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Sexual dysfunction associated with major depressive disorder and antidepressant treatment (1)

Major depressive disorder (MDD)
= Chronic illness that causes significant morbidity worldwide.
= Lifetime prevalence of up to 15% of the population in industrialized countries.
= Wide-ranging effects for an individual’s mental health.
= Risk factor for worse outcomes related to:
----Medical comorbidities
----Misuse of substances
----Poor psychosocial functioning

Reichenpfader U, Gartlehner G, Morgan LC, et al. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug saf 2014

Sexual dysfunction (SD)
= Sexual response cycle:
----Desire, arousal, orgasm, and resolution.
= Relationship between sexual functioning and quality of life.
----Sexual functioning is important to people regardless of mood state.
= SD as a syndrome comprising pathologies affecting:
----Desire, arousal and orgasm, plus sexual pain
= All these active phases of the sexual response can be impaired in the presence of depression.

Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf 2014

Depression and SD
= Depression is not always the cause of SD, as SD itself can lead to depression.
----The decreased interest and pleasure in activities that is a core symptom of depression often applies to sexual function.
= SD and Depression [J Sex Med 2012]
----Depression accounting for a 50~70% increased risk of developing SD
----SD increasing the risk of developing depression by 130~210%
= In depressed patients, SD can be an added source of distress, thereby prolonging or worsening their illness.
= Sexual difficulties are extremely common among those with untreated depression.
----86% among depressed patients not receiving antidepressant treatment versus 73% in those taking these medications. [J Clin Psychopharmacol. 2007]
----Suggest that adequate treatment of the disease could promote improved sexual functioning.

Men with SD
= Frequently report problems with desire and ejaculation.
= Several barriers to the treatment:
----Own lack of knowledge about normal sexual functioning.
----Dearth of available resources and treatment options.
----Fear of embarrassment.
= Erectile dysfunction (ED) is often underreported.
----Low health literacy, cultural taboos, social stigma, and ethnic differences.
= Fewer than half of men with ED seek medical treatment.

Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf 2014

Psychogenic factors to SD in men
= Behaviour-based model:
----Depressed men’s neurotic thoughts and behaviours.
----Negatively affect arousal.
----Leading to reduced desire and sexual pleasure.
= Biological model:
----Stress of depression affects the hypothalamic–pituitary–adrenal (HPA) axis.

Diaz VA and Close JD. Male sexual dysfunction. Prim Care Clin Office Pract 2010

Prevalence of SD in depression
= Different assessment methods (spontaneous report vs direct inquiry) can produce vastly different prevalence estimates.
= Incidence of men’s SD was 60% when asked directly compared with 20% when dependent on spontaneous report.

Antidepressant-induced sexual dysfunction in men. Pharmacol Biochem Behav 2014