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Sexual dysfunction during long-term treatment with antidepressants in unipolar disorder: clinical and management aspects

Disfunzione sessuale nel corso di terapia a lungo termine nel disturbo unipolare: aspetti clinici e di management

L. Franchini, M. Ciracì, C. Redaelli, C. Colombo

Dipartimento di Scienze Neuropsicologiche, Università Vita-Salute, Ospedale "San Raffaele-Turro", Milano

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Summary

Objective

Major depression is a chronic condition. Treatment with antidepressants is often stopped due to long-term side effects. Antidepressants are frequently associated with sexual dysfunction (SD), which can have a negative impact on adherence to treatment and quality of life, although it is often underestimated by clinicians and underreported by patients. The purpose of the present study is to determine the presence of SD using specific self-rating scales in a sample of euthymic unipolar patients undergoing long-term treatment with antidepressants.

Method

The sample was recruited from the Neuroscience Department of San Raffaele-Turro Hospital in Milan. A total of 66 female and 31 males, with a mean age of 55.2 ± 12.5 years and a mean number of episodes of 3.7 ± 3.3, were included. Patients answered specific questionnaires for quality of life (WHOQoL) and sexual dysfunction (SD): IIEF for males and FSFI females. The possible role of sexual dysfunction on long-term adherence to treatment was also evaluated using the MARS self-rating scale. The euthymic condition was assessed with the Hamilton depressive rating scale (mean score < 8).

Results

73.2% of the patient population reported SD, affecting all sexuality domains. Self-rating scales showed high levels of SD in both males and females: in males, the total mean IIEF score was 34.25 ± 20.35; in females, the total mean FSFI score was 15.22 ± 11.26. A majority of patients (55.6%) reported the presence of SD associated with antidepressant therapy, 37.11% referred SD only during a depressive episode and 7.12% reported pre-existent SD. The quality of life was affected by SD in the Environment (p = 0.000), Physical Health (p = 0.000) and Social Relationship (p = 0.000) domains. In males, the quality of life was not affected by SD. However, in females all domains were compromised (Physical, p = 0.001; Psychological, p = 0.022; Environment, p = 0.001; Social Relationship, p = 0.018). All patients with SD showed poorer adherence to therapy (p = 0.001). Male subjects with SD were characterized by greater scores in the subscale that evaluates intentional non-adherence (p = 0.041), while female subjects with SD had lower global adherence to therapy (p = 0.018) and to common stereotypes about antidepressants (p = 0.003). With regard to clinical variables, male subjects with SD were characterized by a shorter duration of both euthymia (p = 0.005) and antidepressant therapy (p = 0.007).

Conclusion

Long-treatment antidepressant treatment is associated with SD regardless of gender. In this study, unipolar patients with SD undergoing long-term antidepressant therapy showed a poorer quality of life and lower adherence to treatment, compared to those without SD, thus increasing the risk of recurrence. Adequate assessment of sexual side effects during antidepressant therapy can help in better defining symptomatic remission. Thus, evaluation of sexual side effects and their management are key points in choosing the optimal therapy for depression and improving physician-patient relationships.