Sexual dysfunction:

1. Frequency of antidepressants-related sexual dysfunction . Results from a multicentric, pragmatic study with 2163 patients in Spain: the SALSEX-I STUDY Montejo AL1,2, Calama J 2, Majadas S 1, Ciprian D 2, Hernández AI 2 on behalf of the SALSEX-I and II Project Working Group 1. Spanish Association of Sexuality and Mental Health (AESexSAME). Spain. 2. University Hospital of Salamanca. University of Salamanca. Spain. INTRODUCTION CONCLUSIONS RESULTS (Cont.) STUDY OBJECTIVE DESIGN AND METHODS RESULTS • Sexual dysfunction: • 79.2% of the patients experimented SD according to PRSexDQ-SALSEX scores: mild in 14.8%, moderate in 40.1% and severe in 24.3% (Figure 1). Mean total PRSexDQ-SALSEX score was 6.87 (SD: 4.55; 95% CI: 6.68, 7.06). • Only 40.5% communicated SD spontaneously. • Risk of discontinuing treatment was present in 17.8% of patients with SD (showing bad to very bad tolerance of SD, measured with item 5 of PRSexDQ-SALSEX). • More severely depressed patients and older patients were more likely to present SD (p< 0,05). Globally here weren’t statistically significant gender differences in SD. SD was only found more frequent in females vs. males in the non-serotoninergic treatment group (p<0.05) • According to PRSexDQ-SALSEX mean global score, SNRI were associated to higher severity of SD (7.98; SD: 4.40), followed by tryciclics (7.60; SD: 4.37) and SSRI (6.97; SD: 4.39). Non serotoninergic agents (mirtazapine, bupropion and agomelatine) showed a much better profile (Mean PRSexDQ-SALSEX global score: 3.28; SD: 4.21; p<0.001). Odds ratio for AD-SD for serotonergic versus non serotonergic drugs was 6.17. • Near 20% of the patients were at risk of treatment withdrawal due to SD. • Agomelatine, bupropion and mirtazapine showed a better sexual side effects profile when compared with SSRI, SNRI and tricyclic ATD, probably as a result of their differences in mechanism of action. • These results highlight the need of consideration by clinicians on the individual patient’s perception of sexual life and the profile of tolerability of each antidepressant before and after initiating any antidepressant treatment Antidepressant-related sexual dysfunction (ADrSD) is a frequent and long-lasting adverse event of many antidepressants, mainly SSRI and SNRI. It is estimated that up to 60% of patients treated with SSRI may experience associated sexual dysfunction in conditions of real clinical practice1,2 Sexual side effects seriously affect the patient’s quality of life and can lead to non-compliance of antidepressant treatment. It’s estimated that approximately 35% of patients are at risk of treatment discontinuation due to AD-SD3. Moreover this adverse event is rarely spontaneously communicated by patients and clinicians don’t usually explore it adequately, so it quite often sexual dysfunction (SD) remains undetected Evaluation of the prevalence and severity of sexual dysfunction (SD) in patients following antidepressant treatment in conditions of usual clinical practice. Cross-sectional, multicentric, naturalistic study conducted in different ambulatory Primary Care and Psychiatric Specialty Care settings in Spain. Selection criteria: • Inclusion criteria: Adult patients following antidepressant treatment for at least 2 months prior to study enter, sexually active and with no sexual dysfunction prior to initiate antidepressant treatment • Exclusion criteria: Patients in concomitant treatment with any antipsychotic and/or mood stabilizer or any other drug that potentially could cause SD (hormone therapy, H2 and b-blockers and antihypertensive agents, among others). Co-morbid alcohol /substances misuse Assessments: • The primary variable (presence and intensity of SD) was assessed with the validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-Salsex). This is a 5 item questionnaire evaluating the different domains of SD: decrease of libido, ejaculation or orgasm delay, anorgasmia, arousal or erectile-lubrication dysfunction and degree of acceptance of SD. Each item scores from 0 (no problem) to 3 (severe dysfunction). SD is defined as a score of ≥1 (except for global score=1 when scored in the item of sexual desire). The questionnaire allows to collect if communication of SD by the patient was spontaneous or not • Socio-demographic and baseline clinical variables were collected, including severity of the main psychiatric disorder assessed with the CGI-S scale Statistical analysis: For the primary endpoint (presence or absence of SD according to global PR-Sex-DQ score) and categorical secondary variables -severity of SD (global and by items) according to PR-Sex-DQ an analysis of frequencies was performed. PR-Sex-DQ score was also analyzed descriptively as a continuous variable using the mean, standard deviation and 95% confidence interval. These variables were analyzed globally, by antidepressant class and gender subgroups. A Tuckey test (HSD) was performed for the subgroups analysis.The SPSS for Windows v.16.0 statistical program was used for the entire analysis. All statistical tests were two-sided and considered significant at p-values < 0.05 • 2163 patients recruited resulted eligible for this analysis. • Mean age was 43.07 y.o. (SD: 11.25). 55.6% were women. • 62.6% were treated with SSRI, 26.1% with NSRI, 9.8% with non serotoninergic AD (agomelatine, bupropion or mirtazapine) and 1.4% with tryciclic AD. Figure 1: Severity of SD accordingPRSexDQ-SALSEX score (total sample) Figure 2: Mean PRSexDQ-SALSEX global score by AD class * p<0.001 vs. SSRI, SNRI and Tryciclics * Fava M, Rankin M. J Clin Psychiatry. 2002;63 (Suppl 5):13–16. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. J Clin Psychiatry. 2001;62 Suppl 3:10-21 REFERENCES 3. Clayton AH, Montejo AL. J Clin Psychiatry. 2006;67 Suppl 6:33-7 4. MontejoAL, García M, EspadaMet al. ActasEspPsiquiatr. 2000 May-Jun;28(3):141-50 Poster presented at the 11th Congress of the European Federation of Sexology – Madrid, September 20-22, 2012