Despite the medical community’s growing focus on mental illness – and countless new and efficacious pharmacologic breakthroughs in the treatments for these diseases – primary care providers’ guidelines and prescribing habits have changed marginally in this time. Selective serotonin reuptake inhibitors (SSRIs) remain the consensus first-line treatment for clinical depression and anxiety in nearly all cases. Still, you need to look no further than popular culture, social media, or online patient forums to appreciate the massive notoriety that SSRIs have achieved in the eyes of young people.
Despite data supporting their use as first-line agents, SSRIs are often discontinued by about one in two patients after less than a year of use. Concurrently, sexual dysfunction has become synonymous with these medications, with increasing and strong evidence supporting this finding. Yet little research has explored if there is a correlation between sexual dysfunction, either experienced or perceived, and adherence to antidepressants in young adults. Additionally, not much has been done to explore whether younger generations would be more amenable to newer, sexual-sparing antidepressant medications like Bupropion or Mirtazapine, among others.
Unfortunately, young adult men experiencing psychological distress are the least likely of all demographics across the lifespan to seek help. The suicide rate among men in 2021 was approximately four times higher than the rate among women. Further, compared to women, men are significantly less likely to pursue any lifetime depression care or to take antidepressants.
Our Young Adult Male Antidepressant Nonadherence (YAMAN) study addressed these questions, with the findings being both informative and sobering. Our results support a correlation between reported nonadherence to antidepressants and their risk of sexual side effects in young adult men. Moreover, the strong preference displayed by our respondents for atypical antidepressants adds to evidence challenging the traditional treatment dogma of depression and anxiety. Further, men in our study viewed experiencing sexual dysfunction as a medication side effect as equally devastating to their everyday life as having heart problems or seizures.
As mental health illness and suicide continue to rise at an alarming rate among young adult men, measures to augment the effectiveness of antidepressants through shared decision-making and improved adherence are critical.
Written by:
- Matthew J. Rabinowitz, MD, PGY-1 Urology Resident, Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia, PA
- Amin S. Herati, MD, The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD