NEW ORLEANS (Reuters Health) - Sexual problems linked with antidepressant use may be more common than widely believed, according to research presented here at the annual meeting of the American Psychiatric Association.

In a study of nearly 6,300 patients on newer types of antidepressants, almost 40% reported sexual dysfunction--a rate nearly twice what the patients' physicians predicted. Dr. Anita L. H. Clayton of the University of Virginia in Charlottesville and her colleagues used questionnaires to gauge primary care doctors' estimates of sexual problems related to antidepressants, and their actual occurrence. In a study of nearly 6,300 patients on newer types of antidepressants, almost 40% reported sexual dysfunction--a rate nearly twice what the patients' physicians predicted. Dr. Anita L. H. Clayton of the University of Virginia in Charlottesville and her colleagues used questionnaires to gauge primary care doctors' estimates of sexual problems related to antidepressants, and their actual occurrence. The physicians said that they expected 20% of patients on antidepressants to have some type of sexual problem. However, among the patients surveyed, 37% of those on newer types of antidepressants such as fluoxetine (Prozac) reported problems. ``Doctors have been hesitant to discuss antidepressant-related sexual dysfunction, often because they are afraid that patients will not want to talk about it,'' Clayton told Reuters Health. ''However, 70% of patients who were asked to participate in the survey chose to do so.'' Because both patients and physicians are reluctant to discuss sexual problems, the topic is often never mentioned, she noted. However, the development of a sexual problem, such as impotence, can be discouraging enough to some patients that they stop their medications. Patients need to bring up sexual problems directly, Clayton said. Most physicians will be willing to find a solution to the problem, and often the doctor can prescribe a different medication or adjust the dose. If the physician seems uninterested or unwilling to help, Clayton said, ``find a different doctor.'' In this study, she and colleagues found that several circumstances added to a patient's risk of sexual problems after starting antidepressant therapy. People were more likely to have problems if they were age 50 or older, less educated, not fully employed, or smoked 6 to 20 cigarettes per day. Surprisingly, married people were also more likely to report problems, perhaps because married patients were also likely to be older, said Clayton. Patients who were simultaneously taking other medications also stood a greater chance of experiencing sexual dysfunction. In addition, certain antidepressants were more likely to be associated with sexual problems. All of the drugs in a class of antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) were highly associated with sexual dysfunction. Fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) are examples of SSRIs. Bupropion (Wellbutrin) and nefazodone (Serzone), antidepressants that act differently on the brain than do the SSRIs, were much less likely to be associated with sexual dysfunction. The study was funded by GlaxoSmithKline, which manufactures several SSRIs as well as bupropion. The physicians said that they expected 20% of patients on antidepressants to have some type of sexual problem. However, among the patients surveyed, 37% of those on newer types of antidepressants such as fluoxetine (Prozac) reported problems. ``Doctors have been hesitant to discuss antidepressant-related sexual dysfunction, often because they are afraid that patients will not want to talk about it,'' Clayton told Reuters Health. ''However, 70% of patients who were asked to participate in the survey chose to do so.'' Because both patients and physicians are reluctant to discuss sexual problems, the topic is often never mentioned, she noted. However, the development of a sexual problem, such as impotence, can be discouraging enough to some patients that they stop their medications. Patients need to bring up sexual problems directly, Clayton said. Most physicians will be willing to find a solution to the problem, and often the doctor can prescribe a different medication or adjust the dose. If the physician seems uninterested or unwilling to help, Clayton said, ``find a different doctor.'' In this study, she and colleagues found that several circumstances added to a patient's risk of sexual problems after starting antidepressant therapy. People were more likely to have problems if they were age 50 or older, less educated, not fully employed, or smoked 6 to 20 cigarettes per day. Surprisingly, married people were also more likely to report problems, perhaps because married patients were also likely to be older, said Clayton. Patients who were simultaneously taking other medications also stood a greater chance of experiencing sexual dysfunction. In addition, certain antidepressants were more likely to be associated with sexual problems. All of the drugs in a class of antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) were highly associated with sexual dysfunction. Fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) are examples of SSRIs. Bupropion (Wellbutrin) and nefazodone (Serzone), antidepressants that act differently on the brain than do the SSRIs, were much less likely to be associated with sexual dysfunction. The study was funded by GlaxoSmithKline, which manufactures several SSRIs as well as bupropion.

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