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Journal of Clinical Medicine Jan 2024Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary...
UNLABELLED
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings.
STUDY OBJECTIVES
To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting.
METHODOLOGY
observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale ( Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up.
RESULTS
global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), < 0.001. There was a significant improvement ( < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit.
CONCLUSION
switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.
PubMed: 38256680
DOI: 10.3390/jcm13020546 -
Addictive Behaviors Sep 2024Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use...
Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N = 1,356, M = 36.86, SD = 11.26; N = 944, M = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.
Topics: Humans; Erotica; Male; Adult; Cross-Sectional Studies; Sexual Behavior; Middle Aged; Young Adult; Behavior, Addictive; Orgasm
PubMed: 38761685
DOI: 10.1016/j.addbeh.2024.108048