Effect of Antidepressant Treatment on Sexual Dysfunction

Effect of Antidepressant Treatment on familiar disfunctionIMPROVEMENT IN SEXUAL DYSFUNCTION FOLLOWING ANTIDEPRESSANT intervention IN DEPRESSED FEMALES*Dr. Abhivant Niteen N. 1, Dr. Sawant Neena S.2,ABSTRACTIntroduction slack is associated with knowledgeable disfunction. As the drop-off improves internal disfunction withal improves. There atomic number 18 non many studies on feminine intimateity. Aims and objectives To find out the changes in sexual functioning in demoralize womanishs after give-and-take with anti-depressant medicates. Method 41 female patients diagnosed to eng eradicateer depression were included in domain. Becks Depression stock-taking and Female Sexual Functioning Index scales were applied at the stock and after 6 weeks to assess the progression in sexual dysfunction and depression. Results When scores were compared after 6 weeks of antidepressant treatment then a highly profound difference was seen on entirely the scores of BDI ( pConclusio ns This discover showed significant improvement in sexual dysfunction and different aspects of sexual dysfunctions after treatment with antidepressants for 6 weeks.Keywords Female sexual dysfunction, Depression, selective-serotonin reuptake inhibitor, FSFI.INTRODUCTIONThe screw 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 un volition to raise the issue of sexual health with health professionals and both the patient and the physician whitethorn be reluctant to hash out it. Female sexual dysfunction is multifactorial and multidimensional condition cartel biological, psychological and interpersonal determinants 1. Although sexual dysfunctions are not life threatening, they fork out major impact on personal relationships, physical health and tone of life. There are several studies on male sexual dysfunctions in Indi a 2 barely literature on the preponderance of sexual dysfunction among women is especially scant 3, 4.The prospective Zurich cohort battleground 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 withal 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 its relation to underlying depression and drug therapy. change magnitude awareness of this problem in medical community will authorize to further research in female sexual dysfunctions and improved treatment.AIMS AND objective lensTo find out the changes in sexual functioning in depressed females after treatment with anti-depressant drugs.MATERIAL AND METHODSThis 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 symptomatic and Statistical Manual of Mental Disorders, 4th edition, Text revision, criteria after square inclusion and exclusion criteria.INCLUSION CRITERIA1) Females diagnosed to have depression as per symptomatic andStatistical Manual of Mental Disorders, 4th edition, Text revision2) Those who were willing to participate in the study.3) Langu date compatibility.EXCLUSION CRITERIA1) Females less than 18 historic period 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 its applications and informed consent was obtained from patients. A proforma was designed to enquire into the socio-demographic enlarge, 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 nave 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 Becks Depression origin and Female Sexual Functioning Index Scale in the drug nave 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.TOOLS1) BECKS DEPRESSION INVENTORY Developed by A. Beck 12 is a rating to cake the severity of depression in which individuals rate their own symptoms of depression. This is a 21 item scale which evaluates the mainstay symptoms of depression including mood, pessimism, sense of failure, egotism dissatisfaction, self accusation, self dislike, guilt, punishment, suicidal ideas, crying, irritability, social withdrawal, indecisiveness, body image changes, insomnia, fatigability, loss of appetite, weighting 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 avow of 0 to 63. center score is a sum of all items.2) FEMALE SEXUAL mathematical operation INDEX 13 The Female Sexual Functioning Index is a 19 item questionnaire. It is a brief, multidimensional, se lf report instrument to assess the key dimensions of sexual function in females. It assesses six domains of sexual function including 1) longsighteding 2) Physical arousal-sensationPhysical arousal-lubrication 4) Orgasm 5) Satisfaction and 6) Pain.All the scales were translated in Marathi and Hindu and were validated by the departmental staff before administration.DATA summaryAll analyses were done with SPSS statistical version 11 at 5% significance. The changes in tools (Becks Depression Inventory, Female Sexual Functioning Index) were analyze pre and post treatment using the pairedt test.RESULTSThe mean age of this sample (n=49) was 28.9 geezerhood (+_ 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 class makers with hardly 6% of them doing some job. As expected, about two-third (67.34%) were Hindus. The mean distance of depression was 2 year s 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 selective-serotonin reuptake inhibitors viz. Escitalopram (optimum dose 10 to 15 mg) and Sertraline (100mg), then a highly significant difference was seen on all the scores of BDI ( pOn the various domains of FSFI a highly significant difference was seen on the domains of Arousal (pDISCUSSIONDepressive disorders are among the most plethoric psychiatric disorders 14. Depression is characterized by loss of interest, reduction in energy, take down self-esteem and inability to experience pleasure, irritability and social withdrawal which whitethorn 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 nu mber of investigators have reported association among 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 study depressed women with greater sexual dysfunction at baseline and improvement in sexual functioning with treatment with SSRIs in areas of improvement in sex drive, physiologic and psychological arousal.SSRIs due to their antidepressant action improve the depression which may hence reduce the various faulty cognitions associated with depression and enhance the persons 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 s exual dysfunction improves with SSRI treatment.There are also various studies which have linked SSRIs 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 unrestrained and psychological dimensions. Studies have also shown that besides antidepressants many other factors fix the incidence and prevalence of sexual dysfunction in patients with depression. These include factors much(prenominal) as, depression itself, cultural and social factors and physical and psychiatric co-morbidities 21.Given the scarceness of show up-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. T he overall treatment should invariably 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. health check College and K. E. M. Hospital, Parel, Mumbai. 400012REFERENCES1. Mathew RJ, Weinman ML Sexual dysfunctions in depression. Arch Sexual Behav.1982 11 3233282. 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