Abstract
Objectives. Sexual dysfunction (SD) is a frequently reported side-effect of antidepressant treatment, particularly of selective serotonin reuptake inhibitors (SSRIs). In the multicentre clinical and pharmacogenetic GENDEP study (Genome-based Therapeutic Drugs for Depression), the effect of the serotonin transporter gene promoter polymorphism 5-HTTLPR on sexual function was investigated during treatment with escitalopram (SSRI) and nortriptyline (tricyclic antidepressant). Methods. A total of 494 subjects with an episode of DSM-IV major depression were randomly assigned to treatment with escitalopram or nortriptyline. Over 12 weeks, depressive symptoms and SD were measured weekly with the Montgomery–Asberg Depression Rating Scale, the Antidepressant Side-Effect Checklist, the UKU Side Effect Rating Scale, and the Sexual Functioning Questionnaire. Results. The incidence of reported SD after 12 weeks of treatment was relatively low, and did not differ significantly between antidepressants (14.9% escitalopram, 19.7% nortriptyline). There was no significant interaction between the 5-HTTLPR and antidepressant on SD. Improvement in depressive symptoms and younger age were both associated with lower SD. The effect of age on SD may have been moderated by the 5-HTTLPR. Conclusions. In GENDEP, rates of reported SD during treatment were lower than those described in previous reports. There was no apparent effect of the 5-HTTLPR on the observed decline in SD.
Highlights
Patients who receive antidepressants frequently report sexual dysfunction (SD), which may affect all phases of the sexual response cycle, i.e. desire, arousal, and orgasm
Patients were treated with nortriptyline or escitalopram for a period of 12 weeks
Genotype frequencies for the 5-HTTLPR variant were 192 l/l (0.41), 211 l/s (0.45), and 70 s/s (0.14). These are consistent with previously reported frequencies, and did not deviate significantly from Hardy–Weinberg equilibrium (P ϭ 0.33)
Summary
Patients who receive antidepressants frequently report sexual dysfunction (SD), which may affect all phases of the sexual response cycle, i.e. desire, arousal, and orgasm. Rates of between 10 and 90% have been reported, with higher rates for antidepressants which act on the serotonergic system (Werneke et al 2006; Correspondence (current affiliation): Jana Strohmaier, MS Psych, Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, J 5, 68159 Mannheim, Germany.
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