Imipramine and sexual dysfunction during the long-term treatment of recurrent depression

Sleep and libido in men with obstructive sleep apnea syndrome

OBJECTIVES

The objectives of this study were to investigate the relationship between a low libido and objective sleep parameters as well as mood disturbances in patients with obstructive sleep apnea syndrome (OSA).

METHODS

We enrolled 436 untreated patients who were newly diagnosed with OSA (all male, mean age 42.8 years). Patients completed the Symptom checklist-90-Revised (SCL-90-R), Epworth Sleepiness Scale (ESS), Beck Depression Inventory-II (BDI), and Beck Anxiety Inventory (BAI). Patients were divided into low-libido and normal-libido groups according to their response to the statement "Loss of sexual interest or pleasure" on the SCL-90-R.

RESULTS

Approximately 23% of patients reported a low libido. Patients with a low libido were older (47.5 ± 9.0 vs. 41.4 ± 11.1 years; p < 0.001), had more nocturia (33.3% vs. 16.6%; p < 0.001), higher BDI (9.0 (5.0-14.0) vs. 5.0 (2.0-9.0); p < 0.001) and BAI score (11.0 (6.3-16.8) vs. 5.0 (2.0-10.0); p < 0.001). These patients had a lower non-REM sleep stage 3 (N3) % (0.1 (0-4.0) vs. 2.3 (0.1-7.9); p < 0.001). Multivariate analysis revealed that older age and higher BDI score were independent factors associated with a low libido.

CONCLUSIONS

Men with untreated OSA suffered from a low libido. Older age and depressed mood were the most important factors of low libido in middle-aged men with OSA.

Erectile dysfunction and depression: screening and treatment

The comorbid conditions erectile dysfunction (ED) and depression are highly prevalent in men. Multiple regression analysis to control for all other predictors of ED indicate that men with high depression scores are nearly twice as likely to report ED than nondepressed men. Depression continues to be among the most common comorbid problems in men with ED, both in the community and in clinical samples. This article reviews the current knowledge about the relationship between ED and depression, the effect of treatments for depression on ED, ways to improve screening for depression, and treatment of ED in patients with this comorbidity.

Prevalence and psychological impact of antidepressant-associated sexual dysfunction: a study from North India

This study attempted to estimate the prevalence and impact of sexual dysfunction on quality of life, treatment compliance, and dyadic adjustment with spouse. For this, 100 consenting subjects who had history of unipolar depression (as per Mini International Neuropsychiatric Interview) and were in remission (Hamilton Depression Rating Scale, <7) at time of intake and met the selection criteria were recruited. Then, they were assessed on Hamilton Anxiety Scale, Global Assessment of Functioning Scale, Compliance Rating Scale, Arizona Sexual Experience Questionnaire, World Health Organization Quality Of Life scale-BREF Version, and Dyadic Adjustment Scale. Twenty-three subjects were found to have sexual dysfunction. Nine subjects had dysfunction in the domain of desire, 5 had arousal difficulty, 6 subjects had problem with erection, and 8 subjects had problem with orgasm. Some of the subjects (n = 5) had sexual dysfunction in more than 1 domain. Significant difference was found between those with and without sexual dysfunction on dyadic adjustment scale and quality of life scale. However, no significant difference was seen on compliance rating scale and global assessment of functioning scale. From this study, it can be concluded that approximately one fourth of married male subjects experience antidepressant-associated sexual dysfunction. Antidepressant-associated sexual dysfunction contributes to poor quality of life and possibly contributes to poor marital adjustment. Hence, proper identification and management of sexual dysfunction is important to improve overall outcome of depression.

Chronic administration of imipramine normalizes decreased sexual motivation and increased predisposition to catalepsy induced by propylthiouracil in rats

Thyroxine synthesis inhibitors increase the predisposition to catalepsy and decrease sexual motivation and the amplitude of the acoustic startle reflex in rats. The sensitivity of these behavioral changes to antidepressants remains uncertain. Chronic administration of the classical tricyclic antidepressant imipramine (15 mg/kg, 21 days) prevented the appearance of high sensitivity to catalepsy and the decrease in sexual motivation in Wistar rats given propylthiouracil (50 mg/liter, 28 days), without altering the amplitude of the startle reflex. Normalization of behavior in response to imipramine was not associated with changes in movement activity in the open field test or the animals' body weight. There was also no change in the expression of the 5-HT2A serotonin receptor gene in the frontal cortex. The model of propylthiouracilinduced catalepsy with reduced sexual motivation in rats has potential for studying the role of thyroid abnormalities in the development of depression and the mechanisms of action of antidepressants.

What is worse for your sex life: starving, being depressed, or a new baby?

OBJECTIVE

To compare the current sexual functioning of women in an intimate relationship with anorexia nervosa, with major depression, and in the postpartum period.

METHOD

Complete data were available for 76 women who reported being in an intimate relationship (anorexia = 10; depression = 24; postpartum = 42). Sexual functioning was assessed using the Social Adjustment Scale (Weissman and Bothwell, Arch Gen Psychiatry, 33, 1111-1115, 1976).

RESULTS

Significant differences were found among groups for the frequency of sex (p =.03) and problems with sex (p < .001), but not for enjoyment of sex (p = .55). In the previous 2 weeks, women with anorexia nervosa or major depression were more likely to have had sex than postpartum women, but were also more likely to have had sexual problems than postpartum women. Most women with anorexia nervosa, women with major depression, and postpartum women reported enjoying sex.

CONCLUSION

Women with anorexia nervosa and women with major depression who are in an intimate relationship report a similar profile of current sexual functioning that is different from postpartum women both in the frequency of sexual encounters and in reported problems with sex.

The effect of hetero- and homosexual experience and long-term treatment with fluoxetine on homosexual behavior in male rats

INTRODUCTION

The selective serotonin reuptake inhibitors have become the most frequently prescribed drugs for the treatment of depression. Sexual side effects have been noted to occur with this treatment on heterosexual behavior in rats. Heterosexual experience facilitates sexual orientation of male rats and decreases the latencies to first mount and first intromission. On the other hand, homosexual behavior in male rats induced by female hormones has not been evaluated.

AIM

The objective of this work is to evaluate the effects of heterosexual and homosexual experience in male rats long-term treated with fluoxetine (FLX) on homosexual hormone-induced behavior.

MATERIALS AND METHODS

Male rats were treated with FLX or saline solution (10 mg/kg for 65 days). At days 36, 50, and 65 of the treatment, the rats were evaluated for homosexual behavior. Other rats treated with FLX or saline solution for 60 consecutive days were submitted to heterosexual behavior at 14, 21, and 28 days of the treatment. After this, they were orquiectomized and homosexual hormone-induced behavior was observed at 45 and 60 days of the treatment.

RESULTS

(1) Only treatment with FLX did not affect the homosexual behavior. (2) The homosexual experience facilitated the homosexual behavior mainly on the animals from the control group. (3) The heterosexual experience facilitated the homosexual behavior on both groups.

CONCLUSIONS

Only long-term administration of FLX does not interfere with the homosexual behavior in male rats. The homosexual and the heterosexual experience facilitated the homosexual behavior on the control and experimental groups. We suggested that learning aspects related to sexual behavior are responsible by these results.

Sexual dysfunction in Saudi depressed male patients

INTRODUCTION Sexual dysfunction is common among depressed male patients; however, its causes are complex and multifactorial. The aim of this study is to identify risk factors for sexual dysfunction associated with depression. METHODS One hundred and twenty-five consecutive depressed male patients were interviewed at Jeddah Psychiatric Hospital. They were divided in to two groups, on the basis of whether they had sexual dysfunction or not. These two groups were then compared on a number of potential risk factors, using chi-square and odds ratio. RESULTS The majority of patients had not previously been asked about sexual dysfunction. Seventy-seven (62%) presented with sexual dysfunction and 48 (38%) without. Marital difficulties, hypertension, diabetes, severity of depression and tricyclic antidepressants were significant risk factors. No association was found with demographic origin, occupation, education or marital status. These results are similar in some aspects to those reported in western studies. CONCLUSIONS (a) The majority of doctors do not take a sexual history despite its high prevalence. (b) Physical illness and overall severity of depression were important risk factors.

Recent developments in the psychobiology and pharmacotherapy of depression: optimising existing treatments and novel approaches for the future

Effective antidepressants include monoamine oxidase inhibitors and tricyclic antidepressants, selective serotonin re-uptake inhibitors and novel agents, including serotonin and noradrenaline re-uptake inhibitors. Although effective, current treatments most often produce partial symptomatic improvement (response) rather than symptom resolution and optimal functioning (remission). While current pharmacotherapies target monoaminergic systems, different symptoms of major depressive disorder (MDD) may have distinct neurobiological underpinnings and other neurobiological systems are likely involved in the pathogenesis of MDD. In this article a review of current pharmacotherapeutic options for MDD, current understanding of the neurobiology and pathogenesis of MDD and a review of new and promising directions in pharmacological research will be provided. It is generally accepted that no single neurotransmitter or system is responsible for the dysregulation found in MDD. While agents that affect monoaminergic systems will likely continue to be first-line treatments for MDD for the foreseeable future, a number of new and novel agents, including corticotropin-releasing factor antagonists, substance P antagonists and antiglucocorticoids show considerable promise for refining treatment options. In order to better understand the neurobiology and treatment response of MDD, it is probable that more sophisticated theory-driven typologies of MDD will have to be developed.

Sister chromatid exchanges produced by imipramine and desipramine in mouse bone marrow cells treated in vivo

Imipramine and desipramine are two widely used tricyclic antidepressants which have shown conflicting results in regard to their in vitro genotoxic evaluation. The aim of this investigation was to determine the capacity of these compounds to induce in vivo sister-chromatid exchanges (SCEs) in mouse bone marrow cells. For each compound, the animals were organized in five groups constituted by five individuals. They were intraperitoneally (ip) administered with the test substances as follows: a negative control group treated with 0.4 ml of distilled water, a positive control group administered with cyclophosphamide (70 mg/kg), three groups treated with imipramine (7, 20 and 60 mg/kg), and three other groups treated with desipramine (2, 20 and 60 mg/kg). The general procedure included the subcutaneous implantation to each mouse of a 5-bromodesoxyuridine tablet (45 mg), and 1 h later, the administration of the chemicals involved. Twenty-one hours after the tablet implantation, the mice received colchicine, and 3 h later their femoral bone marrow was obtained in KCL, fixed, and stained with the Hoechst-Giemsa method. The results showed that both compounds were SCE inducers, starting from the second tested dose. The response of these compounds was dose-dependent, and showed that the highest tested dose increased about four times the SCE control level. The cellular proliferation kinetics was not affected by the chemicals, and the mitotic indexes were slightly diminished with the highest dose. These results indicate an in vivo genotoxic potential for both chemicals, and suggest that it is pertinent to follow their evaluation in other models.

Depression and sexual dysfunction

Adequate sexual expression is an essential part of many human relationships, and may enhance quality of life and provide a sense of physical, psychological and social well-being. Epidemiological and clinical studies show that depression is associated with impairments of sexual function and satisfaction, even in untreated patients. Most antidepressant drugs have adverse effects on sexual function, but accurate identification of the incidence of treatment-emergent dysfunction has proved troublesome, as disturbances of the sexual response can only be detected in a reliable fashion when systematic enquiries are made before and during the course of treatment. Growing awareness of the adverse effects of many antidepressants on sexual function has led to attempts to resolve dysfunction though adjuvant or substitution treatment approaches. There is a need for further studies of the effects of antidepressants on sexual function.

Sexual dysfunction before antidepressant therapy in major depression

BACKGROUND

Decreased sexual interest and function both occur as a consequence of antidepressant medication use, and are especially associated with serotonin reuptake inhibitors (SRIs). However, few investigators have reported the base rate for disturbances in sexual desire, arousal and orgasm or ejaculation in patients with major depression (MD) prior to antidepressant treatment. The purpose of this report is to define the frequency of sexual dysfunction (SD) in 134 patients with MD and examine the relationship between SD and demographic, clinical and personality variables.

METHOD

A consecutive series of 55 male and 79 female MD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire, which asked about change in sexual interest and function as well as sexual activity during the preceding month.

RESULTS

Only 50% of women and 75% of men reported sexual activity during the preceding month. Over 40% of men and 50% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (40-50%) than ejaculatory or orgasm difficulties (15-20%). In women, problems with arousal and orgasm correlated with higher neuroticism and lower extraversion. There was no relationship between SD and personality measures in men. While age at onset of depression and number of prior episodes showed a modest correlation with SD measures, there were no correlations with severity of depression or specific symptoms clusters.

LIMITATIONS AND CONCLUSIONS

Although limited by a relatively small sample of drug free patients with MD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of antidepressant related sexual dysfunction.

Homeostatic disruption and depression

A putative model is presented for the nature of depression. It relies upon changes in core and defense homeostatic activity, subjecting the person either to minor or major depression. The former corresponds with the interaction between assessed brain emotion and altered organic elements which disrupt homeostasis. This is in contrast to the latter, which corresponds with the disruption of several homeostatic systems. We suggest that the frequency and severity of depression may be regulated by biological markers that represent the homeostatic baseline of biochemical, biophysical and mutual data system appraisals. In this framework, the relationship of the coefficient to the baseline of the homeostatic threshold levels evaluates the intensity of depression. The type of depression depends on the properties of the negative feedback mechanism which are replaced either by abnormal (retarded depression), or by a positive feedback mechanism (agitated depression). Homeostasis eliminates depression.

Treatment of antidepressant-induced sexual side effects

Sexual side effects of antidepressant medications are becoming more frequently encountered by patients who require pharmacotherapy. A MEDLINE search was conducted to generate articles that address methods of treating these iatrogenically induced clinical situations. We report here on treatment strategies to alleviate these adverse events. We conclude that clinicians should routinely ask about sexual side effects due to antidepressants and that they should be treated promptly to ensure patient compliance with antidepressant pharmacotherapy.

Sexual side effects of antidepressants: a review

Antidepressant-induced adverse sexual effects are becoming more frequently reported by patients who require pharmacotherapy. A MED-LINE search was conducted to generate articles reporting such events. We report here on the sexual side effects associated with tricyclics, monoamine oxidase inhibitors including moclobemide, selective serotonin reuptake inhibitors, bupropion, and on the newer antidepressants venlafaxine and nefazadone. We conclude that adverse sexual effects are an increasingly important side effect of antidepressant medications, and patients must be routinely asked about their occurrence.