Effect of Antidepressant Treatment on Sexual Dysfunction

Effect of Antidepressant Treatment on Sexual Dysfunction IMPROVEMENT IN SEXUAL DYSFUNCTION FOLLOWING ANTIDEPRESSANT TREATMENT IN DEPRESSED FEMALES *Dr. Abhivant Niteen N. 1, Dr. Sawant Neena S.2, ABSTRACT Introduction: Depression is associated with sexual dysfunction. As the depression improves sexual dysfunction also improves. There are not many studies on female sexuality. Aims and objectives: To find out the changes in sexual functioning in depressed females after treatment with anti-depressant drugs. Method: 41 female patients diagnosed to have depression were included in study. Becks Depression Inventory and Female Sexual Functioning Index scales were applied at the beginning and after 6 weeks to assess the improvement in sexual dysfunction and depression. Results: When scores were compared after 6 weeks of antidepressant treatment then a highly significant difference was seen on all the scores of BDI ( pConclusions: This study showed significant improvement in sexual dysfunction and different aspects of sexual dysfunctions after treatment with antidepressants for 6 weeks. Keywords: Female sexual dysfunction, Depression, SSRI, FSFI. INTRODUCTION: The issue of sexual health, once regarded as taboo subject, has been widely debated recently. Reliable estimates of incidence and severity of sexual dysfunctions in females is difficult to obtain as the patients are often unwilling to raise the issue of sexual health with health professionals and both the patient and the physician may be reluctant to discuss it. Female sexual dysfunction is multifactorial and multidimensional condition combining biological, psychological and interpersonal determinants [1]. Although sexual dysfunctions are not life threatening, they have major impact on personal relationships, physical health and quality of life. There are several studies on male sexual dysfunctions in India [2] but literature on the prevalence of sexual dysfunction among women is particularly scant [3, 4]. The prospective Zurich cohort study shows that the prevalence of sexual problems in depressed subjects is approximately twice that in controls [5]. A number of investigators have reported various sexual dysfunctions associated with depression [1, 6, 7, 8].Female sexual function is also regulated by a variety of neurotransmitters and hormones. Estrogen, testosterone and progesterone promote sexual desire; dopamine promotes desire and arousal, and norepinephrine promotes arousal [9, 10]. Prolactin inhibits arousal, and oxytocin promotes orgasm [11]. Hence a need was felt to look into the aspects of female sexual dysfunctions and it’s relation to underlying depression and drug therapy. Increased awareness of this problem in medical community will lead to further research in female sexual dysfunctions and improved treatment. AIMS AND OBJECTIVE To find out the changes in sexual functioning in depressed females after treatment with anti-depressant drugs. MATERIAL AND METHODS This study was a prospective (6 week) study conducted in a psychiatry outpatient department of a general municipal hospital. The sample consisted of 52 female patients who were diagnosed to have depression as per Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text revision, criteria after satisfying inclusion and exclusion criteria. INCLUSION CRITERIA: 1) Females diagnosed to have depression as per Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text revision 2) Those who were willing to participate in the study. 3) Language compatibility. EXCLUSION CRITERIA: 1) Females less than 18 years of age. 2) Those with past history of depression or any psychiatric illness. 3)Those who were on any other psychotropic medications. 4) Sexual dysfunction prior to depression. 52 female patients were screened of which 3 patients refused the consent and so had to be dropped out of the study. 49 female patients gave consent and so were enrolled in the study protocol. Of the 49 patients, 8 patients dropped out of the follow-up period over 6 weeks. At the end of 6 weeks, 41 patients were available for analysis. All patients were explained about the nature of study and it’s applications and informed consent was obtained from patients. A proforma was designed to enquire into the socio-demographic details, details of psychopathology, presence of sexual dysfunctions and questions pertaining to aims and objectives of study. All the patients were interviewed in presence of female co-investigator or another lady doctor or a nurse and were interviewed in drug naà ¯ve state and then they were started on any of the Selective Serotonin Reuptake Inhibitor medications viz Sertraline, Escitalopram for underlying depression. All the patients were administered Beck’s Depression Inventory and Female Sexual Functioning Index Scale in the drug naà ¯ve state and all the scales were again administered at the end of 6 weeks of anti-depressant medication to gauge the improvement in mood and sexual functioning. TOOLS: 1) BECK’S DEPRESSION INVENTORY: Developed by A. Beck [12] is a rating to measure the severity of depression in which individuals rate their own symptoms of depression. This is a 21 item scale which evaluates the key symptoms of depression including mood, pessimism, sense of failure, self dissatisfaction, self accusation, self dislike, guilt, punishment, suicidal ideas, crying, irritability, social withdrawal, indecisiveness, body image changes, insomnia, fatigability, loss of appetite, weight loss, somatic pre-occupation and loss of libido. Individuals are asked to rate themselves on a 0 to 3 spectrum [0=least, 3=most] with a score range of 0 to 63. Total score is a sum of all items. 2) FEMALE SEXUAL FUNCTIONING INDEX [13]: The Female Sexual Functioning Index is a 19 item questionnaire. It is a brief, multidimensional, self report instrument to assess the key dimensions of sexual function in females. It assesses six domains of sexual function including 1) Desire 2) Physical arousal-sensation Physical arousal-lubrication 4) Orgasm 5) Satisfaction and 6) Pain. All the scales were translated in Marathi and Hindi and were validated by the departmental staff before administration. DATA ANALYSIS: All analyses were done with SPSS statistical version 11 at 5% significance. The changes in tools (Beck’s Depression Inventory, Female Sexual Functioning Index) were analyzed pre and post treatment using the paired‘t’ test. RESULTS The mean age of this sample (n=49) was 28.9 years (+_ 3.03 yrs) with range of 23- 39 years and majority (81.6%) patients were from 25-31 years age group. Majority (63.26%) of patients had completed their secondary education and 94% were home makers with hardly 6% of them doing some job. As expected, about two-third (67.34%) were Hindus. The mean duration of depression was 2 years with standard deviation of 1.8 years with range being from 3 months to 7 years. When all the patients were assessed for improvement in their depression and areas of sexual functioning after a 6 week treatment with SSRI’s viz. Escitalopram (optimum dose 10 to 15 mg) and Sertraline (100mg), then a highly significant difference was seen on all the scores of BDI ( p On the various domains of FSFI a highly significant difference was seen on the domains of Arousal (p DISCUSSION Depressive disorders are among the most prevalent psychiatric disorders [14]. Depression is characterized by loss of interest, reduction in energy, lowered self-esteem and inability to experience pleasure, irritability and social withdrawal which may impair the ability to form and maintain intimate relationships. This constellation of symptoms may be expected to produce difficulties in sexual relationships, and depression has long been associated with sexual problems [15]. A number of investigators have reported association between sexual dysfunctions and depression [1, 6, 7, 8]. Depression is also associated with various neurotransmitter changes which may also contribute to sexual dysfunction in depression [10, 16, 17]. Our study showed that as depression improves, sexual functioning also improves which has been corroborated by Piazza [18] who had studied depressed women with greater sexual dysfunction at baseline and improvement in sexual functioning with treatment with SSRI’s in areas of improvement in sex drive, physiologic and psychological arousal. SSRI’s due to their antidepressant action improve the depression which may consequently reduce the various faulty cognitions associated with depression and enhance the person’s self esteem and energy. Also as the depression improves the various biological changes associated with it also improves which may also contribute to the reduction in sexual dysfunction. In short, with reversal of biological and psychological changes sexual dysfunction improves with SSRI treatment. There are also various studies which have linked SSRI’s with sexual dysfunction and have been discussed in critical reviews [19, 20] but Montgomery and colleagues [21] have also pointed out numerous obstacles to establishing the exact prevalence of antidepressant-related sexual dysfunction. Sex is more than a physical act. It also includes emotional and psychological dimensions. Studies have also shown that besides antidepressants many other factors influence the incidence and prevalence of sexual dysfunction in patients with depression. These include factors such as, depression itself, cultural and social factors and physical and psychiatric co-morbidities [21]. Given the scarcity of evidence-based treatments, the management of sexual dysfunction is still an art rather than a science. Even a seemingly clear-cut case of medication-associated sexual dysfunction should not be treated in a vacuum or in a strictly biological sense. The overall treatment should always take into consideration psychological factors and normal fluctuation of sexual functioning. ACKNOWLEDGEMENTS: We sincerely acknowledge the support and guidance of Dr. Shubhangi Parkar, Professor and Head, Department of Psychiatry, Seth G. S. Medical College and K. E. M. Hospital, Parel, Mumbai. 400012 REFERENCES: 1. Mathew RJ, Weinman ML: Sexual dysfunctions in depression. Arch Sexual Behav.1982; 11: 323–328 2. Verma K.K. et al: The frequency of sexual dysfunctions in patients attending a sex therapy clinic in north India, Arch sex behav.1998; 27: 309-314 3. Kulhara P, Avasthi A. Sexual dysfunction on the Indian subcontinent. Int Rev Psychiatry.1995; 7: 231-9 4. Avasthi A, Kaur R, Prakash O, Banerjee A, Kumar L, Kulhara P. Sexual behavior of married young women: A preliminary study from north India. Indian J Community Med.2008; 33: 163-7 5. Angst J. Sexual problems in healthy and depressed patients. Int Clin Psychopharmacol.1998; 13 (Suppl 6): S1–3 6. Clayton A H et al: assessment of Paroxetine induced sexual dysfunction using the changes in sexual functioning questionnaire: Psychopharmacol Bull.1995; 31: 397-413 7. Harvey K. V., Balon R: Clinical implications of antidepressant drug effects on sexual functioning; Ann Clin Psychiatry.1995; 7: 189-201 8. Harrison W.M. et al; Effects of an antidepressant medication on sexual function, a controlled study: J Clin Psychopharmacol.1986; 6: 144-149 9. Buss DM. The evolution of desire: Strategies of human mating. London: Harper Collins; 1994. p. 84-5. 10. Bloom FE. Brain, mind and behaviour. W.H. Freeman Co. 1985-88. p.208-17, 227-8. 11. Panksepp J. The foundfations of human and animal emotions.. New York. Oxford University Press. 12. Beck A T et al: â€Å"Psychometric properties of Beck Depression Inventory: Twenty five years of evaluation†. Clin Psychol Rev.1988; 8: 77-100 13. R Rosen et al: Journ of Sex and Marital therapy.2000; 26: 191-208 14. Rihmer Z, Angst A.; Mood disorders: Epidemiology: in Comprehensive Textbook Of Psychiatry; Sadock B J, Sadock V. A.; 8th edition, Lippincott Williams And Wilkins; 2004. 15. Baldwin DS. Depression and sexual function. J Psychopharmacol.1996; 10 (Suppl. 1): S30–34 16. Clayton A H. Sexual dysfunction in depression. Tricks of the trade in the long-term treatment of depression. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. 17. Levin R. J. et al: The mechanism of human female sexual arousal; Ann Rev Sex Res.1992; 3: 1-48 18. Piazza L. A., Markowitz J. C., Kocsis J.H.: Sexual functioning in chronically depressed patients treated with SSRI Antidepressants: A pilot study; Am J Psychiatry.1997; 154: 1757-1759 19. Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacology.1999; 19: 67–85 20. Williams VSL, Baldwin DS, Hogue SL, Fehnel SE, Hollis KA, Edin HM: Estimating the prevalence and impact of antidepressant-induced sexual dysfunction in 2 European countries: a cross-sectional patient survey. J Clin Psychiatry.2006; 67: 204–210 21. Montgomery SA, Baldwin DS, Riley A: Antidepressant medications: a review of the evidence for drug-induced sexual dysfunction. J Affect Disord. 2002; 69: 119–140

Personal Portfolio Essay

My journey as a student started out as a young child. Coming from nurturing parents, I was always taught my ABC’s, 123’s and colors. I was an eager student and when it was time to go to school, I was excited and motivated. As I moved on in my educational career, I didn’t keep with the same attitude I started with when I was younger. I feel now, I’ve regained my passion to be a student with the maturity I’ve gained over just this past year. I feel that I will always be a student because I will never cease to learn. I’ve been successful and unsuccessful in my efforts in my formal education. With each new endeavor I take, I learn something new about myself and what I can handle. One of the biggest things I’ve accomplished was the completion of high school. For me, my high school years were some of my darkest. I was in regular day school or the first two years and because of personal issues spent the last two years on home instruction. Being able to graduate with a high school diploma in the allotted 4 year time span meant so much to me and still does. Another successful experience I’ve had before coming to MCC was obtaining my Medical Assistant Certification. I worked in the field for some time and decisions I made in my life, lead me to give away what I had worked so hard for. The most recent and successful thing I’ve done thus far is coming to MCC. Before enrolling here, I was in a very lost and dark place in my life. I wasn’t sure if I was ever going to get out. I was given an opportunity at a second chance and I am going to take full advantage of it this time around. I’ve encountered many challenges along the way; some of them I’ve even let stunt me in my growth as a person in society. When I was in grammar school, I lost my father suddenly, as I entered high school I fell into the wrong crowd of friends and my life took a turn down the wrong path for a while and I have a diagnosed mental illness that makes everyday life difficult sometimes. I’ve learned that I need to be open and honest with my life in order to get better. How I’ve learned cope with theses everyday challenges it to just face every day and know my limits. I attend self-help groups that have changed my life and afforded me with nineteen months clean and showed me there is a better way to live. I decided to enroll in Middlesex County College because I need a change of pace. Before coming to MCC, I was stagnant; I wasn’t sure I’d ever move from the dreary place I found myself in. When the Fall 2012 semester was about to close, I had a choice, was I going to participate in life or was another year going to pass me by? I made a decision to put all my fears aside and enroll. Honestly, the first few weeks of that fall semester were great. I felt on top of the world, things were coming so easy. Then reality started to set in. I saw that I was in remedial classes and my friends were in more advanced courses some even in universities. Life started to show up and responsibilities were beginning to knock on my door and tests were on days I wanted to have for myself. I felt trapped and on some days, I really wanted to give up. However, I kept pushing forward because I know that I came this far and wasn’t going to give up over a little pressure. Plus, I had so much support from the people that love me I was doing this more for just selfish reasons this time. I’m not sure how my professors this semester would describe me being we’ve only known each other a short period of time. Going on the opinion of last semester’s professors, I feel they would describe me as outgoing and responsible. I remain accountable for the things I do and the things I don’t do. I’m on time for classes and not shy about asking for help or staying after class to voice a concern. That is something I’ve learned in my short time as a college student and it’s taught me well. An academic goal of mine in the short term has been in the short term to complete my remedial classes and some of my basic psychology classes. In the long term I would then like to matriculate to Rutgers University to complete my Bachelor’s degree. It has always been a dream of mine to graduate from the University my mother did. Although I don’t want to follow in the medical field the same way my mother did, I still want to obtain my doctorate as she did. I feel it is in my blood to help people, just in different ways. I plan to accomplish this goal by staying focused on my plan and using my time wisely. I need to start to identify my weaknesses and work on them more thoroughly. I need to obtain better study skills begin to prepare to the weeks ahead instead of the just the week or the day. Also, I need to get out of the mindset that things will get done for me or over time just go away; in life, things don’t happen like that. In conclusion, I plan to take my new lease on life and my academic career very seriously. I have a pretty good understanding what is ahead of me of me given I keep doing the next right thing. On the other hand I know what is waiting for me if I slip and go back to the life I was leading before I made the decision to change and start this new way of life. The good thing about today is today I am free and have a choice of what I want to do. I no longer have to be dictated to on what I have to get done, it’s my life and from this point on I will decide how I will live each day.

Academic English And Academic Language - 1753 Words

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Analysis of Ioi Corporation Berhad Performance Based on 5...

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