Posted by SalArmy4me on June 2, 2001, at 15:01:58
Volume 20(6) December 2000 pp 645-652
Journal of Clinical Psychopharmacology. Sertraline Versus Paroxetine in Major Depression: Clinical Outcome After Six Months of Continuous Therapy{Not from abstract} "Among the specific SSRIs, there is limited data to suggest that paroxetine may be associated with an increased rate of sexual difficulties. Possible explanations for this association include greater selectivity for serotonin reuptake relative to dopamine reuptake for paroxetine, increased cholinergic receptor blockade, and the recent discovery that paroxetine is an inhibitor of NO synthetase. This latter finding may account for the increased rate of erectile dysfunction observed in several studies. Sexual problems in patients taking fluoxetine may emerge later in treatment because of the long half-life of the active metabolite, norfluoxetine, which may result in accumulation over several months and late emergent side effects.
A variety of strategies have been found useful in the medical management of SSRI-induced orgasm and ejaculatory dysfunction, including waiting for tolerance to develop, dosage reduction, drug holidays, switching to a different antidepressant, and various augmentation strategies with 5-HT2, 5-HT3, [small alpha, Greek] (2) adrenergic receptor antagonists, PDE5 inhibitors, and dopamine receptor agonists.
The SSRIs may also have advantageous effects on sexual functioning, and these positive effects may be underappreciated because of the same factors that cause underreporting of sexual problems (i.e., lack of direct inquiry, patient-physician factors). Placebo-controlled studies have suggested a distinct role for the SSRIs in the management of premature ejaculation. Paroxetine seems to have the most potent effects on delaying ejaculation, although anorgasmia or erectile dysfunction has also been reported. The use of fluoxetine presents problems of dose titration, in which long periods, up to several weeks, may be required to approach steady state. Sertraline and fluvoxamine have somewhat milder effects on ejaculatory latency but may be preferable for patient safety and tolerability."
poster:SalArmy4me
thread:65191
URL: http://www.dr-bob.org/babble/20010530/msgs/65191.html