Antidepressant-Induced Sexual Dysfunction

OBJECTIVE:

To review the evidence regarding antidepressant-induced sexual dysfunction and address implications for treatment strategy and health plan coverage policies for antidepressant medications.

DATA SOURCES:

Primary articles were identified by a MEDLINE and HealthSTAR search to identify English-language studies published between January 1986 and July 2000. Search terms included sexual dysfunction or sexual function and antidepressants, fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, venlafaxine, nefazodone, bupropion, and mirtazapine. A cross-check of references cited in 10 published reviews yielded additional in-scope articles.

STUDY SELECTION AND DATA EXTRACTION:

Approximately 200 articles were identified, including 8 randomized controlled trials and numerous open-label studies, case series, and case reports. Of the randomized controlled trials, only 5 were designed to evaluate the incidence of sexual dysfunction associated with antidepressant treatment. Three additional randomized controlled trials included a structured assessment of sexual dysfunction within an efficacy trial. Data extraction excluded case reports, letters, and other limited study designs. A panel survey augmented published reports.

DATA SYNTHESIS:

Sexual dysfunction is a relatively common adverse effect of many of the antidepressants in common use today. Rates of sexual dysfunction observed in clinical practice may be higher than those reported in the product information for several agents. Selective serotonin-reuptake inhibitors (SSRIs) appear to be the class of antidepressants most likely to cause sexual dysfunction. Published studies suggest that between 30% and 60% of SSRI-treated patients may experience some form of treatment-induced sexual dysfunction. Bupropion and nefazodone appear to be much less likely to cause sexual dysfunction (≤10% of patients). Mirtazapine also appears to be associated with a low rate of sexual adverse effects. Panel results largely reflect the consensus of the literature.

CONCLUSIONS:

Sexual dysfunction is a common adverse effect of antidepressant treatment. Physicians should monitor their patients for antidepressant-induced sexual adverse effects, as these may affect compliance with therapy and ultimate treatment success. In addition to the consequences for patient health and well-being, managed-care organizations should be concerned with sexually related adverse effects of antidepressants, insofar as additional healthcare resources may be required to treat depressed patients in whom these adverse effects arise.

Sternocleidomastoid imbalance versus congenital muscular torticollis: their relationship to positional plagiocephaly

OBJECTIVE

The purpose of this study was to investigate the existence of sternocleidomastoid (SCM) imbalance in a plagiocephalic population and further clinically describe its difference, if any, from congenital muscular torticollis (CMT). If SCM imbalance is different from CMT, then the development of terminology and a differential diagnosis may allow early recognition and intervention and possible prevention of positional plagiocephaly in the first place.

DESIGN

This was a retrospective, random review of 100 patients referred for orthotic correction of their positional plagiocephaly.

SETTING

The data was collected in a private orthotic clinic and was directed by a physical therapist. The patients were seen on a weekly or biweekly basis.

PATIENTS

Eighty-three patients diagnosed with positional plagiocephaly that were referred for Dynamic Orthotic Cranioplasty during 1996 were studied.

RESULTS

Sixty-four percent of the sample was identified as having SCM imbalance and 12% was diagnosed with CMT. There were no statistically significant differences between the characteristics of these two groups in relation to the etiological factors of positional plagiocephaly. The only observed difference was related to symptoms of the neck itself.

CONCLUSIONS

Seventy-six percent of the sample was found to have some degree of SCM dysfunction, whether it be SCM imbalance or CMT. The finding that over three quarters of our population suffers from some form of SCM dysfunction, either SCM imbalance or CMT, suggests that any degree of SCM dysfunction may act as a precursor to positional plagiocephaly and therefore should be recognized and treated at the earliest opportunity.

Treatment of craniofacial asymmetry with dynamic orthotic cranioplasty

Dynamic Orthotic Cranioplasty (DOC) was developed to treat craniofacial deformities associated with positional plagiocephaly. This investigation describes the treatment of more than 750 patients with the DOC Band since 1988. All patients undergoing DOC treatment were fit with a custom fabricated orthosis made from a plaster impression taken from the infant's head. When the orthosis was applied, the corrective pressure was directed to hold growth at the calvarial prominences and redirect symmetrical growth. A detailed medical history was obtained and anthropometric measurements were taken at start, exit, 12, 18, and 24 months follow-up. This information was recorded in a database created in Microsoft Excel. Mean length of treatment was 4.3 months with an average entrance age of 6.9 months. Analysis of anthropometric data showed significant reduction in mean cranial vault, skull base, and facial asymmetries. Correction of the more difficult skull base was documented with computed tomography. Our anthropometric and clinical observations document complete or near complete correction of asymmetry for a wide variety of head shapes. Based on the results of this investigation, we are able to support the earlier claims of our pilot study, which concluded that DOC is effective in the treatment of positional plagiocephaly.