Strategies for managing sexual dysfunction induced by antidepressant medication

 

Abstract

Background

Sexual dysfunction (including altered desire, orgasmic dysfunction, erectile and ejaculatory problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health.

Objectives

The objective of this review was to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication.

Search methods

We searched the CCDANCTR (March 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library issue 2, 2004), MEDLINE (1966 - June 2004), EMBASE (1980 - March 2004), CINAHL (1982 - March 2004), PsycINFO (1984 - March 2004) and the reference lists of articles. We also contacted pharmaceutical companies and experts in the field of sexology.

Selection criteria

Randomised controlled trials comparing the management strategies for antidepressant induced sexual dysfunction were included.

Data collection and analysis

Two reviewers independently extracted data and assessed trial quality. Study authors were contacted for additional information. Adverse effect information was collected from the trials.

Main results

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 - 0.6) and was not associated with any worsening of depression.
Fourteen trials involving 829 people assessed the addition of other medication while continuing the same antidepressant. 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). There was no significant difference in dropout rates between sildenafil and placebo. One 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 - 1.55). One trial found that 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.

Authors' conclusions

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.

 

Plain language summary

Strategies for managing sexual dysfunction induced by antidepressants

Antidepressants can have numerous effects on sexual function including altered sexual desire, erection difficulties and orgasm problems. This systematic review investigated the effectiveness of ways of managing such sexual dysfunction. Fifteen randomised studies which included a total of 904 participants who had developed sexual dysfunction whilst taking antidepressant medication were included in the review. Fourteen of these studies looked at the addition of further medication to the ongoing antidepressant treatment. In three studies with 211 men, adding sildenafil was more effective than placebo in treating antidepressant-induced erectile dysfunction. However the general lack of randomised data available limits the confidence with which any one strategy can be advocated.

 

摘要

背景

處理抗憂鬱劑造成性功能障礙的策略

性功能障礙(包含性慾改變,性高潮功能失調,勃起及射精障礙)是抗憂鬱藥物相對常見的副作用. 這些性功能副作用可能影響患者的生活型態且導致處方抗憂鬱藥物時缺乏順從度並因而影響患者心靈健康.

目標

此篇文獻回顧的次標在於評估抗憂鬱造成的性功能障礙相關處置策略的效果.

搜尋策略

我們搜尋the CCDANCTR (2003年3月), the Cochrane Central Register of Controlled Trials (Cochrane Library issue 2, 2004), MEDLINE (1966年−2004年6月), EMBASE (1980年−2004年3月), CINAHL (1982年 2004年3月), PsycINFO (1984年  2004年3月) 等資料庫及相關文獻列表等文章. 我們也聯繫性學領域的藥廠及專家.

選擇標準

納入各種比較針對抗優預計導致性功能障礙處置方式的隨機分配試驗

資料收集與分析

2位回顧者獨立解讀數據且評估試驗的品質. 也聯繫各試驗的作者瞭解需補充事項. 並收集試驗中副作用資訊.

主要結論

納入15個,共包含904位受試者的試驗. 其中一項試驗包含75位患者,評估sertraline造成的性功能障礙更換抗憂鬱劑後之結果. 更換為nefazodone比重新使用sertraline明顯有意義地降低性功能障礙的再度出現.(RR 0.34, 95% CI 0.15  0.6)且並未和任何憂鬱症惡化相關.14項共包含829位受試者的試驗持續使用相同抗憂鬱劑,並評估附加其他藥物的效果.2項共包括113位有勃起異常之男性試驗的後設研究發現附加使用sildenafil在試驗終點時在國際勃起功能指標(the International Index of Erectile Function (IIEF; WMD 19.36, 95% CI 15.00 to 23.72))較少造成性功能障礙. 退出率在附加使用sildenafil或安慰劑並沒有明顯差異. 一項試驗發現附加使用bupropion可以改善性功能問卷性慾頻繁度次量表.(Sexual Functioning Questionnaire desirefrequency subscale)(WMD 0.88, 95% CI 0.21  1.55). 一項試驗發現附加使用tadalafil比安慰劑在國際勃起功能指標的勃起功能領域上有較大的進步(WMD 8.10; 95% CI 4.62 to 11.68). 其他增強策略對比安慰劑在性功能障礙的改善上沒有統計上的意義.

作者結論

目前可知的資料都相當侷限,每個評估治療策略試驗的數目都相當少. 然而,儘管還需等待進一步的隨機數據,使用抗憂鬱劑造成勃起功能障礙之男性附加使用sildenafil是一項有效的治療策略.

翻譯人

本摘要由彰化基督教醫院張庭綱翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗憂鬱藥物造成許多對性功能的影響(包含性慾改變,勃起困難,性高潮問題). 此篇系統性回顧探索處理這些性功能障礙上不同方法的效果. 此文獻回顧共納入15個隨機分布試驗,包含904位使用抗憂鬱劑出現性功能障礙的受試者. 其中14項研究針對目前進行的抗憂鬱劑使用附加藥物. 增加使用sildenafil在3篇共211男性的研究中發現在治療抗憂鬱劑引起之勃起障礙比安慰劑有效. 然而因為普遍缺乏可獲得的隨機分布數據,限制了目前任一種治療策略的信賴和擁戴.