Effects of 50 and 100 mg desvenlafaxine versus placebo on sexual function in patients with major depressive disorder

Abstract

The primary objective of this post-hoc analysis was to evaluate the effect of short-term treatment with desvenlafaxine versus placebo on sexual dysfunction (SD), assessed from Arizona Sexual Experiences Scale scores, in adult outpatients with major depressive disorder. Data from three randomized, double-blind, placebo-controlled trials of 50 or 100 mg/day desvenlafaxine for major depressive disorder were pooled. SD status, determined from Arizona Sexual Experiences Scale scores, was assessed at baseline and week 8, last observation carried forward. Subgroup analyses addressed the effects of sex, baseline SD, and antidepressant response. At week 8, last observation carried forward (n=1562), SD rates were 54, 47, and 49% for 50 mg/day desvenlafaxine, 100 mg/day desvenlafaxine, and placebo, respectively [adjusted odds ratios (95% confidence interval) vs. placebo: 1.205 (0.928, 1.564) and 1.129 (0.795, 1.604), respectively]. The treatment by baseline SD interaction approached statistical significance (P=0.0663), mainly driven by poorer scores for desvenlafaxine versus placebo in the 100 mg group. Treatment by sex interactions were not statistically significant. Small but statistically significant treatment by sex interactions were observed for sex drive (P=0.0011) and ease of erection/lubrication (P=0.0151). Although there was no overall effect of desvenlafaxine on SD, a treatment by baseline SD interaction was suggested for 100 mg desvenlafaxine.

Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach

“…If an AD is required to have some serotoninergic effect and also to have a lower impact on sexual function and orgasm/ejaculation, fluvoxamine is the best candidate when not dosing above 100 mg/day [2]. Among drugs which are partially serotoninergic, the possibilities are desvenlafaxine (when dosing under 100 mg/day) [46] and vortioxetine (10–15 mg per day) [55]. A prospective naturalistic study of desvenlafaxine conducted by our Sexuality and Mental Health project group [56] showed promising results when prescribing this drug as the first AD to a group of depressed patients, with an incidence of TESD of 44.4% being observed.…”

“…Desvenlafaxine [43], which has a smaller serotoninergic profile than venlafaxine, appears to cause less TESD at 50 mg, however TESD can appear at doses above 100 mg [46,70]. Recent observational data from a switching study in which inclusion and exclusion criteria were controlled showed that switching to desvenlafaxine led to a decrease of severe TESD from 93.3% to 75.6% [56] and an improvement of sexual desire and orgasmic dysfunction, but no improvement in sexual arousal.…”

“…One study that was specifically designed to detect alterations in sexual function, a post-hoc analysis of a drug trial that was compared with a placebo using the Arizona Sexual Experiences Scale (ASEX), found that, when compared to placebo, two groups of females had a similar incidence of orgasm retardation [45], while other sexual functions such as sexual desire and arousal were not affected. The results of another study suggest that the incidence of TESD could be higher in patients taking 100 mg of desvenlafaxine than those taking 50 mg [46]; however, these results are not conclusive since no statistically significant differences were observed.…”

Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study

“…The existing information on the frequency of desvenlafaxine-associated SD comes from a post-hoc analysis of three double-blind and short-term clinical trials (two months) using the self-administered ASEX Scale in outpatients with depression using doses of 50–100 mg. The results indicate that SD rates were 54%, 47%, and 49% for 50 mg/day, 100 mg/day, and placebo, respectively, with adjusted odds ratios (95% confidence interval) vs. placebo of 1,205 (0.928, 1.564) and 1,129 (0.795, 1.604), respectively [54]. These results partially coincide with the SD figures found in our study with 44% of moderate/severe SD at three months in desvenlafaxine-naïve patients; however, the frequency was much higher (76%) in patients switched to desvenlafaxine due to previous AD-related sexual dysfunction after following the course for three months.…”

Desvenlafaxine: Short review of selective antidepressant of class of selective inhibitors of reuptake of serotonine and noradraniline - SNRI

“…Naredna studija koja je ispitivala seksualnu disfunkciju kod pacijenata tretiranih velafaksinom bila je od iste grupe autora 2015. godine i rezultati te studije su ukazali da je veća doza • br. 1 leka povezana sa višom incidencom seksualnih disfunkcija odnosno da pacijenti koji uzimaju 100 mg desvenlafaksina imaju veći intenzitet seksualnih disfunkcija u odnosu na pacijente koji uzimaju 50 mg desvenlafaksina [11] .…”