ABSTRACT
BACKGROUND: Sexual side effects are a common and bothersome reaction to selective serotonin reuptake inhibitors (SSRIs), frequently leading to cessation of treatment. Mirtazapine, an alpha2-adrenoceptor and serotonin-2/3 receptor antagonist, appears to cause few sexual problems. METHOD: Nineteen patients (12 women and 7 men), with SSRI-induced sexual dysfunction who were in remission from major depressive disorder (total Hamilton Rating Scale for Depression [HAM-D] score < or = 10), were switched to open-label mirtazapine for up to 6 weeks. Mirtazapine was titrated from 7.5 mg to 45 mg daily, as tolerated. Sexual functioning was measured weekly with the Arizona Sexual Experiences Scale (ASEX), and depression was measured weekly with the HAM-D. RESULTS: Eleven patients (58%) had a return of normal sexual functioning (mean +/- SD ASEX score = 12+/-3), and another 2 (11%) reported significant improvement in sexual functioning (mean ASEX score reduced from 24+/-1 to 20+/-0). All nineteen patients maintained their antidepressant response (HAM-D score after 6 weeks of mirtazapine = 6+/-3). The most commonly reported side effects (using moderate/severe rating on a symptom checklist) were initial sedation (N = 3), irritability (N = 6), and muscle soreness and stiffness (N = 3). Weight gain of 10 to 20 lb (4.5-9 kg) was seen in 3 patients (2 women and 1 man). CONCLUSION: Mirtazapine is an effective antidepressant for many patients experiencing SSRI-induced sexual dysfunction.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Depressive Disorder/drug therapy , Mianserin/analogs & derivatives , Selective Serotonin Reuptake Inhibitors/adverse effects , Sexual Dysfunctions, Psychological/chemically induced , Sexual Dysfunctions, Psychological/prevention & control , Adult , Aged , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Irritable Mood , Male , Mianserin/adverse effects , Mianserin/therapeutic use , Middle Aged , Mirtazapine , Muscular Diseases/chemically induced , Pilot Projects , Psychiatric Status Rating Scales , Selective Serotonin Reuptake Inhibitors/therapeutic use , Severity of Illness Index , Sexual Behavior/drug effects , Sexual Behavior/psychology , Sleep Wake Disorders/chemically induced , Treatment Outcome , Weight GainABSTRACT
Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated, user-friendly scales. In order to address this problem, the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.
Subject(s)
Personality Inventory/statistics & numerical data , Sexual Behavior , Sexual Dysfunctions, Psychological/diagnosis , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Comorbidity , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Female , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Sexual Dysfunctions, Psychological/psychologyABSTRACT
Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of 5-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.
Subject(s)
Anxiety Disorders/physiopathology , Hydroxyindoleacetic Acid/urine , Vanilmandelic Acid/urine , Adult , Anxiety Disorders/psychology , Arousal/physiology , Female , Humans , Male , Middle Aged , Norepinephrine/physiology , Personality Inventory , Serotonin/physiologyABSTRACT
There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.
Subject(s)
Anxiety Disorders/urine , Hydroxyindoleacetic Acid/urine , Vanilmandelic Acid/urine , Anxiety Disorders/physiopathology , Female , Humans , Male , Middle Aged , Norepinephrine/metabolism , Norepinephrine/physiology , Serotonin/metabolism , Serotonin/physiologyABSTRACT
Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine samples for 5-hydroxyindoleacetic acid (5-HIAA) and N-acetyl-beta-glucosaminidase (NAG). Nine patients with no comorbid psychiatric diagnosis showed a significant association between 5-HIAA and NAG, r = -0.683, p = 0.04. The possibility that NAG could be a marker for serotonin metabolism is discussed.
