fluvoxamine and Sexual-Dysfunctions--Psychological

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

Topics: 1-Naphthylamine; Adult; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Paroxetine; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Sertraline; Severity of Illness Index; Sexual Dysfunctions, Psychological; Surveys and Questionnaires

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

Topics: 1-Naphthylamine; Adult; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Paroxetine; Prospective Studies; Selective Serotonin Reuptake Inhibitors; Sertraline; Severity of Illness Index; Sexual Dysfunctions, Psychological; Surveys and Questionnaires

Sexual dysfunction is a major side effect of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs). We conducted a genome-wide association study to identify the genetic factors contributing to the risk of SSRI/SNRI-induced sexual dysfunction by testing 186 320 single nucleotide polymorphism (SNP) markers in a cohort of 201 Japanese major depression patients including 36 with sexual dysfunction induced by SSRI (paroxetine or fluvoxamine) or SNRI (milnacipran). The Cochran-Armitage trend test showed that 11 SNPs, tightly clustered in a distinct region on chromosome 14q21.3, were associated with SSRI/SNRI-induced sexual dysfunction at a genome-wide significance level after false discovery rate (FDR) correction, and the strongest SNP association was with rs1160351 (P=3.04 × 10(-7), risk ratio=2.92, 95% confidence interval (CI)=1.79-4.76). These SNPs mapped to the intronic region of the MDGA2 gene. A Manhattan plot showed that the strong association peak remained in MDGA2 after adjustment for sex and age in a multivariable logistic regression analysis although P values increased slightly and became non-significant. Replication studies with larger sample sizes are required to validate this exploratory study, but our findings may provide insights into the genetic basis of sexual dysfunction induced by SSRI/SNRI.

Topics: Adrenergic Uptake Inhibitors; Adult; Aged; Aged, 80 and over; Asian People; Cohort Studies; Cyclopropanes; Depressive Disorder, Major; Female; Fluvoxamine; Genome-Wide Association Study; Genotype; GPI-Linked Proteins; Humans; Male; Middle Aged; Milnacipran; Neural Cell Adhesion Molecules; Paroxetine; Polymorphism, Single Nucleotide; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological

The safety profile of the selective serotonin reuptake inhibitor, fluvoxamine, has been assessed in clinical and post-marketing studies. Post-marketing surveillance provides the opportunity to assess a drug's safety in every day clinical conditions in a much greater patient population than in clinical trials and therefore serves as a useful tool to detect signals for adverse effects with an incidence of less than 1 : 10,000. The safety profile of fluvoxamine was evaluated based on data from 17 years of global post-marketing surveillance in an estimated 28 million patients exposed to fluvoxamine. A total of 6,658 adverse drug reaction reports received from world-wide sources were reviewed and analysed. Post-marketing surveillance data confirmed the favourable safety profile already observed in clinical and post-marketing studies. A remarkably low level of suicidality, switch to mania, and sexual dysfunction was found. Serotonin syndrome appeared to be a very rare complication of fluvoxamine treatment. No signals for drug interactions unknown so far were identified. Withdrawal symptoms were observed in everyday clinical conditions, which were generally mild and resolved spontaneously. However, no cases suggestive for drug dependence have been reported. In conclusion, the data presented underlined that fluvoxamine offers a safe and well-tolerated option in the treatment of depression and obsessive-compulsive disorder.

Topics: Antidepressive Agents, Second-Generation; Bipolar Disorder; Cardiovascular Diseases; Death; Drug Interactions; Fluvoxamine; Humans; Product Surveillance, Postmarketing; Retrospective Studies; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Sexual Dysfunctions, Psychological; Substance Withdrawal Syndrome; Suicide

Topics: Animals; Clinical Trials as Topic; Ejaculation; Fluvoxamine; Humans; Libido; Male; Rats; Receptors, Serotonin; Research Design; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Surveys and Questionnaires

Topics: Clinical Trials as Topic; Fluvoxamine; Humans; Research Design; Selective Serotonin Reuptake Inhibitors; Sexual Behavior; Sexual Dysfunctions, Psychological

Given their equal efficacy, the choice of a specific antidepressant is largely influenced by side effect (SE) profiles. A number of new agents have recently become available. However, data directly comparing the side effects of these agents are scarce. As suggested by AHCPR guidelines, we used the 1998 Physicians' Desk Reference (PDR) to construct a comparison table using treatment emergent, placebo-adjusted incidence rates for the major (gastrointestinal, central nervous system, and sexual) side effects caused by nine antidepressants (fluoxetine, paroxetine, sertraline, fluvoxamine, nefazodone, bupropion SR, mirtazapine, venlafaxine XR, and citalopram). The results were tabulated to show the relative propensity of each drug to cause a particular side effect. Bupropion SR had the most favorable overall side-effect profile, and fluvoxamine the least favorable. However, there are several limitations in using the PDR to compare the newer antidepressants. Clinical studies directly comparing SEs of newer antidepressants are needed. Sexual SEs substantially affected total SE liability. A simplified summary table, with its advantages and some limitations, is not simple to construct. Pitfalls in this process are discussed.

Topics: Antidepressive Agents; Bupropion; Central Nervous System Diseases; Citalopram; Cyclohexanols; Delayed-Action Preparations; Drug Information Services; Fluvoxamine; Gastrointestinal Diseases; Guidelines as Topic; Humans; Incidence; Paroxetine; Piperazines; Placebos; Selective Serotonin Reuptake Inhibitors; Sertraline; Sexual Dysfunctions, Psychological; Triazoles; United States; United States Agency for Healthcare Research and Quality; Venlafaxine Hydrochloride

Current literature suggests that the incidence of sexual dysfunction secondary to fluvoxamine therapy is 1% to 8%, while other selective serotonin reuptake inhibitors may have rates as high as 75%. The objective of this study was to determine the incidence of sexual dysfunction secondary to fluvoxamine in healthy volunteers.. 20 healthy volunteers (10 men, 10 premenopausal women) had adverse effects assessed at 6 visits while not receiving fluvoxamine, then twice while taking 150 mg fluvoxamine daily. Assessments occurred at 2-week intervals. Incidence rates for sexual dysfunction were calculated.. No sexual dysfunction was reported prior to fluvoxamine therapy. After 2 weeks and 4 weeks of therapy respectively, sexual dysfunction occurred in 20% (N = 4) and 35% (N = 7) of the healthy volunteers.. The incidence of sexual dysfunction during fluvoxamine therapy in healthy volunteers is 35%. This incidence is higher than previously reported and similar to that of other selective serotonin reuptake inhibitors.

Topics: Adult; Body Weight; Female; Fluvoxamine; Humans; Incidence; Male; Premenopause; Selective Serotonin Reuptake Inhibitors; Sex Factors; Sexual Dysfunctions, Psychological; Surveys and Questionnaires

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Humans; Incidence; Male; Mental Disorders; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological

Topics: Adult; Comorbidity; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fluvoxamine; Half-Life; Humans; Obsessive-Compulsive Disorder; Orgasm; Sexual Dysfunctions, Psychological

Treatment of serotonin reuptake inhibitors (SRIs) is associated with sexual dysfunction. The cause of this dysfunction is unclear but may be related to stimulation of the serotonergic system. In the present article, we describe seven patients in whom iatrogenic sexual dysfunction induced by SRIs was treated with cyproheptadine, a 5HT-2 antagonist with antihistaminergic and adrenolytic properties. Seven obsessive-compulsive male patients, aged 29-54 years, who developed sexual dysfunction following treatment with SRIs (fluoxetine, fluvoxamine, and clomipramine) were instructed to take cyproheptadine (4-12 mg) 1-2 h before commencing sexual activity. Five of the seven patients displayed improvement in sexual function, although the improvement was transitory in two. The two remaining patients did not respond. All patients exhibited sedation on the day following cyproheptadine administration. Our preliminary observation suggests that some patients with sexual dysfunction associated with SRI treatment, mainly decreased libido and anorgasmia, may benefit from cyproheptadine administration. The role of 5HT-2 antagonists in SRI-induced sexual dysfunction merits further investigation.

Topics: Adult; Clomipramine; Cyproheptadine; Female; Fluoxetine; Fluvoxamine; Humans; Male; Middle Aged; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological