement of the extraction of infused tritiated noradrenaline by the heart, and estimation of cardiac dihydroxyphenylglycol production provided direct quantification of neuronal noradrenaline reuptake.
Sympathetic activity, particularly in the heart and for the whole body, in patients with MDD followed a bimodal distribution. Elevated values were observed in patients with co-morbid panic disorder (P = 0.006). Consistent with a defect in noradrenaline reuptake, the cardiac extraction of tritiated noradrenaline (0.80 +/- 0.01 versus 0.56 +/- 0.04%, P < 0.001) and cardiac dihydroxyphenylglycol overflow (109 +/- 8 versus 73 +/- 11, P = 0.01) were reduced in patients with MDD. SSRI therapy abolished the excessive sympathetic activation, with whole body noradrenaline spillover falling from 518 +/- 83 to 290 +/- 41 ng/min (P = 0.008).
We have identified a subset of patients with MDD in whom sympathetic nervous activity is extraordinarily high, including in the sympathetic outflow to the heart. Treatment with an SSRI may reduce sympathetic activity in a manner likely to reduce cardiac risk.
Physical activity assess-ment methodology in the Five-City Project
- Sallis
- Jf
- Haskell
- Wl
- Wood
- Pd
Sallis JF, Haskell WL, Wood PD, et al. Physical activity assess-ment methodology in the Five-City Project. Am J Epidemiol 1985;121(1):91–106.
Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients
- Montejo