Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale

Abstract

Background Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking. Methods To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: −1.8, 95% credible interval [CrI]: [−3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: −1.2, 95% CrI [−2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance. Conclusions While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.

Peony-Glycyrrhiza Decoction for Antipsychotic-Related Hyperprolactinemia in Patients with Schizophrenia: A Randomized Controlled Trial

“…The sexual function of the patients at the beginning of the experiment and after the investigation was assessed using the ASEX. 25,26 In addition, some unusual adverse reactions such as amenorrhea, irregular menstruation, and non-lactation lactation were recorded.…”

A Systematic Review on the Effect of Nutraceuticals on Antidepressant-Induced Sexual Dysfunctions: From Basic Principles to Clinical Applications

“…First of all, to verify whether these side effects are reversible, clinicians might consider waiting for few weeks for spontaneous symptom remission. Alternatively, clinicians can opt for specific pharmacological interventions, such as the use of phosphodiesterase-5 inhibitors, which are usually effective in the treatment of AD-induced erectile dysfunction and anorgasmia in men [ 9 ]. Other suggestions include the prescription of the lowest effective dose of AD, the switch to another class of AD, and the so-called “weekend holiday”, in which patients do not intake ADs 24–48 h before the sexual intercourse [ 6 , 10 ].…”

“…Other suggestions include the prescription of the lowest effective dose of AD, the switch to another class of AD, and the so-called “weekend holiday”, in which patients do not intake ADs 24–48 h before the sexual intercourse [ 6 , 10 ]. However, despite the aforementioned clinical strategies and the interventions proposed, clear guidelines for the management of these side effects are still lacking [ 9 ]. Moreover, the large number of people taking ADs worldwide, the use of ADs for several psychiatric disorders [ 11 , 12 , 13 , 14 , 15 ], and the potential adverse impact on treatment compliance and long-term outcome calls for broadening the range of approaches to AISD treatment.…”

“…Nutraceuticals have also been given significant attention as an alternative therapeutic approach because they are considered more affordable and widely available [ 16 ]. As such, over the last two decades, interest and demand for nutraceuticals have grown worldwide, and the increased interest in finding novel therapeutic options to treat SDs has led to a consistent increase in the use of nutraceuticals [ 9 , 25 ]. Namely, Maca Root [ 26 , 27 , 28 ], Saffron [ 29 ], S-adenosyl-L-methionine (SAMe), Ginkgo Biloba [ 30 , 31 ], and Rosa Damascema [ 32 , 33 ] have been used for several illnesses, including SDs.…”

Drug-Induced Sexual Dysfunction in Individuals with Epilepsy: Beyond Antiepileptic Compounds

“…Possible alternatives include waiting for tolerance to appear, decreasing the dosage, giving drug holidays, adding an additional drug, and switching to an alternative antidepressant less likely to cause SD. In most cases, sildenafil could be of help to improve both erectile function and ejaculation [ 12 ], but care should be taken in patients with epilepsy because of the drug’s potential to induce seizures if not used adequately [ 13 ].…”