Assessment of sexual functioning in depressed patients treated with mirtazapine: a naturalistic 6-month study

Abstract

Mirtazapine showed in this study that it is an effective and well-tolerated antidepressant treatment with a possibly lower incidence of sexual side effects than other antidepressants.

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors

“…In a mirtazapine switching study, Gelenberg et al (2000) showed that 11 (58%) out of 19 patients experienced a return of normal sexual functioning after 6 weeks of mirtazapine treatment. Another switching study suggested that mirtazapine led to a reduction in the mean total PRSexDQ score from day 30, achieving statistical significance on days 90 and 180 (Saiz-Ruiz et al, 2005). However, it was noted that augmentation with mirtazapine was not different from placebo in ameliorating the SSRI-induced sexual dysfunction of premenopausal women (Michelson et al, 2002).…”

“…Those agents have effects on dopaminergic (Masand et al, 2001), serotonergic (Landen et al, 1999), noradrenergic (Hollander and McCarley, 1992) or both noradrenergic and specific serotonergic (Koutouvidis et al, 1999) receptors, or local effects on blood flow in the genitals (Nurnberg et al, 1999). Mirtazapine blocks postsynaptic 5-HT2 and 5-HT3 receptors and has an antagonistic effect on presynaptic a-2 adrenergic autoreceptors and heteroreceptors (Saiz-Ruiz et al, 2005;Stimmel et al, 1997). The antagonist effects at 5HT and 5HT3 receptors may enhance libido (Mendelson, 1992) and antagonism of a2-adrenoceptors may enhance erectile function (Munoz et al, 1994).…”

“…Quality of life is an important issue and includes sexual functioning (Williams et al, 2006) and concern about antidepressant-induced sexual dysfunction has continued to grow; however, the mechanism of action of sexual dysfunction associated with SSRIs is not well understood (Saiz-Ruiz et al, 2005). Studies examining the pharmacologic treatment for SSRI-induced sexual dysfunction are limited, although there are more studies of switching to different agents than augmentation.…”

An Open-Label Study to Evaluate Switching from an SSRI or SNRI to Tiagabine to Alleviate Antidepressant-Induced Sexual Dysfunction in Generalized Anxiety Disorder

“…In the absence of guidelines to inform clinicians how to manage those with antidepressant-induced sexual dysfunction, a number of published studies are available that compare rates of sexual dysfunction following treatment. These suggest that switching to an alternative antidepressant such as bupropion and possibly mirtazapine, whose pharmacological profiles differ from that of the SSRIs, results in lower rates of sexual impairment (10,(29)(30)(31). Another strategy involves using an antidepressant with the ability to obtain a satisfactory clinical response at a relatively low dose, such as escitalopram (32), while some studies suggest using an agent such as sildenafil to overcome antidepressant-induced erectile dysfunction (33).…”

Bupropion extended-release induced spontaneous orgasms

“…Boora et al (13) reported that ziprasidone might be causing an increase in sexual orgasm by 5-HT2 receptor antagonism, of which preclinical evidence suggests that it facilitates dopamine release in cortex. Saiz-Ruiz et al (14) reported improvement of sexual function in depressed patients treated with mirtazapine. The main mechanism considered responsible for this improvement, as well as for the spontaneous orgasms that have been reported with other drugs, is the agonism of 5-HT1 receptors and antagonism of 5-HT2c receptors.…”