Abstract:
Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.
摘要:
抗抑郁药(AD)是全球最常用的处方药之一。服用AD的精神病患者通常报告与治疗有关的性功能障碍(SD)。对性功能的神经生物学和紧急治疗性SD(TESD)的机制进行了简要讨论。已经对各种研究中TESD的患病率进行了综述。TESD影响患者,因为它经常导致不依从性,而精神科医生在推进此类患者的治疗方面面临挑战。描述了对可疑TESD患者的评估,重点是临床医生的实用技巧。五种策略(警惕等待,毒品假期,向下滴定,切换,和附加治疗)来管理TESD已经在文献中得到了广泛的讨论。每种策略都有自己的优点和缺点,为了简单起见,已经指出了这一点。详细讨论了个体药理学策略,并列出了可以尝试的非药物管理选项。已经讨论了常见的临床病例方案,以纳入本文献的实施。