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Analysis of the side effects of antidepressants and other psychotropic drugs affecting sexual function

Introduction

Erection disorders predominate among the complaints that men make when seeking sexological help. Based on this, it is often concluded that erectile dysfunction is the most common sexual pathology among men. However, a more detailed study of this issue reveals that erectile dysfunction is often combined with sexual desire disorders or occurs against their background. This is often due to mental disorders. The cause of sexual desire disorder and erectile dysfunction may be vaguely expressed mental disorders that are not recognized by somatic doctors, to whom men most often turn for help in an effort to improve their potency. Affective disorders in such patients are most often presented in the form of somatized subdepressive and asthenic disorders. This explains why they rarely turn to psychiatrists and psychotherapists. Against the background of such a clinical picture, patients are often recommended various hormonal agents, anti-inflammatory drugs, dietary supplements, vitamins, and drugs from the group of phosphodiesterase type 5 inhibitors.
Despite the fact that in the presence of mental disorders, men often develop erectile dysfunction, treatment of depression, anxiety and other mental disorders, which requires the use of advances in psychopharmacotherapy, in itself has a depressing effect on male sexual function.
The causes and forms of development of erectile dysfunction in men vary greatly and combine biological, social and psychological reasons. In the structure of sexual functions today, the following basic formulas of disorders are distinguished: sexual desire disorders, sexual arousal disorders, orgasmic phase disorders and sexual pain disorders. At the same time, human sexual activity is modeled by a number of neurotransmitters and hormones, but their exact mechanism of action on all phases of the sexual response cycle is still poorly understood.
Antidepressants are the most commonly used drugs to treat mental disorders. They influence the levels of the neurotransmitters serotonin, norepinephrine and dopamine. With proper use and selection of the substance and its dosage, antidepressants are very effective in the treatment of many mental illnesses, however, like any other psychoactive substance acting at the level of the central nervous system, all antidepressants have a number of side effects. Decreased sexual function is very common. Sexual dysfunction in men is one of the most common side effects of antidepressants and a leading cause of non-compliance with treatment. The relevance of this study is explained by the importance of preserving sexual function in the treatment of mental disorders in men.

Analysis of side effects of antidepressants and other psychotropic drugs affecting sexual function

The reasons why antidepressants cause sexual side effects are not fully understood. Perhaps they are due to the fact that each drug acts individually in the body. Sexuality is complex and involves many psychological and physiological processes. Neurotransmitters including serotonin, norepinephrine, dopamine, acetylcholine, GABA, nitric oxide and oxytocin play a role in normal sexual function. Specifically, sexual arousal and erection are associated with the parasympathetic nervous system, while the sympathetic nervous system, dependent on acetylcholine and norepinephrine, is more associated with ejaculation.
Different groups of antidepressants have different effects on sexual function. More often, the side effect of decreased potency is characteristic of the group of tricyclic antidepressants (amitriptyline and anafranine) and SSRIs (fluoxetine, Zoloft, Paxil, escitalopram, etc.). To a lesser extent, sexual function is affected by drugs from the AIDS group (Trittico), tetracyclic antidepressants (Mirtazapine), MT1 receptor agonists (Valdoxan) and an atypical antidepressant (Brintellix).
In order to combat the side effect of antidepressants in the form of erectile dysfunction, there are several behavioral strategies. The first is to wait until the side effect goes away on its own. However, for some men this may not happen. The second option is to stimulate sexual activity, reducing the influence of unfavorable factors. Normalizing sleep and eating patterns, as well as psychotherapy, can help with this. The third option is to reduce the dosage of the antidepressant, but in such a way that it does not harm the patient’s mental state. The fourth option is to change the antidepressant to another one that does not cause sexual dysfunction or causes it to a lesser extent. It should be noted that these drugs, such as trazodone, mirtazapine, vortioxetine, are not the first line of treatment for depressive and anxiety disorders and may not be effective enough. The fifth option is to select corrective drugs in addition to an antidepressant to restore sexual function. Often these are phosphodiesterase type 5 inhibitors, such as sildenafil and vardenafil.
There is considerable variability across studies, types of antidepressants, and phases of sexual response. Drugs with greater effects on serotonin (eg, sertraline, escitalopram, venlafaxine) are often associated with a significantly higher incidence of treatment-emergent sexual dysfunction than drugs with predominantly noradrenergic, dopaminergic, or atypical effects (eg, mirtazapine, bupropion).
Notably, because depression, anxiety, and other psychological problems can themselves impair sexual function, some men’s sexual function improves when taking antidepressants.

Conclusion

When talking about sexual dysfunction as a side effect of drug therapy for mental disorders, it is important to understand the reversibility of this condition. In some cases, patients experience this side effect within the first few weeks or months of starting treatment. Treatment of sexual dysfunction caused by antidepressants requires an individual approach (considering other causes of decreased potency, reducing the dosage, adding medication to correct the side effect, switching to another antidepressant or another type of therapy, etc.).
Stopping antidepressants due to sexual side effects is a common problem, but for most patients it means a return of depression. When choosing an antidepressant, the doctor should carefully consider the aspect of sexual tolerance of a particular drug in a particular patient.

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