RESUMO
BACKGROUND: We examine changes in sexual functioning and depressive symptoms in patients' transition from a selective serotonin reuptake inhibitor (SSRI), which induced both a therapeutic response and sexual dysfunction, to bupropion sustained release (SR) over the course of an 8-week trial. METHOD: The study included 11 adults (8 women and 3 men) who had a DSM-IV diagnosis of major depressive disorder in remission (Hamilton Rating Scale for Depression [HAM-D] score < 11) and were receiving an SSRI. Depression (using the HAM-D) and sexual dysfunction (using the Changes in Sexual Functioning Questionnaire) were assessed at baseline, 2 weeks after bupropion SR was added to the current antidepressant (combined treatment), 2 weeks after taper of the SSRI was initiated and completed, and after 4 weeks of bupropion SR monotherapy. T tests were performed to assess changes in depression and sexual function. RESULTS: Patient participation dropped from the initial group of 11 at week 2 to 9 at week 4 and to 6 by week 8. Sexual functioning improved from week 0 (baseline) to week 2 and from week 2 to week 4. The patients showed no significant change in mean HAM-D scores in weekly comparisons during the study period; 55% of patients completed the substitution without significant adverse events or recurrence of depressive symptoms. CONCLUSION: Bupropion SR as a treatment for depression also alleviates sexual dysfunction due to SSRI treatment. Results show that sexual functioning improves after the addition of bupropion SR to SSRI treatment and continues to improve, after discontinuation of the SSRI, with bupropion SR treatment alone.
Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Bupropiona , Bupropiona/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Disfunções Sexuais Psicogênicas/induzido quimicamente , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Adulto , Antidepressivos de Segunda Geração/administração & dosagem , Bupropiona/administração & dosagem , Cicloexanóis/efeitos adversos , Cicloexanóis/uso terapêutico , Preparações de Ação Retardada , Transtorno Depressivo/psicologia , Esquema de Medicação , Quimioterapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Comportamento Sexual/efeitos dos fármacos , Disfunções Sexuais Psicogênicas/prevenção & controle , Inquéritos e Questionários , Resultado do Tratamento , Cloridrato de VenlafaxinaRESUMO
The compulsive behaviors seen in sexual paraphilias may be related to those of obsessive-compulsive disorder (OCD). Based primarily upon case reports as well as studies indicating the effectiveness of serotonin reuptake inhibitors in the treatment of sexual paraphilias, it has been speculated that sexual paraphilias lie within the obsessive-compulsive spectrum. There have been no reports of the use of paroxetine in the treatment of sexual paraphilias. This is a report of two patients, the first a voyeur and the second an exhibitionist, both of whom responded to treatment with paroxetine. The discussion addresses the need for further comparative studies investigating the role of the serotonin system in the pathogenesis of sexual paraphilias and OCD as well as the effect of serotonin reuptake inhibitors in comparison to other pharmacologic modalities used in the treatment of paraphilias.
