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Gregorian RS, Golden KA, Bahce
A, Goodman C, Kwong WJ, Khan ZM.
The Lewin Group, Falls
Church, VA 22042, USA.
OBJECTIVE: To review the evidence
regarding antidepressant-induced sexual dysfunction and address
implications for treatment strategy and health plan coverage policies
for antidepressant medications. DATA SOURCES: Primary articles were
identified by a MEDLINE and HealthSTAR search to identify
English-language studies published between January 1986 and July 2000.
Search terms included sexual dysfunction or sexual function and
antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine,
citalopram, venlafaxine, nefazodone, bupropion, and mirtazapine. A
cross-check of references cited in 10 published reviews yielded
additional in-scope articles. STUDY SELECTION AND DATA EXTRACTION:
Approximately 200 articles were identified, including 8 randomized
controlled trials and numerous open-label studies, case series, and case
reports. Of the randomized controlled trials, only 5 were designed to
evaluate the incidence of sexual dysfunction associated with
antidepressant treatment. Three additional randomized controlled trials
included a structured assessment of sexual dysfunction within an
efficacy trial. Data extraction excluded case reports, letters, and
other limited study designs. A panel survey augmented published reports.
DATA SYNTHESIS: Sexual dysfunction is a relatively common adverse effect
of many of the antidepressants in common use today. Rates of sexual
dysfunction observed in clinical practice may be higher than those
reported in the product information for several agents. Selective
serotonin-reuptake inhibitors (SSRIs) appear to be the class of
antidepressants most likely to cause sexual dysfunction. Published
studies suggest that between 30% and 60% of SSRI-treated patients may
experience some form of treatment-induced sexual dysfunction. Bupropion
and nefazodone appear to be much less likely to cause sexual dysfunction
(<or=10% of patients). Mirtazapine also appears to be associated with
a low rate of sexual adverse effects. Panel results largely reflect the
consensus of the literature. CONCLUSIONS: Sexual dysfunction is a common
adverse effect of antidepressant treatment. Physicians should monitor
their patients for antidepressant-induced sexual adverse effects, as
these may affect compliance with therapy and ultimate treatment success.
In addition to the consequences for patient health and well-being,
managed-care organizations should be concerned with sexually related
adverse effects of antidepressants, insofar as additional healthcare
resources may be required to treat depressed patients in whom these
adverse effects arise.
PMID: 12243609 [PubMed - indexed for