Depression and Erectile Dysfunction
Section snippets
Epidemiologic association
Depression is an affective disorder with a heterogeneous manifestation and multifactorial etiology. Excluding bipolar (manic-depressive) disorders, clinical depression generally is classified as major depressive disorder (MDD) or dysthymia, depending on severity. In this article we use depression to refer to both conditions. The hallmark symptoms of depression include feelings of sadness and hopelessness, loss of interest in pleasurable activities (anhedonia), changes in appetite, disturbance
Causality
Epidemiologic data and common sense suggest that the relationship between ED and depression is bidirectional. In the model proposed by the authors of the MMAS study, ED and depression are depicted as two conditions that reinforce each other in a downward spiral [1]. Additional factors, such as lifestyle, social context, and medical interventions, can hasten or reverse this interaction [1]. The underlying mechanism of the link between ED and depression, however, has not been established. In
Hypogonadism, depression, and erectile dysfunction
Hypogonadism and depression share several symptoms, such as loss of libido, fatigue, poor appetite, and dysphoria [6], [30]. They also may be linked epidemiologically. In a study of 856 men in southern California, depressed mood (measured by the Beck Depression Inventory questionnaire) correlated with lower bioavailable testosterone levels, independent of age [31]. In a cohort of 278 men attending a single hospital, the 2-year incidence of depression was 21% in men who had hypogonadism (defined
Antidepressants and erectile dysfunction
Sexual dysfunction is associated often with depression. Antidepressant therapy is highly effective in treating depression. Unfortunately, improvement of sexual function as a result of antidepressant therapy is seldom seen (with the notable exception of premature ejaculation) [46], [47]. Rather, exacerbation of de novo development of sexual dysfunction can occur as an untoward side effect of antidepressants [48], and the incidence of sexual dysfunction in men who are on antidepressant therapy is
Management of antidepressant-associated erectile dysfunction
The management of the sexual side effects of SSRIs has been reviewed extensively in the psychiatric literature [68], [69], [70]. This falls into two general categories: manipulation of psychotropic drugs and ED-directed therapy.
Summary
Comorbid ED and depression are seen commonly in practice. The association between the two conditions is bidirectional, with each factor reinforcing the other. Additional factors, such as hypogonadism or cardiovascular disease, could contribute to the vicious cycle. Medical antidepressant therapy can exacerbate ED. The various classes of antidepressants vary in their sexual side effect profile, with the conventional SSRIs (paroxetine, fluoxetine, sertraline) being the worst offenders. Management
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