Effects of Depression and Antidepressants on Sexual Health and the Sexual Response Cycle - Research Paper Example

The Effects of Depression and Antidepressants on Sexual Health and the Sexual Response Cycle The Effects of Depression and Antidepressants on Sexual Health and the Sexual Response Cycle The fact that adequate sexual expression is an important and integral part of human health and relationship cannot be overstated bearing an impact on the physical, social and psychological well-being of an individual. Sexual and mental health have been found to be interrelated with clinical and epidemiological studies indicating that sexual dysfunction is a common symptom of depression. Besides this, studies also indicate that treatment with antidepressants also has adverse effects on sexual functioning, capable of predisposing one to sexual dysfunction or aggravating the condition (Baldwin, 2001). Knowledge of the terminology commonly used in sexual and mental health studies is crucial for the study of the interrelationship between the two. The physiology of sexual functioning can be best described through the sexual response cycle which is divided into four phases i.e. desire, excitement, orgasm and resolution. The sexual response cycle is regulated by a multi-component system involving endocrine glands, autonomic nervous system, sex hormones and neurotransmitters which intimates the relationship between sexual health and mental health. Sexual dysfunction refers to problems experienced during any of the phases of the sexual response cycle hence preventing an individual from obtaining satisfaction from sexual activity. Statistics present on sexual dysfunction indicate that about 41% of women and 34% of men in the general population experienced various manifestations of sexual problems ranging from diminished libido, vaginal dryness, erectile dysfunction, premature ejaculation and anorgasmia (Outhoff, 2009). Further breakdown of the epidemiology reveals that 35% of women and 16% of men experience inhibited sexual desire; 10-20% of men experience premature ejaculation while a further 35% experience erectile dysfunction. The prevalence of orgasm problems among women is 5-15% (Baldwin et al. 2003). Among the several causes of sexual disorders, discovery of a link with psychopathology stands out with sexual dysfunction being a common symptom among depressed individuals as indicated by the fact that sexual dysfunction occurs in only 26% of normal individuals while it stands at 45% of depression cases. Widespread use of antidepressant medications also led to the realization that such drugs had an adverse effect on sexual functioning with several experimental studies confirming this (Jespersen, 2006). The strong link between depression, antidepressants and sexual dysfunction alongside the grave statistics of sexual problems are the considerations that informed this study. Undertaking this study is important as more knowledge on the link between the two needs to be generated through experimental, meta-analytical and review approaches and the research findings communicated to medical practitioners especially with the growing importance of evidence-based practice. Such research findings have the potential of influencing the prescription and treatment decisions for depression. This study will undertake to review literature from experimental studies into the effects of depression and antidepressant medications on the sexual response cycle after which the implications of the study findings on sexual health intervention research and policy will be discussed. The approach of the literature review will be through analyzing information from experimental research into the issue with focus given to work from the turn of the millennium so as to get up-to-date findings on the subject. Each study will be analyzed in terms of research topic theory, the method undertaken for the research and finally the research findings and conclusions arrived at by the researchers. Review of Literature Peng et al. (2006) undertook a study to find out the relationship between physiological and psychological factors with sexual dysfunction among male hemodialysis patients. They based their study on the observation from other inquiries that sexual dysfunction was highly prevalent among patients at the end-stage renal disease on hemodialysis and that psychological depression was also highly prevalent among end-stage renal disease (ESRD) patients. They sought to address the psychological factors affecting sexual dysfunction among male ESRD patients since there was a considerable data gap in this area. To do this, they utilized a multicenter cross-sectional method to study the determinants of sexual dysfunction among male ESRD patients. On a sample size of 411 individuals, biochemical and hematological information was obtained alongside issuance of self-filled questionnaires to the patients. Sampling considerations included exclusion of ESRD patients who were on antipsychotic or antidepressant therapy. The questionnaires consisted of International Index of Erectile Function (IIEF), the Beck Depression Inventory (BDI) the 36-item Short Form Health Survey Questionnaire (SF-36). The researchers found out that at advanced age, hemodialysis and depressive symptoms were all associated independently with sexual dysfunction among the test patients. Hence, the researchers arrived at a conclusion that depression among male ESRD was significantly associated with sexual dysfunction and thus recommended that management of sexual dysfunction among male ESRD patients integrates the relevant psychological evaluation. Montejo et al. (2001) note that antidepressants mainly from the SSRI class are frequently associated with inhibition of sexual functions while others such as bupropion has fewer effects. There is however underestimation of the incidence of this sexual dysfunction and specified questionnaires are thus needed. On a sample size of 1022 outpatients who had previously normal sexual function and were being treated with antidepressants, the authors undertook to analyze the incidence of sexual dysfunction through a Psychotropic-Related Sexual Dysfunction Questionnaire with data on ejaculation, erectile function and satisfaction. Their results indicated that there was 59.1% incidence of sexual dysfunction with men being more affected than women (62.4% versus 56.9%) but with women exhibiting higher severity. Segraves et al. (2000) undertook an evaluation of the sexual functioning of patients with depression under treatment with antidepressants. The researchers pointed out that the effects of antidepressants on such patients were already known but there was missing information on comparisons of the extent of sexual dysfunction effects among different drugs to inform choice of prescription. A double-blind comparison of the effects of bupropion and sertraline in terms of sexual side effects was undertaken on 248 outpatients diagnosed with moderate to severe depression was undertaken. The study findings indicated that 63% of men and 41% of women treated with sertraline experienced sexual side effects as compared to 15% men and 7% women treated with bupropion. The symptoms in sertraline administration showed up as early as the 7th day and persisted throughout the entire treatment period. Clayton et al. (2002) also indicated that the extent of sexual dysfunction associated with antidepressants differed according to categories of these drugs. Their study was aimed at investigating the prevalence of sexual dysfunction from new antidepressants and also to compare patient reported sexual dysfunction with what physicians perceived. 4,534 women and 1,763 men were involved in a cross-sectional study in which mono-therapy sexual dysfunction was measured through the Changes in Sexual Functioning Questionnaire. It was found out that new antidepressants were associated with sexual dysfunction and that physicians mostly underestimated the incidence of sexual dysfunction associated with antidepressants. Ferguson et al. (2001), observing that antidepressants were associated with sexual dysfunction, sought to confirm this by evaluating the reemergence of sexual dysfunction among patients who had experienced sertraline-induced sexual dysfunction. To do this, 105 of such patients were involved in a double-blind random study in which they were either retreated with sertraline or treated with nefazodone. 76% of sertraline-retreated patients experienced reemergence of sexual dysfunction while only 26% of the nefazodone-treated patients making implications on the choice of drugs for use in clinical practice. Michelson et al. (2000) investigated the sexual dysfunction among women as associated with antidepressant medication identifying that both depression and antidepressant medications such as serotonin reuptake inhibitors (SSRIs) had been experimentally implicated in sexual dysfunction. There were however inadequate systematic studies especially among women regarding this phenomenon. The aim of their study was to confirm the association of antidepressant medication and sexual dysfunction among women and follow this up with establishing the efficacy of placebo-controlled pharmacologic intervention. Sampling was done among women who were not older than 50 years and who were on floxetine (an SSRI) for at least 8 weeks. They were placed on a 4 week assessment with daily diaries for sexual dysfunction after which they were randomly assigned to an 8 week treatment with buspirone, amantadine or a placebo with assessment being undertaken through daily diaries and clinician interviews. The results indicated that SSRIs have adverse effects on sexual function and that the pharmacological interventions had no significant advantages over the placebo since all categories experienced improvements pointing to a placebo effect in reduction of sexual dysfunction symptoms. A closely related study in which random placebo control was used to investigate efficacy of interventions on SSRI-induced sexual dysfunction also indicated no significant differences between the pharmacologic agent and the placebo confirming first that SSRIs do cause sexual dysfunctions and secondly a placebo effect may be important in intervention (Masand et al, 2001). Other researchers have conducted review studies investigating the association between antidepressants and sexual dysfunction among depressed patients. Baldwin and Mayers (2003) appreciate the existence of this association in literature and undertook a comparative study of such literature to investigate the effects of depression and its medications on sexual function. The comparative study found out that sexual dysfunction among depression and schizophrenic patients was common but largely unreported. Different antidepressants and antipsychotics had had different extents of impact on sexual function. In a similar earlier study by Baldwin (2001), comparative analysis indicated that depression was associated with sexual dysfunction even among untreated patients. The theorized explanations for this suggested that the loss of interest, reduced energy, lowered self esteem, irritability and social withdrawal characteristic of depression contributed to inability to maintain intimate relationships and thus sexual problems. Outhoff (2009) analyzed several experimental and theoretical studies into the link between depression and sexual dysfunction indicating that the causal relationship was still little known and that the effects of depression on sexual function were quite variable. In his study, the author demonstrated sufficient proof from several studies indicating that depression and antidepressant medications had an adverse impact on sexual function. Theoretically, Outhoff’s study explored new directions of research in terms of pathophysiological perspectives where suggestions have been made to the effect that sexual dysfunction and depression could bear similar etiology. Implications This wide literature review reveals evidence that depression and antidepressant drugs are associated with sexual dysfunction. The considerations that can be drawn from these studies are based on the fact that different antidepressant drugs have different levels of sexual inhibition; some antidepressants are actually used to reverse antidepressant-induced sexual dysfunction; interventions indicate that a placebo effect is important in drug efficacy and lastly sexual dysfunction among patients with other ailments may be due to underlying depression. Hence, selection of the antidepressant to use for the treatment of depression should be informed by the best evidence from research regarding the drug with the least sexual dysfunction impacts. Besides this, antidepressant-induced sexual dysfunction can be treated with drugs such as bupropion. However, the clinicians approach and communication with the patient may play the bigger part in treatment. Lastly, sexual dysfunction in patients with other ailments may be treated through psychotherapy to address underlying depression. Conclusion There is a great deal of evidence suggesting that depression and antidepressant medications have an adverse effect on sexual health observed through the stages of the sexual response cycle resulting in sexual dysfunction. However, different antidepressants have different extents of the effects while in fact some can even reverse the sexual dysfunction. The implications of the studies undertaken in this area can find important use as evidence for clinical practice where they can be used for selection of appropriate antidepressants for the treatment of depression besides reversal of sexual dysfunction among the affected patients. Hence, there is huge importance attached to depression and its treatment with relation to sexual health. There is however need for more studies to explain the association between the two. References Baldwin, D. and Mayers, A. (2003). Advances in psychiatric treatment, 9, 202–210. Baldwin, D. (2001). Depression and sexual dysfunction. British Medical, 57, 81–99. Clayton, A. H. et al. (2002). Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychopharmacology, 63(4), 357-366. Ferguson, J. M. et al. (2001). Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. Journal of Clinical Psychopharmacology, 62(1), 24-9 Jespersen, S. (2006). Antidepressant induced sexual dysfunction Part 1: epidemiology and clinical presentation. SA Psychiatry Review, 9, 24-27. Masand, P. S. et al. (2001). Sustained-release bupropion for selective serotonin reuptake inhibitor-induced sexual dysfunction: A randomized, double-blind, placebo-controlled, parallel-group study. American Journal of Psychiatry, 158, 805-807. Michelson, D. et al. (2000). Female sexual dysfunction associated with antidepressant administration: A randomized, placebo-controlled study of pharmacologic intervention. American Journal of Psychiatry, 157, 239-243 Montejo, A. L. et al. (2001). Incidence of sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 participants. Journal of clinical Psychiatry, 62(3), 10-21 Outhoff, K. (2009). Antidepressant-induced sexual dysfunction. SA Family Practice, 51(4), 298-302. Peng, Y. et al. (2006). The association of higher depressive symptoms and sexual dysfunction in male hemodialysis patients. Nephrology Dialysis Transplant, 22, 857–861. Segraves, R. T. et al. (2000). Evaluation of sexual functioning in depressed outpatients: a double-blind comparison of sustained-release bupropion and sertraline treatment. Journal of Clinical Psychopharmacology, 20(2), 122-128. Read More