RESUMO
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.
Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Mianserina/análogos & derivados , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Disfunções Sexuais Psicogênicas/induzido quimicamente , Disfunções Sexuais Psicogênicas/prevenção & controle , Adulto , Idoso , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Humor Irritável , Masculino , Mianserina/efeitos adversos , Mianserina/uso terapêutico , Pessoa de Meia-Idade , Mirtazapina , Doenças Musculares/induzido quimicamente , Projetos Piloto , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Índice de Gravidade de Doença , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/psicologia , Transtornos do Sono-Vigília/induzido quimicamente , Resultado do Tratamento , Aumento de PesoRESUMO
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.
Assuntos
Inventário de Personalidade/estatística & dados numéricos , Comportamento Sexual , Disfunções Sexuais Psicogênicas/diagnóstico , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Disfunções Sexuais Psicogênicas/psicologiaAssuntos
Encéfalo/metabolismo , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Serotonina/metabolismo , Triptofano/fisiologia , Ansiedade , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Humanos , Transtornos Psicóticos/sangue , Valores de ReferênciaRESUMO
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.
Assuntos
Transtornos de Ansiedade/fisiopatologia , Ácido Hidroxi-Indolacético/urina , Ácido Vanilmandélico/urina , Adulto , Transtornos de Ansiedade/psicologia , Nível de Alerta/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Norepinefrina/fisiologia , Inventário de Personalidade , Serotonina/fisiologiaRESUMO
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.
Assuntos
Acetilglucosaminidase/urina , Ácido Hidroxi-Indolacético/urina , Lisossomos/enzimologia , Acetilglucosaminidase/metabolismo , Adulto , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/urina , Biomarcadores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação PsiquiátricaRESUMO
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.