The findings of this survey of patients with mild to severe10 depression suggest that compliance, and hence efficacy, can be promoted by (1) understanding what patients expect and desire from the antidepressants they are prescribed and (2) prescribing antidepressants associated with low rates of weight gain, sexual dysfunction, or tiredness.

Future studies should compare higher doses of bupropion for treating sexual dysfunction and should include a greater number of subjects.

No abstract

In the present study, a large-scale retrospective case review was undertaken to assess the incidence and type of sexual dysfunctions associated with serotonin reuptake inhibitor (SRI) therapy, in addition to the effects of three pharmacological antidotes (yohimbine, amantadine, cyproheptadine) on SRI-induced sexual dysfunctions. A retrospective chart review was conducted on 596 patients treated with SRIs in an outpatient psychiatric practice between July 1991 and September 1994. Patients who reported new-onset sexual dysfunction during this time were categorized as having SRI-induced sexual dysfunctions. Sexual difficulties were characterized by type and duration, and the background characteristics and psychiatric diagnoses of all patients were recorded. Psychiatric outcome and sexual functioning at follow-up were independently assessed by a single psychiatrist by means of a 4-point rating scale. Sexual dysfunction symptoms were clearly associated with SRI administration in 97 (16.3%) cases. The most common problems reported were orgasmic delay or anorgasmia and hypoactive sexual desire. Sexual difficulties were more frequent among men (23.4%) and married patients of both sexes (22.3%), whereas psychiatric diagnosis and type of SRI were unrelated to the occurrence of sexual problems. Of the patients with sexual dysfunction, 45 (46.4%) opted for a trial of antidote therapy with yohimbine, amantadine, or cyproheptadine. All three antidotes were found to be safe and relatively effective, although yohimbine was significantly more effective than amantadine or cyproheptadine in reversing SRI-induced sexual dysfunction.

The search for an effective aphrodisiac has been a perennial pursuit of most societies throughout history. In the past decade, attention has focused increasingly on the prosexual effects of oral pharmacological agents with central neurotransmitter actions. The role of various dopaminergic, adrenergic, and serotonergic agents, in particular, has been intensively investigated in both human and animal studies. Some of these drugs have been considered for their potential role in the treatment of sexual dysfunction, while others have contributed to our understanding of basic neurophysiological processes in sexual arousal. This review provides a critical evaluation of current laboratory and clinical research on the "new aphrodisiacs," including studies in both patient populations and normal volunteers. Several conceptual and methodological problems are addressed, such as the definition and measurement of sexual response, the need to separate specific and nonspecific drug effects on sexual response, and the lack of studies in women. Although no single drug has proven to be clinically safe and reliably effective for human use, several promising candidates have been identified. Overall, research on prosexual drugs has contributed significantly to our understanding of basic mechanisms in sexual response, as well as providing new treatment options for common sexual disorders.