sildenafil-citrate and Depressive-Disorder

This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication.. Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction.. Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo.. The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Topics: Antidepressive Agents; Depressive Disorder; Female; Humans; Male; Piperazines; Placebos; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

This article examines the relationships among depression, ischemic heart disease, and erectile dysfunction. Depression is an independent risk factor for the development of ischemic heart disease, and depression in the post-myocardial infarction patient is associated with increased morbidity and mortality. Ischemic heart disease and erectile dysfunction are also frequently comorbid and share many common risk factors including age, hypertension, diabetes, dyslipidemia, obesity, sedentary lifestyle, and smoking. Depression and erectile dysfunction often occur together; however, the causal relation may be difficult to determine because erectile dysfunction may be a symptom of depression, social distress accompanying erectile dysfunction may precipitate depressive symptoms, or both conditions may result from a common factor such as vascular disease.

Topics: Adult; Aged; Blood Circulation; Catecholamines; Comorbidity; Depressive Disorder; Erectile Dysfunction; Humans; Hydrocortisone; Male; Middle Aged; Models, Biological; Myocardial Ischemia; Piperazines; Purines; Risk Factors; Sildenafil Citrate; Sulfones; Treatment Outcome

Normal sexual function is a biopsychosocial process; sexual dysfunction almost always has organic and psychological components and requires multidisciplinary, goal-directed evaluation and treatment. Factors such as aging, declining testosterone levels, medical illness, certain medications. and comorbid depressive illness can contribute to sexual dysfunction. Erectile dysfunction is one of the more common male sexual dysfunctions encountered in the clinical setting. Comorbidity between erectile dysfunction and depressive illness is high, but the causal relationship is unclear. The psychosocial distress that often accompanies erectile dysfunction might stimulate the development of depressive illness, or, as some data suggest, depression might cause erectile dysfunction. This article reviews the literature on the relationship between depression and erectile dysfunction, as well as the design of a new study that may provide some answers, and concludes that erectile dysfunction is a common, treatable condition that may cause or be the result of depression. Recent data suggest that sildenafil is an effective treatment for erectile dysfunction in men with comorbid depression. Erectile dysfunction should be considered a multifactorial condition that may require a multidisciplinary approach to treatment, especially when depression is present.

Topics: Adult; Age Factors; Aged; Aging; Antidepressive Agents; Comorbidity; Depressive Disorder; Erectile Dysfunction; Humans; Male; Meta-Analysis as Topic; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; United States

Sexual dysfunction and dissatisfaction are common symptoms associated with depression. Optimal antidepressant treatment should result in remission of the symptoms of the underlying illness and minimize the potential for short- and long-term adverse effects, including sexual dysfunction. Sexual dysfunction and dissatisfaction are frequently persistent or worsen with the use of some antidepressant medications; this sexual dysfunction and dissatisfaction can have negative impact on adherence to treatment, quality of life, and the possibility of relapse. Successful management of sexual complaints during antidepressant treatment should begin with a systematic approach to determine the type of sexual dysfunction, potential contributing factors, and finally management strategies that should be tailored to the individual patient. The basic physiologic mechanisms of the normal sexual phases of libido, arousal, and orgasm and how these mechanisms may be interrupted by some antidepressants provide a framework for the clinician to utilize in order to minimize sexual complaints when initiating and continuing antidepressant treatment. This article provides guidelines, based upon this type of model, for the assessment, management, and prevention of sexual side effects associated with antidepressant treatment.

Topics: Antidepressive Agents; Bupropion; Buspirone; Central Nervous System Stimulants; Depressive Disorder; Drug Administration Schedule; Female; Humans; Male; Patient Compliance; Piperazines; Purines; Quality of Life; Secondary Prevention; Serotonin Antagonists; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Sulfones

Topics: Cardiovascular Diseases; Depressive Disorder; Diabetes Complications; Erectile Dysfunction; Humans; Hypertension; Male; Phosphodiesterase Inhibitors; Piperazines; Prostatic Diseases; Purines; Sildenafil Citrate; Smoking; Sulfones

Normal sexual function is a biopsychosocial process; sexual dysfunction almost always has organic and psychologic components, and it requires multidisciplinary, goal-directed evaluation and treatment. Factors such as aging, declining testosterone levels, medical illness, certain medications, and comorbid depressive illness can contribute to sexual dysfunction. Erectile dysfunction (ED) is the most common male sexual dysfunction encountered in the clinical setting. Comorbidity between ED and depressive illness is high, but the causal relationship is unclear, and likely bidirectional. In this article, we review the existing literature on the relationship between depression and ED.

Topics: Comorbidity; Depressive Disorder; Dopamine Agonists; Erectile Dysfunction; Humans; Male; Piperazines; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Depressive Disorder; Diabetes Complications; Erectile Dysfunction; Humans; Hypertension; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones

Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem.. In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions.. This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Depressive Disorder; Double-Blind Method; Erectile Dysfunction; Expressed Emotion; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Prostatic Hyperplasia; Purines; Quality of Life; Self Concept; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Young Adult

Erectile dysfunction (ED) is commonly associated with depressed mood and diminished quality of life (QoL), but few studies have investigated the causal associations involved. Therefore, we evaluated the correlation between several measures of mood, QoL, and sexual function in a retrospective analysis of a sample of depressed men (n=152), with ED enrolled in a clinical trial of sildenafil citrate (VIAGRA). Strong correlations were observed at baseline among measures of erectile function (EF), mood, and overall QoL. Significant treatment effects were observed on all three domains, with significant interactions between changes in mood and QoL. Based on multiple regression and path analysis, a model was developed in which EF changes were associated with improved mood and quality of sexual life, which resulted in improved partner satisfaction, family life, and overall life satisfaction. These data suggest that QoL changes associated with ED therapy may be mediated by changes in sexual function, mood, and family relationships.

Topics: Adolescent; Adult; Affect; Depressive Disorder; Double-Blind Method; Erectile Dysfunction; Humans; Male; Models, Psychological; Phosphodiesterase Inhibitors; Piperazines; Psychiatric Status Rating Scales; Purines; Quality of Life; Regression Analysis; Sexual Behavior; Sildenafil Citrate; Sulfones; Treatment Outcome

Selective serotonin reuptake inhibitor (SSRI)-induced ejaculatory delay is a common problem that has no treatment with established efficacy. Sildenafil citrate is effective for erectile dysfunction and appears to be safe at doses up to 200 mg.. We enrolled men who were in remission from depression according to DSM-IV criteria and who reported that they had developed new-onset ejaculatory delay in the setting of SSRI treatment. Enrolled patients were instructed to use 25 mg of sildenafil 1 hour prior to sexual activity on at least 2 occasions. If this was not effective for the ejaculatory delay, they were instructed to increase the dose progressively up to a maximum of 200 mg. We compared baseline sexual functioning to 2 phases of open treatment: low-dose phase (sildenafil 25-100 mg) and high-dose phase (sildenafil 150-200 mg). The primary outcome measure was a modified, self-report Clinical Global Impressions (CGI) scale that was specific for erectile (CGI-EF) and ejaculatory (CGI-EJF) aspects of sexual function.. Twenty-one men (mean age = 56 years) with major depressive disorder (MDD) in remission and SSRI-associated ejaculatory delay enrolled in the study and received sildenafil. At baseline, 14 of 21(67%) had comorbid erectile dysfunction. At the low-dose phase follow-up assessment, 12 of 14 achieved full erectile dysfunction remission, and 4 of 21 achieved ejaculatory delay remission. Sixteen patients with persistent ejaculatory delay were eligible for the high-dose phase: 5 withdrew from the study, 4 increased to a maximum dose of 150 mg, and 6 increased to a maximum dose of 200 mg. The 1 patient who had clinically significant erectile dysfunction and ejaculatory delay reported improvement of both conditions after the high-dose phase. Of the 10 patients who had ejaculatory delay without significant erectile dysfunction and who chose to take high-dose sildenafil, 9 reported a significant clinical improvement in ejaculatory delay (CGI-EJF improvement score of 1 or 2) and 7 achieved full remission (CGI-EJF severity score of 1 or 2 and CGI-EJF improvement score of 1 or 2).. In this open clinical trial with men who had SSRI-induced ejaculatory delay, high-dose sildenafil appeared to be effective in reducing ejaculatory latency.

Topics: Adult; Aged; Depressive Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Ejaculation; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Psychiatric Status Rating Scales; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Depressed men commonly have erectile dysfunction, and men with erectile dysfunction are frequently depressed. Since the etiologic and modulatory relationships between depression and erectile dysfunction have been poorly characterized, a 12-week, randomized, double-blind, placebo-controlled trial was conducted at 20 urologic clinics to evaluate the effects of sildenafil treatment in men with erectile dysfunction and mild-to-moderate comorbid depressive illness.. Men (N=152, mean age=56 years) with erectile dysfunction for > or =6 months (mean=5.7 years), a DSM-IV diagnosis of depressive disorder not otherwise specified, and a Hamilton Depression Rating Scale score > or =12 (mean at baseline=16.9) were randomly assigned to flexible-dose treatment with sildenafil citrate or matching placebo. Interviewer-rated and self-report instruments were used to assess changes in sexual function, depressive symptoms, and quality of life. Conservative criteria were used to classify erectile dysfunction treatment response and nonresponse.. Sildenafil was strongly associated with erectile dysfunction treatment response. Fifty-eight men met the conservative criteria for response (48 given sildenafil, 10 given placebo), and 78 men did not respond (18 given sildenafil, 60 given placebo). Mean decreases of 10.6 and 2.3 in Hamilton depression scale scores were seen in treatment responders and nonresponders, respectively; 76% of treatment responders showed a > or =50% decline in Hamilton depression scale score versus 14% of nonresponders. Quality of life was similarly improved in treatment responders.. Sildenafil is efficacious for erectile dysfunction in men with mild-to-moderate depressive illness. Improvement of erectile dysfunction is associated with marked improvement in depressive symptoms and quality of life.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adult; Aged; Comorbidity; Depressive Disorder; Double-Blind Method; Erectile Dysfunction; Humans; Male; Middle Aged; Personality Inventory; Phosphodiesterase Inhibitors; Piperazines; Placebos; Psychiatric Status Rating Scales; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Treatment Outcome

To evaluate the effect of sildenafil on iatrogenic serotonergic antidepressant-induced sexual dysfunction.. Four outpatients (2 men, 2 women) who developed sexual dysfunction (erectile impotence, anorgasmia) during treatment with a serotonin reuptake inhibitor antidepressant for psychiatric disorder were selected. Each subject was initially prescribed sildenafil 50 mg to be taken approximately 1 hour before sexual activity. The dose was increased to 100 mg for a partial or failed response.. Four cases are detailed in case report fashion. All 4 had rapid reversal of their sexual dysfunction, usually with the first dose. Reversal equates to 1 successful use of sildenafil in each of 2 patients and 3 uses in 2 patients.. Sildenafil may be an effective treatment for serotonergic antidepressant-induced sexual dysfunction and deserves further evaluation in randomized placebo-controlled studies.

Topics: Adult; Ambulatory Care; Depressive Disorder; Drug Administration Schedule; Enzyme Inhibitors; Female; Humans; Iatrogenic Disease; Male; Middle Aged; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. A 50 mg dose of sildenafil was prescribed, and patients were instructed to take it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil.

Topics: Adult; Ambulatory Care; Antidepressive Agents; Depressive Disorder; Drug Administration Schedule; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sex Factors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Adolescent; Adult; Ambulatory Care; Antidepressive Agents; Anxiety Disorders; Depressive Disorder; Drug Administration Schedule; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Inflammation, oxidative and nitrosative stress underlie depression being assessed in rodents by the systemic administration of lipopolysacharide (LPS). There is an increasing body of evidence of an involvement of nitric oxide (NO) pathway in depression, but this issue was not investigated in LPS-induced model. Thus, herein we evaluated the effects of NO-pathway-modulating drugs, named aminoguanidine, l-NAME, sildenafil and l-arginine, on the behavioral (forced swimming test [FST], sucrose preference [SPT] and prepulse inhibition [PPI] of the startle) and neurochemical (glutathione [GSH], lipid peroxidation, IL-1β) alterations in the prefrontal cortex, hippocampus and striatum as well as in BDNF levels in the hippocampus 24h after LPS (0.5mg/kg, i.p.) administration, a time-point related to depressive-like behavior. Twenty-four hours post LPS there was an increase in immobility time in the FST, decrease in sucrose preference and PPI levels accompanied by a decrease in GSH levels and an increase in lipid peroxidation, IL-1β and hippocampal BDNF levels suggestive of a depressive-like state. The pretreatment with the NOS inhibitors, l-NAME and aminoguanidine as well as sildenafil prevented the behavioral and neurochemical alterations induced by LPS, although sildenafil and l-NAME were not able to prevent the increase in hippocampal BDNF levels induced by LPS. The iNOS inhibitor, aminoguanidine, and imipramine prevented all behavioral and neurochemical alterations induced by LPS. l-arginine did not prevent the alterations in immobility time, sucrose preference and GSH induced by LPS. Taken together our results show that the NO-cGMP pathway is important in the modulation of the depressive-like alterations induced by LPS.

Topics: Animals; Antidepressive Agents; Arginine; Behavior, Animal; Brain; Brain-Derived Neurotrophic Factor; Cyclic GMP; Depressive Disorder; Disease Models, Animal; Enzyme Inhibitors; Guanidines; Imipramine; Interleukin-1beta; Lipopolysaccharides; Male; Mice; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Oxidative Stress; Piperazines; Purines; Signal Transduction; Sildenafil Citrate; Sulfones

Topics: Adult; Antidepressive Agents; Depressive Disorder; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Adult; Androgens; Anxiety; Bupropion; Cabergoline; Citalopram; Depressive Disorder; Dopamine Agonists; Dopamine Uptake Inhibitors; Ergolines; Female; Fluoxetine; Humans; Male; Monoamine Oxidase Inhibitors; Piperazines; Plants, Medicinal; Purines; Selective Serotonin Reuptake Inhibitors; Selegiline; Sertraline; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sleep Initiation and Maintenance Disorders; Sulfones; Testosterone; Time Factors; Treatment Outcome; Vasodilator Agents

To examine the use and correlates of the use of prescription drugs that may affect sexual behavior among HIV-positive gay and bisexual men.. In a cross-sectional assessment of baseline data from a behavioral intervention, we recruited 1168 HIV-positive gay and bisexual men in 2000-2001 from community venues in New York City and San Francisco, and determined the point prevalence of the use of viagra, testosterone, and antidepressants. We examined bivariate and multivariate associations between the use of each drug and demographics, health status, substance use, psychological symptoms, and sexual risk.. The current use of antidepressants was 21%, testosterone 19%, and viagra 12%. Some viagra users reported using drugs that could interact dangerously with viagra. The use of viagra, testosterone, or antidepressants was related to unprotected receptive anal intercourse and unprotected insertive oral intercourse (UIOI) with both HIV-positive and HIV-negative/unknown-status casual partners. The use of viagra was also associated with unprotected insertive anal intercourse. In multivariate models, viagra use was associated with being older, more educated, using ketamine, and engaging in UIOI with HIV-negative/unknown-status casual partners. Testosterone use was associated with being more educated and using nitrites (poppers). Antidepressant use was associated with race, using poppers, and being more depressed.. Prescription medications used by HIV-positive men can have unintended negative effects such as drug interactions or associations with risky sexual behavior, particularly a drug such as viagra that is fast acting, short lasting, and provides a desirable effect. Physicians should discuss these issues with patients when prescribing, and interventions should address these challenges.

Topics: Adult; Antidepressive Agents; Bisexuality; Cross-Sectional Studies; Depressive Disorder; Drug Interactions; Drug Prescriptions; Erectile Dysfunction; Health Status; HIV Seropositivity; Homosexuality, Male; Humans; Male; Multivariate Analysis; New York City; Phosphodiesterase Inhibitors; Piperazines; Purines; Regression Analysis; Risk Factors; San Francisco; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Testosterone

Topics: Adult; Aged; Antidepressive Agents; Comorbidity; Depressive Disorder; Erectile Dysfunction; Hormone Replacement Therapy; Humans; Male; Middle Aged; Myocardial Ischemia; Piperazines; Prevalence; Purines; Sildenafil Citrate; Sulfones; Testosterone

Sexual side effects of serotonin reuptake inhibitors, such as antidepressant-associated erectile dysfunction, are common and negatively impact treatment compliance. Current management approaches have important limitations, and most lack clear and meaningful efficacy in double-blind, placebo-controlled trials. A MEDLINE search (English language, 1966-2003) was performed using the terms antidepressive agents, erectile dysfunction, and sildenafil. Emphasis was placed on studies that used specific sexual function measurements and were placebo controlled. Sildenafil citrate, a selective and competitive inhibitor of phosphodiesterase type 5, enhances the cyclic guanosine monophosphate-mediated relaxation of cavernosal smooth muscles in response to sexual stimulation, permitting vascular engorgement and penile erection. The efficacy and tolerability of sildenafil in the treatment of antidepressant-associated erectile dysfunction have been confirmed in double-blind, placebo-controlled trials.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adult; Antidepressive Agents; Attitude to Health; Clinical Trials as Topic; Comorbidity; Depressive Disorder; Erectile Dysfunction; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

Topics: Adult; Depressive Disorder; Erectile Dysfunction; Female; Humans; Male; Phosphodiesterase Inhibitors; Physician's Role; Piperazines; Psychiatry; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Antidepressive Agents; Clinical Trials as Topic; Comorbidity; Depression, Postpartum; Depressive Disorder; Drug Therapy, Combination; Erectile Dysfunction; Female; Humans; Male; Milk, Human; Piperazines; Purines; Sertraline; Sildenafil Citrate; Sulfones; Treatment Outcome; Triiodothyronine

Topics: Adult; Depressive Disorder; Enzyme Inhibitors; Erectile Dysfunction; Humans; Male; Orgasm; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sertraline; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Depressive Disorder; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome

This report describes the presence of sexual dysfunction associated with selective serotonin reuptake inhibitors (SSRIs) in two male patients treated successfully with sildenafil (Viagra). The sexual dysfunction was assessed using the Arizona Sexual Experiences Scale for males (ASEX-Males; McGahuey et al. [1997: Presented at the 150th Annual Meeting of the American Psychiatric Association, May 19, 1997, San Diego, CA]).

Topics: Adult; Depressive Disorder; Dose-Response Relationship, Drug; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: Adult; Antidepressive Agents; Depressive Disorder; Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones