Serotonin reuptake antidepressant effects on sexual function in patients with anxiety disorders.

BACKGROUND: Serotonin reuptake inhibitor (SRI) antidepressants have been associated with sexual dysfunction, though there have been few prospective reports specifically examining this problem. The purpose of this study was to determine if three SRIs affected sexual function in anxiety disorder patients over a 3-month period. METHODS: Thirty-one patients were enrolled in a prospective study of the effect of three SRIs, fluoxetine, sertraline, and paroxetine, on five aspects of sexual function: libido, erection/lubrication, orgasm quality, orgasm delay, and sexual frequency. Measurements were made at baseline and at each month on visual analogue scales. RESULTS: For men and women, orgasm quality was lower and orgasm delay longer at months one, two, and three compared to baseline (p < .01). Erection scores were lower over time, but this change was not statistically significant. Lubrication, libido, and sexual frequency were not appreciably changed over 3 months. A higher rate of anorgasmia was noted in women at months one and two, but this did not achieve significance. CONCLUSIONS: Orgasm appears to be a primary sexual function affected by SRIs.

Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction.

Serotonin reuptake inhibitor (SRI)-induced sexual dysfunction is common, and a number of pharmacologic adjunctive strategies have been employed to treat this vexing problem. This open label study tested the efficacy of adjunctive bupropion across several measures of sexual function. Patients taking SRIs for various mood or anxiety disorders who reported prospective decline in sexual function after at least 2 months on SRIs were offered treatment with bupropion, 75 mg/day. Eight patients were treated, and sexual function was measured by use of a visual analog scale at 1 month of treatment. Four of eight patients experienced marked improvement in sexual dysfunction following adjunctive bupropion treatment. Bupropion may be a pharmacologic option for treating SRI-associated sexual dysfunction, though controlled clinical trials are needed.

Roentgen rounds #81. Posteromedial bowing of the tibia.

Posteromedial bowing of the tibia is a rare deformity which is being recognized more frequently. It is frequently associated with and may be the result of a calcaneovalgus foot deformity. It has a better overall prognosis than the other two categories of congenital angular deformity of the tibia. It does not, however, have a prognosis of normality. The frequent sequelae of LLD and foot hypoplasia should be taken into account when counseling parents of children with PMBT. The need for clinical follow-up with interval scanograms should be emphasized.

Adverse hemodynamic and ultrastructural changes in dog hearts subjected to protein-calorie malnutrition.

In the absence of thiamine deficiency, the specific effects of protein-calorie malnutrition on left ventricular (L.V.) function are unknown. Mature beagle dogs of both sexes were subjected to a hypocaloric, nitrogen-poor diet which resulted in a weight loss of approximately 40% after seven weeks. Following preparation of this nutritional model, myocardial contractility was assessed acutely by obtaining isovolumetric L.V. contractions on cardiopulmonary bypass at constant heart rate, mean aortic pressure, and at a wide range of end-diastolic volumes. These changes were compared to a matched group of animals which were normally fed. There were consistent decreases in L.V. compliance in malnourished animals compared with normals; indices of ventricular contractility per se (L.V. dp/dt, force-velocity relations, peak developed L.V. pressure) were also diminished in the experimental animals. Myocardial concentration of glycogen was diminished in malnourished compared to control animals. Light and electron microscopic examination confirmed the presence of myofibrillar atrophy in the presence of interstitial edema. These results suggest that protein-calorie malnutrition seriously interferes with normal L.V. function in the experimental animal by reducing compliance as a result of "starvation edema," and by reducing myocardial contractility associated with atrophy of the myofibers.

Acute hemodynamic effects of intravenous fat emulsion in dogs.

An intravenous infusion of Intralipid-10% was observed to exert a negative inotropic effect on left ventricular performance in a canine isovolumetric left heart preparation. There was no effect on diastolic compliance, however. Intravenous fat emulsion also produced significant decreases in systemic vascular resistance. The mechanism of these actions has not been elucidated, but it is postulated that free fatty acid (FFA) components or their metabolites directly affect the contractile properties of both myocardium and smooth muscle. These results suggest that until suitable clinical studies can be obtained, caution should be exercised in administering intravenous fat emulsions, particularly at maximum rates of infusion or in conjunction with sodium heparin in patients with known cardiac dysfunction.