Recommended
More Related Content
Recently uploaded
Recently uploaded (20)
Featured
Featured (20)
Medication-Induced Sexual Dysfunction.pptx
- 2. Why bother? - Underreported unless specifically screened for - Not likely to resolve without intervention; ~5-10% develop tolerance
- 3. What does it look like? - libido - arousal - orgasms - erectile function - ejaculation
- 4. What’s to blame? - SSRI (especially Paroxetine), SNRI > TCAs, MAOi
- 5. What can I do? - Decrease the dose - Risk of diminishing AD efficacy and relapse - Switch to another SSRI - No definitive comparison studies exist
- 6. Switch? - Buproprion - SR 150mg bid in females - Mirtazapine - 45mg qday - Vilazodone ($$) - Duloxetine
- 7. Anything more? - Add a second drug: - Sildenafil - 50-100mg - Buproprion - 100-300mg/day - Buspirone - 15-60mg/d (45mg/d)
Editor's Notes
- Presence of sxs during 75%-100% occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts): 1. Marked delay in, marked infrequency of, or absence of _____ 2. Markedly reduced intensity of _____ there's no specific time that indicates a diagnosis of delayed ejaculation. Instead, you are probably experiencing delayed ejaculation if the delay is causing distress or frustration, or if you have to stop sexual activity due to fatigue, physical irritation, loss of erection or a request from your partner.
- Package inserts report <= 20% for most SSRIs, up to 50% for Fluoxetine
- Decrease the dose Poorly studied, but a reasonable first step Risk of diminishing AD efficacy and relapse Switch to another SSRI But no definitive comparison studies exist
- Bupropion Bupropion SR 150mg bid Safarinejad, M. R. (2011). Reversal of SSRI-induced female sexual dysfunction by adjunctive bupropion in menstruating women: a double-blind, placebo-controlled and randomized study. Journal of Psychopharmacology (Oxford), 25(3), 370–378. A total of 218 women (25–45 years old) with SSRI-induced sexual dysfunction were randomized to receive 12 weeks of double-blind fixed dosed treatment with bupropion sustained release 150 mg b.i.d. (n = 109) or placebo (n = 109) highest improvement was observed in sexual desire, followed by lubrication Mirtazapine Gelenberg, A., Laukes, C., McGahuey, C., Okayli, G., Moreno, F., Zentner, L., & Delgado, P. (2000). Mirtazapine substitution in SSRI-induced sexual dysfunction. The Journal of Clinical Psychiatry, 61(5), 356–360. https://doi.org/10.4088/JCP.v61n0506 Method: Nineteen patients (12 women and 7 men), with SSRI-induced sexual dysfunction who were in remission from major depressive disorder (total Hamilton Rating Scale for Depression [HAM-D] score <= 10), were switched to open-label mirtazapine for up to 6 weeks. Mirtazapine was titrated from 7.5 mg to 45 mg daily, as tolerated. Sexual functioning was measured weekly with the Arizona Sexual Experiences Scale (ASEX), and depression was measured weekly with the HAM-D. Results: Eleven patients (58%) had a return of normal sexual functioning (mean ± SD ASEX score = 12 ± 3), and another 2 (11%) reported significant improvement in sexual functioning (mean ASEX score reduced from 24 ± 1 to 20 ± 0). All nineteen patients maintained their antidepressant response (HAM-D score after 6 weeks of mirtazapine = 6 ± 3). Switch to Vilazodone ($$) or Duloxetine (<SSRI)
- Sildenafil 50-100mg Trials show improved erection, orgasm and ejaculation in men, NOT libido PDE-5is have positive effect in females Buproprion 100-300mg/day RCTs show improved libido in women with SR 150mg bid* But trials for both men and women have been retracted... Buspirone 15-60mg/d (conflicting RCT data) Landen, M., Eriksson, E., Agren, H., & Fahlen, T. (1999). Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. Journal of Clinical Psychopharmacology, 19(3), 268–271. https://doi.org/10.1097/00004714-199906000-00012 placebo-controlled trial designed to explore the efficacy of buspirone as add-on treatment for patients not responding to an SSRI alone. all patients met the criteria for a major depressive episode according to DSM-IV and had received citalopram or paroxetine during a minimum of 4 weeks without responding to the treatment Buspirone (flexible dosage, 20-60 mg/day) or placebo was added to the SSRI for 4 weeks; the mean daily dose of buspirone at endpoint was 48.5 mg 40% (47 of 117) reported at least one kind of sexual dysfunction (decreased libido, ejaculatory dysfunction, orgasmic dysfunction) During the 4 weeks of treatment, approximately 58% of subjects treated with buspirone reported an improvement with respect to sexual function; in the placebo group, the response rate was 30%. The difference between placebo and active drug treatment was more pronounced in women than in men. The response was obvious during the first week, with no further improvement during the course of the study.