September 2012

Seksuelle problemer hos deprimerede: Hønen eller ægget?

Det er velkendt at depressive patienter ofte klager over seksuelle problemer, men kan klager over seksuelle problemer også være en indikator for depression?
Atlantis & Sullivan belyser hvorvidt depression forudsiger seksuelle problemer, og om seksuelle problemer forudsiger depression. De finder, at det går begge veje, og anbefaler at patienter med depressive symptomer bør udspørges om seksuelle problemer, og patienter med seksuelle problemer børe udspørges om depressive symptomer.
I vores behandling af psykiatriske patienter risikerer vi ofte at inducere seksuelle problemer som bivirkning til den psykofarmakologiske behandling. Dette kan medføre dårlig compliance og for tidligt ophør med behandlingen. I artiklen af Seretti & Chiesa gives en oversigt over seksuelle bivirkninger ved psykofarmakolgisk behandling. Artiklen indeholder en god oversigt, der sammenligner seksuelle bivirkninger ved antidepressiva og antipsykotika behandling

Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis.
Atlantis E, Sullivan T.
J Sex Med. 2012 Jun;9(6):1497-507. doi: 10.1111/j.1743-6109.2012.02709.x. Epub 2012 Mar 29.

Depression is frequently associated with sexual dysfunction in both men and women.
Aim:To examine whether depression predicts sexual dysfunction and, conversely, whether sexual dysfunction predicts depression.

A systematic review and meta-analysis was conducted. PubMed and EMBASE biomedical answers electronic databases were searched for relevant studies up to November 2011. Reference lists of relevant articles were hand-searched and expert opinions were sought. Studies identified for inclusion had to be prospective cohort studies in adult populations that reported an association between depression and sexual dysfunction variables.

Odds ratios (ORs), prioritized where available, or relative risks (RRs) were pooled across studies using random-effects meta-analysis models.

Eight citations included for review yielded six studies on depression and risk of sexual dysfunction in 3,285 participants followed for 2-9 years, and six studies on sexual dysfunction and risk of depression in 11,171 participants followed for 1-10 years. Depression increased the risk of sexual dysfunction in pooled unadjusted (RR/OR 1.52 with 95% confidence intervals [1.02, 2.26]) and adjusted (RR/OR 1.71 [1.05, 2.78]) meta-analyses but not in the partially adjusted model (RR/OR 1.41 [0.90, 2.23]). There was significant heterogeneity between studies, but after removal of a single outlying study was diminished and the pooled partially adjusted, RR/OR increased to 1.69 (1.15, 2.47). Sexual dysfunction increased the odds of depression in the pooled unadjusted (OR 2.30 [1.74, 3.03]), adjusted (OR 3.12 [1.66, 5.85]), and partially adjusted (OR 2.71 [1.93, 3.79]) meta-analyses; heterogeneity was significant only in the adjusted model. Meta-regression analyses did not detect significant sources of heterogeneity in either examination.

Clinicians should be aware of a bidirectional association between depression and sexual dysfunction. Patients reporting sexual dysfunction should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for sexual dysfunction.
Sexual side effects of pharmacological treatment of psychiatric diseases.
Serretti A, Chiesa A.

Clin Pharmacol Ther. 2011 Jan;89(1):142-7. Epub 2010 Jul 28.

Since the introduction of psychiatric medications with relatively good safety profiles, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors, increasing attention has been given to side effects such as sexual dysfunction (SD), which, although unrelated to risks of mortality, could undermine compliance with treatment regimens and impair quality of life. Indeed,there is consistent evidence to suggest that a large number of psychiatric medications adversely affect one or more of the three phases of normal sexual response: desire, arousal, and orgasm.

Annamaria Giraldi, Overlæge, ph.d., ekstern lektor/ Consultant, PhD