Across the globe, antidepressants (AD) and phosphodiesterase-5 inhibitors (PDE-5i) are commonly prescribed psychopharmacological agents for patients with co-morbid mental-health problem and sexual dysfunction (SD). The serotonergic and/or noradrenergic ADs, although is an effective agent are not without SD side-effects, especially erectile dysfunction (ED). ED is an inability to achieve, or maintain an erection for satisfactory sexual intercourse during the phases of male's sexual arousal. It is recognized as an important reason why non-adherence to treatment was observed in patients who are on AD. AD intervention caused remission to some of the pre-treatment psychopathology of ED, but to many patients, AD potentially magnified the unwanted sexual side-effects. This made this situation a challenging task for the mental health professional. These challenges are based on the complexity of ED - its etiology, and the associated risk factors, which further compounded with AD side-effect. The neuro-psychopharmacological basis for AD treatment selection used was deliberated. Biopsychosocial interventions are recommended at a two pivotal stage. First, a step should be taken for proper assessment (e.g. detailed history, psychosocial and laboratory investigations); and identifying some modifiable risk factors for ED and associated mental health issue. Secondly, with guidance of an algorithm pathway, a practical intervention should include steps like dose reduction, augmentation or changing to an AD with lesser/ no sexual side-effects like bupropion and mirtazepine. Some achievable suggestions, e.g. revising sexual scripts and improving sexual techniques, life-style modifications, psychotherapy and other non-pharmacological approaches will be beneficial for both patients and his partner.
Current drug targets. 2017 Mar 15 [Epub ahead of print]
Maszaidi Zainol, Hatta Sidi, Jaya Kumar, Srijit Das, Shaiful Ismail, Muhammad Hizri Hatta, Najwa Baharudin, Arun Ravindran
Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur. Malaysia., Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre Jalan Yaacob Latif Bandar Tun Razak 56000, Kuala Lumpur. Malaysia., Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur. Malaysia., Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur. Malaysia., Universiti Sains Malaysia, Department of Family Medicine, School of Medicine, Universiti Sains Malaysia Kelantan. Malaysia., Zwirki I Wiguri 62, Medical University of Warsaw. Poland., Department of Psychiatry, University of Toronto, Ontario. Canada.