To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: APA: Viagra (Sildenafil) Mitigates SSRI-Induced Sexual Dysfunction URL: http://www.pslgroup.com/dg/1FA632.htm Doctor's Guide May 9, 2001
By Ed Susman Special to DG News
NEW ORLEANS, LA -- May 9, 2001 -- Administration of sildenafil (Viagra, Pfizer, Inc.) appears to diminish the sexual dysfunction which sometimes results from use of selective serotonin reuptake inhibitors (SSRIs) in both men and women.
Importantly, researchers at the 154th annual meeting of the American Psychiatric Association said that because the sexual dysfunction can be overcome with sildenafil there is less need to switch medication in hopes of finding an SSRI that causes fewer sexual problems.
"We now know there are certain facts about SSRIs. They are effective against depression, but about 30 to 40 percent of people will report some sexual dysfunction," said Dr. George Nurnberg, professor and vice chairman of psychiatry at the University of New Mexico, Albuquerque. "Sildenafil (Viagra) was effective for reversing the antidepressant-associated sexual dysfunction."
He said the SSRIs tend to decrease arousal, cause erectile dysfunction, vaginal dryness, difficulty in reaching orgasm, and other problems involved in normal sexual function.
Dr. Nurnberg included 90 men and women in his study, which was funded by Pfizer. The subjects were randomly assigned to receive either Viagra or placebo.
All the subjects had to score less than 10 on the Hamilton depression scale-an indication that their depressive symptoms were being controlled by the SSRIs. If they had no pre-existing sexual problems prior to beginning antidepressant medication, the subjects were given a series of psychological tests and were started on 50 mg or 100 mg doses of sildenafil in the six-week double-blind study. Patients remained on sildenafil another 17 weeks in an open-label extension of the study.
"Sildenafil demonstrated highly significant improvement in sexual function on primary and secondary measures," Dr. Nurnberg said. Three-quarters of patients said their sexual functioning was very much improved while on sildenafil, compared with 11 percent on placebo, he reported.
The patients who were helped in this study were those whose antidepression drugs were the only cause of sexual dysfunction. If the person was having problems prior to taking the drugs, Dr. Nurnberg said it wasn't likely sildenafil would help. "But if the guy comes to his doctor and says, 'I really want to do it, but I can't' then the problem is likely to be the [antidepressant] drugs," he said.
The return of desire is indicative that the antidepressants are working; the failure to perform the act is a problem with the medication. While sildenafil appears to help men overcome erectile dysfunction, Dr. Nurnberg said that in women the drug seems to increase blood flow to the genitals and increase vaginal lubrication, making sex less painful and more enjoyable, he said.
In response to audience questions, he suggested that sildenafil was ready for prime time use in selected patients with sexual dysfunction as a side effects of the antidepressants.
However, Dr. Vinod Kumar, professor of psychiatry at the University of Illinois-Chicago, and moderator of the symposium at which Dr. Nurnberg presented his sildenafil data, said the single study would not be enough evidence for him to consider the drug treatment as standard-of-care.
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