Depressed Women Have More Sexual Dysfunction Than Depressed Men

Laurie Barclay, MD

November 07, 2003

Nov. 7, 2003 — Depressed women have more sexual dysfunction than do depressed men, according to a presentation on Nov. 1 at the Canadian Psychiatric Association 53rd annual meeting in Halifax, Nova Scotia. Paroxetine adversely affected men more than it did women, whereas bupropion did not seem to affect sexual function in either men or women.

"Rates of sexual dysfunction are different in depressed men and women, both before and during antidepressant treatment," lead author Sidney Kennedy, MD, from the University Health Network in Toronto, Ontario, told Medscape. "Differences in the effects of Welbutrin and Paxil on sexual dysfunction influence the treatment of depression."

Investigators in this before-and-after study compared sexual function in 73 depressed men and 68 depressed women, aged 18 to 65 years, treated for eight weeks with bupropion or paroxetine for a major depressive episode meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Starting dose was 20 mg for paroxetine and 150 mg for bupropion SR, with an option to double the dose after four or six weeks. The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Sex Effects Questionnaire (Sex FX) were administered at baseline, two, four, six, and eight weeks.

At baseline, women had significantly higher levels of sexual dysfunction than did men (P <.001). In 71 subjects receiving paroxetine and 69 receiving bupropion SR who completed the trial, both drugs were equally effective in the reduction of HRSD scores. At endpoint, female nonresponders reported significantly more sexual dysfunction than did responders in both the bupropion (P = .03) and the paroxetine (P = .01) groups.

Although sexual dysfunction scores in women and men treated with bupropion did not change significantly, men treated with paroxetine reported significantly higher rates of sexual dysfunction, especially orgasmic difficulties at endpoint compared with baseline (P = .001). Women consistently reported higher levels of sexual dysfunction, but sexual dysfunction induced or exacerbated by antidepressant treatment was only apparent in depressed men who received paroxetine.

"Despite the fact that both drugs were equally effective in treatment of depression, only paroxetine treatment in men was associated with significantly higher rates of sexual dysfunction," Dr. Kennedy said.

GlaxoSmithKline supported this study and several of its authors as research assistants.

CPA 54th Annual Meeting: Poster P2-1. Presented Nov. 1, 2003.

Reviewed by Gary D. Vogin, MD

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