This is the first study to compare frequency of sexual side effect reporting between paroxetine and desipramine. We found no statistically significant differences in sexual side effect reporting between the two antidepressants. Also, the addition of naltrexone did not show any beneficial effect on the sexual side effect profile.

Nepal has a multitiered health system involving the Ministry of Health, nongovernmental organizations, private for profit, and faith-based organizations. There are national, district, and community-level health centers and health workers that come together to deliver services and input information into both the community and national level health information systems. In terms of mental health, there is a very small portion of the budget allocated to mental health and very few mental health interventions and programs. The system has strengths including that the service delivery is put together in an effective manner and there is some mental health integration in primary care and in the health information system. However, there are weaknesses including that there needs to be an increase in the number of health workers and the training given to the workforce to further integrate mental health and there also needs to be more attention brought to mental health overall. Nepal's COVID-19 response highlighted weaknesses within its health system, especially in the context of its essential medicine products. The COVID-19 response from Nepal was especially hindered by a shortage of medical supplies, personal protective equipment, medications, and coronavirus tests.