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Switching to Tiagabine Alleviates Antidepressant-Induced Sexual Dysfunction in Patients With Generalized Anxiety Disorder: Presented at ADAA

By Fran Lowry

MIAMI, F.L. --March 29, 2006 -- Patients with generalized anxiety disorder (GAD) who develop sexual dysfunction as a result of their treatment can have improved sexual function if they are switched to the anti-epileptic drug tiagabine, according to results of a small open-label study.

The research was presented here at the 26^th Annual Conference of the Anxiety Disorders Association of America (ADAA) by David E. Kang, MD, forensic psychiatry fellow, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, United States.

Sexual dysfunction is an important side effect of treatment with selective serotonin reuptake inhibitors (SSRI) and serotonin/norepinephrine reuptake inhibitors (SNRI), affecting from 30% to 60% of patients in a clinical setting, Dr. Kang said during his presentation on March 25^th. This effect can lead to noncompliance with treatment and subsequent relapse of symptoms, he explained.

Besides serotonin, norepinephrine and gamma-aminobutyric acid (GABA) have been implicated in the pathophysiology of GAD, he said. Tiagabine is a selective GABA reuptake inhibitor (SGRI) that has been shown to significantly reduce symptoms in patients with GAD.

Dr. Kang and colleagues sought to investigate the effects of a cross-titration switch to tiagabine monotherapy in patients whose GAD symptoms were well-controlled on SSRI or SNRI treatment, but who experienced sexual dysfunction as a result of treatment.

Tiagabine was administered in uneven divided doses with breakfast and in the evening with a snack, initially at 4 mg/day. After 6 days, the dose was increased to 8 mg/day. From day 13 onward, the dose could be increased to 12 mg/day if required. Efficacy of treatment was assessed with the Hamilton Anxiety Rating Scale (HAM-A), the Hospital Anxiety and Depression Scale (HADS) and the Arizona Sexual Experience Scale (ASEX).

After 14 weeks of tiagabine treatment, patients had maintained improvement of GAD symptoms, as indicated by HAM-A and HADS scores, while having significant improvement in sexual function scores (P <.001).

Tiagabine did not adversely affect depressive symptoms in this population of GAD patients, the researchers reported.

Tiagabine monotherapy was tolerated by most patients. However, the rapid dose titration did cause several subjects to withdraw from the study, due to adverse events, which included dizziness/lightheadedness, nausea, and fatigue.

Of the initial 26 patients, 17 completed the study, 7 dropped out due to the side effects, 1 subject withdrew consent, and 1 left because of a return of anxiety symptoms, Dr. Kang said.

"Less aggressive dosing may achieve improvement in symptoms of GAD and sexual functioning without the tolerability problems," he concluded.


[Presentation title: An Open-Label Study to Evaluate Switching from an SSRI or SNRI to Tiagabine to Alleviate SSRI or SNRI Induced Sexual Dysfunction in Generalized Anxiety Disorder.]

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