Double-Blind Comparison of Bupropion Sustained Release and Sertraline in Depressed Outpatients

Rj, Kavoussi; Rt, Segraves; Ar, Hughes; Ja, Ascher; Ja, Johnson

doi:10.4088/jcp.v58n1204

Cited by 131 publications

(70 citation statements)

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“…To manage adverse effects of medication, physicians learned to adjust dose or, combine with other drugs, to ameliorate the problem. 12 For instance, many might reduce the SSRI and supplement with buproprion or try sildenafil as a possible adjunct. While intrapenile injections or a 'combination approach' might be effective, sex therapy enhanced all these strategies.…”

Section: Sex Therapy Overviewmentioning

confidence: 99%

“…Early failures can be reframed into learning experiences and eventual success. [10][11][12][13][14][15][16][17][18][19][20] …”

Section: Time Crunchmentioning

confidence: 99%

“…2,4,13,16,18,23 There is a need for partner education, counseling and/or referral: when the partner's comfort with pharmacotherapy is too adversely effected by a concern for his safety; if compliance is adversely affected by a perception of the treatment being too 'artificial or mechanicalyis it me or the Viagra;' if her own capacity and readiness for sex is physiologically impaired for any of a multiplicity of reasons. 4,9,12,13,18 It is easy to extrapolate from the MMAS findings of increased ED frequency and severity with aging, that many aged men have older partners, who are also at risk for arousal phase disorders. 24 Finally, she may not be psychologically ready for sex.…”

Section: Partner Issuesmentioning

confidence: 99%

“…The physician's challenge is not necessarily requiring an office visit with the partner, as many CME programs have advocated. 8,9,12 Instead, the emphasis should be on evaluating the level of partner cooperation and support.…”

Section: Partner Issuesmentioning

confidence: 99%

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Sex coaching for physicians: combination treatment for patient and partner

Perelman

2003

Int J Impot Res

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Physicians dealing with sexual dysfunction (SD) must consider the psychological and behavioral aspects of their patient's diagnosis and management, as well as organic causes and risk factors. Integrating sex therapy and other psychological techniques into their office practice will improve effectiveness in treating SD. This presentation provides information about the psychological forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere performance anxiety. Four key areas are reviewed: (1) 'Sex coaching for physicians' uses the 'Cornell Model' for conceptualizing and treating SD. A 5-min 'sex status,' manages 'time crunch' by rapidly identifying common causes of sexual dysfunction (insufficient stimulation, depression, etc). (2) Augmenting pharmacotherapy with sex therapy when treating erectile dysfunction (ED) specifically, or SD generally is stressed. Sex therapy is useful as a monotherapy or an adjunctive treatment and is often the 'combination therapy' of choice when treating SD. The following therapeutic integrations are highlighted: modifying patient's initial expectations; sexual pharmaceuticals use as a therapeutic probe; 'follow-up' to manage noncompliance and improve outcome; relapse prevention. (3) Issues specific to the role of the partner of the ED patient are described. The physician must appreciate the role of couple's issues in causing and/or exacerbating the ED and the impact of the ED on the patient/partner relationship. Successful treatment requires a supportive available sexual partner, yet partner cooperation may be independent of partner attendance during the office visit. Preliminary data from a survey of SMSNA members practice patterns, regarding partner issues, is presented and discussed. The importance of evoking partner support and cooperation independent of actual attendance during office visits is emphasized. (4) Finally, the need for more patient and partner educational materials to assist the physician in overcoming a patient/partner's emotional barriers to sexual success in a time efficient manner are discussed.

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Section: Sex Therapy Overviewmentioning

confidence: 99%

“…Early failures can be reframed into learning experiences and eventual success. [10][11][12][13][14][15][16][17][18][19][20] …”

Section: Time Crunchmentioning

confidence: 99%

Section: Partner Issuesmentioning

confidence: 99%

Section: Partner Issuesmentioning

confidence: 99%

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Sex coaching for physicians: combination treatment for patient and partner

Perelman

2003

Int J Impot Res

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“…5,6 A number of studies have identified delayed orgasm as a side effect of SSRI medications, with rates generally ranging from 16% to 37% 7,8 ; some studies have reported rates of this side effect as great as 60% to 70%. 9,10 Other proposed etiologies for retarded ejaculation include neurologic disorders, as well as psychological and relationship issues. Most of the research that has examined the association between neurologic disorders and ejaculatory problems has investigated patients with spinal cord injuries.…”

mentioning

confidence: 99%

Assessment of Penile Vibratory Stimulation as a Management Strategy in Men with Secondary Retarded Orgasm

Nelson

Ahmed

Valenzuela

et al. 2007

Urology

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OBJECTIVES-To evaluate the effectiveness of penile vibratory stimulation for the management of retarded orgasm. Retarded orgasm, a condition characterized by difficulty achieving orgasm and ejaculation, is one of the most recalcitrant of the male sexual dysfunctions. Currently, no evidence-based treatments have been proven to ameliorate this condition. METHODS-Menwho had a complete inability to achieve an orgasm during sexual relations in the previous 3 months were instructed in the use of penile vibratory stimulation. The men's responses were measured by self-report of orgasm function and using the orgasm and satisfaction domains of the International Index of Erectile Function. The responses were assessed at baseline (admission into the study) and at 3 and 6 months.RESULTS-A total of 36 men met the inclusion criteria, and 72% reported the restoration of orgasm. These responders reported that orgasm during sexual relations occurred 62% of the time. A statistically and clinically significant increase occurred in the orgasm and satisfaction domains of the International Index of Erectile Function between the baseline visit and the 3-month followup visit. These gains were sustained at 6 months. CONCLUSIONS-Penile vibratory stimulation is an effective treatment for retarded orgasm.Penile vibratory stimulation should be integrated into current cognitive-behavioral sex therapy techniques to achieve maximal effectiveness and satisfaction.Retarded orgasm (ejaculation) is characterized by prolonged ejaculatory latency. This condition is one of the most poorly understood and pharmacologically recalcitrant of the male sexual dysfunctions. In general, a scarcity of original research has focused on this dysfunction. 1 Almost all the published studies in this area have consisted of case reports or reviews that have defined the dysfunction and highlighted the types of treatments available for this disorder. Few reports, if any, have described original research that has systematically investigated and provided empirical evidence delineating the impact of this disorder or demonstrating the effectiveness of the available treatments.

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Treatment of Antidepressant-Associated Sexual Dysfunction With Sildenafil

Nurnberg¹,

Hensley²,

Gelenberg³

et al. 2003

JAMA

200

127

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Context Sexual dysfunction is a common adverse effect of antidepressants that frequently results in treatment noncompliance.Objective To assess the efficacy of sildenafil citrate in men with sexual dysfunction associated with the use of selective and nonselective serotonin reuptake inhibitor (SRI) antidepressants.Design, Setting, and Patients Prospective, parallel-group, randomized, doubleblind, placebo-controlled trial conducted between November 1, 2000, and January 1, 2001, at 3 US university medical centers among 90 male outpatients (mean [SD] age, 45 [8] years) with major depression in remission and sexual dysfunction associated with SRI antidepressant treatment.Intervention Patients were randomly assigned to take sildenafil (n=45) or placebo (n = 45) at a flexible dose starting at 50 mg and adjustable to 100 mg before sexual activity for 6 weeks. Main Outcome MeasuresThe primary outcome measure was score on the Clinical Global Impression-Sexual Function (CGI-SF); secondary measures were scores on the International Index of Erectile Function, Arizona Sexual Experience Scale, Massachusetts General Hospital-Sexual Functioning Questionnaire, and Hamilton Rating Scale for Depression (HAM-D).Results Among the 90 randomized patients, 93% (83/89) of patients treated per protocol took at least 1 dose of study drug and 85% (76/89) completed week 6 endpoint assessments with last observation carried forward analyses. At a CGI-SF score of 2 or lower, 54.5% (24/44) of sildenafil compared with 4.4% (2/45) of placebo patients were much or very much improved (PϽ.001). Erectile function, arousal, ejaculation, orgasm, and overall satisfaction domain measures improved significantly in sildenafil compared with placebo patients. Mean depression scores remained consistent with remission (HAM-D score Յ10) in both groups for the study duration. ConclusionIn our study, sildenafil effectively improved erectile function and other aspects of sexual function in men with sexual dysfunction associated with the use of SRI antidepressants. These improvements may allow patients to maintain adherence with effective antidepressant treatment.

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Double-Blind Comparison of Bupropion Sustained Release and Sertraline in Depressed Outpatients

Cited by 131 publications

References 0 publications

Sex coaching for physicians: combination treatment for patient and partner

Sex coaching for physicians: combination treatment for patient and partner

Assessment of Penile Vibratory Stimulation as a Management Strategy in Men with Secondary Retarded Orgasm

Treatment of Antidepressant-Associated Sexual Dysfunction With Sildenafil

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