Cjp-mar-2-06.vp

Sexual Function During Bupropion or Paroxetine
Treatment of Major Depressive Disorder
Sidney H Kennedy, MD, FRCPC 1, Kari A Fulton, BA, CCRC2, R Michael Bagby, PhD 3,
Andrea L Greene, BA4, Nicole L Cohen, MA5, Shahryar Rafi-Tari, MSc6
Objective: The primary objective was to evaluate sexual function (SF) separately in men and
women with major depressive disorder (MDD) before and during treatment with bupropion
sustained release (SR) or paroxetine. The secondary objectives involved a comparative evaluation
of the Sex Effects Scale (Sex FX) and the Investigator-Rated Sexual Desire and Functioning Scale
(IRSD-F), as well as a comparison of antidepressant outcomes and an examination of the relation
between level of depression and SF over time.
Method: There were 141 patients (68 women and 73 men) who met DSM-IV criteria for a current
major depressive episode. They were randomly assigned to receive bupropion SR (150 to 300 mg
daily) or paroxetine (20 to 40 mg daily) under double-blind trial conditions. Patients were assessed
at baseline and at 2, 4, 6, and 8 weeks with the 17-item Hamilton Depression Rating Scale
(HDRS17), Sex FX, and IRSD-F.
Results: Prior to treatment, women reported significantly lower SF on both the Sex FX and
IRSD-F scales, compared with men. During treatment, there were no significant drug differences
on measures of SF over time for women; however, men who were treated with paroxetine reported
a worsening of SF, whereas bupropion SR did not significantly alter SF. Both bupropion SR and
paroxetine produced clinically and statistically significant reductions in HDRS17 scores as well as
comparable rates of response and remission. There was a statistically significant correlation
between the 2 measures of SF at all visits. There was also a significant inverse relation between
depression and SF in women, but not in men, irrespective of drug.
Conclusion: According to the Sex FX scale, a significant difference in antidepressant-related
sexual dysfunction was detected in men, but not women, during treatment with bupropion SR or
paroxetine.
Information on funding and support and author affiliations appears at the end of the article.
Clinical Implications
· Systematic evaluation of SF before initiating and during antidepressant therapy is an important
· The Sex FX is a simple clinician-administered measure of SF.
· Paroxetine and burpropion influence SF differently in men and women.
Limitations
· There was no placebo control group in this study.
· Difference between men and women on Sex FX scores may have been influenced by uncontrolled
variables; including personality dimensions or anxiety.
· The diagnosis of MDD and severity of depression rather than the impairment of SF were the primary entry criteria, which coincidentally resulted in significantly higher baseline SF scores for women inthe paroxetine group.
W Can J Psychiatry, Vol 51, No 4, March 2006 Sexual Function During Bupropion or Paroxetine Treatment of Major Depressive Disorder
Key Words: sexual function, depression, bupropion,
Although pharmacologically unrelated to other antidepres- sants, bupropion SR has demonstrated efficacy comparable toSSRIs (15) and is generally considered to have a low inci- Impaired SF, particularly decreases in desire and arousal, dence of drug-induced sexual dysfunction (4). This has been reported in over 50% of untreated men and women double-blind comparator trial was conducted to assess the rel- with depression (1,2,3). Antidepressant medications may also ative effects of bupropion and an SSRI on SF, efficacy, and interfere with SF, often resulting in orgasmic or ejaculatory safety. We selected paroxetine as the active comparator difficulties (4,5,6). This can lead to patient dissatisfaction as because of its wide spread use and broad range of indications well as decreased compliance with treatment (7). Men and women with depression may also experience these effects dif- The objectives of this study were threefold. The primary ferently. For example, Montejo and others found that men objective was to evaluate SF separately in men and women reported a higher frequency, while women reported greater with depression who met criteria for MDD—current MDE severity, of sexual dysfunction (8). There is also evidence that before and during treatment with bupropion SR or paroxetine.
men report more orgasmic impairment than women during The secondary objectives were to compare the Sex FX with SSRI treatment (9,10) and are less likely to report improved the IRSD-F, and to compare antidepressant outcomes with an SF over the course of treatment (11). A direct relation between examination of the relation between level of depression and antidepressant response and improved SF has also been SF over time. The study was not designed with adequate reported in women, but not in men (5).
power to detect significant differences in antidepressant The Sex FX was developed as a brief comprehensive scale effectiveness between the 2 antidepressants.
that applied equally to men and women (figure 1). It has been We hypothesized that there would be differences between evaluated in drug-free, depressed, (2) and nonclinical popula- reported SF in men and women prior to antidepressant treat- tions (12). In general, women reported lower scores on indi- ment and that paroxetine, but not bupropion, would adversely vidual subscales (Drive–Desire, Arousal, Orgasm– affect SF in both men and women during antidepressant treat- Ejaculation) and overall satisfaction, compared with men.
ment with a significant correlation between the 2 SF scales This scale also discriminated between drugs during antide- overtime. We further hypothesized that both antidepressant pressant treatments (5,13). Since the scale has not been previ- agents would demonstrate significant reductions in severity of ously compared with other measures of sexual dysfunction, depression and that there would be a direct relation between we selected the IRSD-F because of its face validity with antidepressant response and SF in women but not in men.
DSM-IV criteria for sexual dysfunctions and its use in previ-ous trials (10,14) involving various SSRIs and bupropion.
Patient Population
Abbreviations used in this article
Subjects were outpatients between age 18 and 65 years who currently met DSM-IV criteria for MDD—current MDE of at least 4 weeks duration. They were also required to have a min- imum score of 18 on the HDRS17 (16), to be in good physical health, to report sexual interest and activity within the past month, and to be willing to complete the assessments and questionnaires over the course of several clinical visits. In addition, they were required to be free of any antidepressant use for a minimum of 2 weeks (4 weeks for fluoxetine) beforeinitiating treatment with either study medication. Concomi- tant treatment with psychoactive medication, whether pre- scription or over the counter, was not permitted, except for the hypnotic zopiclone (up to 7.5 mg at night) during the first 2 weeks. Women of child-bearing age were also required to have a negative pregnancy test and to use an acceptable con- Exclusion criteria included serious suicide risk (> 3 on the HDRS17 “suicide” item), more than 2 failed trials of antide- pressant medications at adequate dose and duration during thecurrent episode, drug abuse or dependence within the past 12 Can J Psychiatry, Vol 51, No 4, March 2006 W The Canadian Journal of Psychiatry—Original Research
months, and a history of bipolar disorder, psychotic disorder, or organic disorder. We obtained research ethics board approval at each participating site as well as written informed consent from each patient prior to study enrolment.
Study Design
Patients from 15 sites across Canada were randomly assigned to a double-blind, flexible-dosage trial of bupropion SR (150 to 300 mg daily) or paroxetine (20 to 40 mg daily). They were assessed at 5 study visits, each separated by 2 weeks, over an 8-week period. There was an option to increase the dosage of either medication at Week 4 or Week 6, at the discretion of thetreating psychiatrist, up to 300 mg daily for bupropion SR (maximum recommended dosage in Canada) (17) or 40 mgdaily for paroxetine.
Measures
ubscales)
s
SF was assessed using the Sex FX scale, a brief 13-item clinician-rated interview that takes approximately 5 minutes to administer and evaluates the frequency of desire, arousal, orgasm, and overall satisfaction during the preceding 2 weeks in men and women. The 3 subscales of SF (Desire, 4-items; Arousal, 4-items; Orgasm, 3-items) are rated on a 5-point ordered-frequency scale. Reverse scoring is applied to some items. The sum of scores on these 3 subscales provides a total functioning score. Overall Satisfaction, which is a separatedimension, comprised 2 items, each scored between 0 and 10.
Higher scores are associated with better levels of SF or overall paroxetine
SF was also assessed with the IRSD-F assessment, a clinician administered interview developed to confirm the presence orabsence, according to DSM-IV criteria, of sexual desire dis- bupropion
order, sexual arousal disorder, and orgasm delay or failure. It also assesses overall satisfaction with SF, with 1 representing very satisfied and 6 representing dissatisfied. A total score was obtained by adding each of these 4 subscales. Higherscores are associated with reduced quality of SF.
treatment
Depression severity was rated with the HDRS17 by psychia- trists who achieved interrater reliability across sites. Response was defined as a reduction of at least 50% from baseline to endpoint, and remission was defined as a score of 7 or less on Statistical Analysis
We performed statistical analysis using the LOCF method on all subjects who took at least one dose of medication and com- pleted at least a second visit. We used a 1-way ANOVA to examine between-group and sex differences at baseline for HDRS17 and Sex FX scales. To evaluate the changes over time in the Sex FX ad the HDRS17, we performed an MMRM (18)ANOVA, controlling for random and nonrandom effects at baseline and prospectively. We examined mean change from W Can J Psychiatry, Vol 51, No 4, March 2006 Sexual Function During Bupropion or Paroxetine Treatment of Major Depressive Disorder
baseline to endpoint using within-subject paired t tests.
Pearson chi-square tests were used to compare response and remission rates. All tests of statistical significance were per- formed at a 2-sided alpha level of 0.05.
We performed Pearson correlations to examine the relation between the Sex FX total and overall satisfaction scores with the IRSD-F, separately for men and women. The relationbetween Sex FX and the HDRS17 over time was also evaluated separately by sex using the Pearson correlation statistic.
According to the Bonferroni correction to control for type 1 error, a P value of less than P < 0.001 was required for statisti- Demographic and Clinical Characteristics
A total of 141 patients were enrolled; 68 were women (48%)and 73 were men (52%). The mean age was 37.8 (SD 10.5) ubscales)
s
years. Prior to a second visit, 10 patients (5 women and 5 men)dropped out and are not included in outcome analyses. During the remainder of the trial, 21 patients (8 on bupropion SR and 13 on paroxetine) dropped out between Week 2 and Week 8.
There were no statistically significant baseline differences between treatment groups with respect to demographics,dropout rates, or severity of depression. The dosage of bupropion SR was increased to 300 mg daily in 38 (29%) patients. In the paroxetine group, 25 (19%) patients receivedan increase to 40 mg. The mean dosage for bupropion was 178.5 mg daily. The mean dosage for the paroxetine group paroxetine
Differences in SF Between Men and Women
Prior to treatment, there were statistically significant differ-
ences between men and women on Sex FX total, Desire, bupropion
Arousal, Orgasm, and overall satisfaction scores (P < 0.001).
A one-way ANOVA yielded a significant main effect for sex(P < 0.001) across all visits for Sex FX scores, with the excep- tion of Arousal at Weeks 4, 6, and 8, and Orgasm at Weeks 2, 6, and 8. Where significant differences existed between men treatment
and women, women reported lower SF scores. For the IRSD-F total score, a significant difference was also observed across all visits between men and women, with the exception of Week 6. Again, women reported greater levels of sexual dysfunction than men. All further analyses of SF were there- fore conducted separately for men and women.
Women: Changes in SF During Treatment
A 1-way ANOVA revealed significant baseline differences in Sex FX scores among treatment conditions (Sex FX total, P < 0.01; Desire, P < 0.01; Arousal, P < 0.01; overall satisfaction, P < 0.01): women in the paroxetine group reported signifi-cantly lower levels of SF than women in the bupropion SR group, on all comparisons. The MMRM analysis of change Can J Psychiatry, Vol 51, No 4, March 2006 W The Canadian Journal of Psychiatry—Original Research
Table 3 Relation for men and women between IRSD-F and the Sex FX
aCorrelations are significant at the 0.001 level (2-tailed) Table 4 Comparative efficacy of bupropion SR and paroxetine according to HDRS17 scorea
Response was defined as a reduction of 50%, and remitters were defined as those having a score of 7 or less on the HDRS17.
for Sex FX with visit, treatment, and visit-by-treatment inter- was accounted for by a decrease in SF scores during actions as effects in the model, and with corresponding base- paroxetine treatment (Sex FX total, P < 0.002; Desire, P < line scores included as covariates, revealed no significant 0.005; Arousal, P < 0.005; and overall satisfaction P < 0.057).
difference by visit, treatment, or visit-by-treatment on total, The paroxetine group displayed a significant deterioration Desire, Arousal, Orgasm, or overall satisfaction scores on the from baseline to Week 8, on Sex FX total (P < 0.01), Desire (P < 0.01), Arousal (P < 0.05), Orgasm (P < 0.01), and overallsatisfaction (P < 0.01) scores, whereas no significant change Men: Changes in SF During Treatment
was observed in any of these measures across visits in men There was no statistically significant difference in Sex FX randomized to bupropion SR (Table 2).
scores between treatment groups for men at baseline (Sex FX,P = 0.50; Desire, P = 0.76; Arousal, P = 0.23; Orgasm, P = Correlation Between Sex FX and the IRSD-F in Men
0.96; and overall satisfaction, P = 0.67). The analysis of and Women
change for the Sex FX was conducted using the MMRM with Concurrent validity of the Sex FX scale was evaluated by visit, treatment, and visit-by-treatment interactions as effects examining the correlations between Sex FX total and overall in the model and with corresponding baseline scores as satisfaction scores, and the IRSD-F total score. The results of covariates. This revealed a significant treatment effect by visit the correlational analysis are presented in Table 3. A statisti- for Sex FX total (P < 0.001), Desire (P < 0.001), and overall cally significant negative correlation was found for both men satisfaction (P < 0.01). Paired t tests confirmed that this effect and women between the IRSD-F total and Sex FX scores at all W Can J Psychiatry, Vol 51, No 4, March 2006 Sexual Function During Bupropion or Paroxetine Treatment of Major Depressive Disorder
Figure 1 SEX FX Scale
Both sexual interest and activity can be affected by depression. Some of the medications used to treat depression can also altersexual interest and activity I am going to ask you a few questions about different aspects of your sexual life DURING THE PAST TWO WEEKS HOW MANY TIMES DID YOU
Have an interest in initiating sexual activity Have the ability to feel sexually excited (“turned on”) (F) Have difficulty with vaginal lubrication (M) Have an erection without being touched Engage in sexual activity (intercourse or masturbation) (M) Have difficulty staying erect during sexual activity (F) Have difficulty staying lubricated during sexualactivity (M) Take longer than you would like to ejaculate (F) Take longer than you would like to have an orgasm (M) Fail to ejaculate during sexual activity (F) Fail to have an orgasm during sexual activity OVERALL, if you have to give a number between 0 (worst case) and 10 (best case) how would you describe:
Satisfaction with your sexual functioning Note: where indicated (M) = Males, (F) = Females2001 S.H. Kennedy & R.M. Bagby visits, reflecting the inverse relation between function on Sex between treatments or between men and women. Pearson chi-square tests also yielded no significant differencesbetween treatment groups on HDRS17 scores response or in Changes in Depression Over Time
There was no difference in HDRS17 scores at baselinebetween bupropion SR (mean 21.8, SD 2.9) and paroxetine Relation Between SF and Depression
(mean 22.2, SD 3.6) groups or between men (mean 22.1, SD We computed correlation coefficients separately for men and 3.1) and women (mean 21.9, SD 3.5). Repeated measures women to examine the relation between Sex FX and HDRS17 ANOVA indicated a significant reduction over time for both scores. To evaluate the relation between SF scores and treatment groups (P < 0.01), with no significant difference responder status (response > 50% reduction in HDRS17 score) Can J Psychiatry, Vol 51, No 4, March 2006 W The Canadian Journal of Psychiatry—Original Research
as well as remitter status (a score of 7 or less on the HDRS17), antidepressant efficacy or response rates to paroxetine or we conducted a 1-way ANOVA separately for men and bupropion SR between men and women, there was a direct correlation between change in SF and change in depression inwomen but not in men. This was true for both paroxetine and For women, there was a significant negative relation across bupropion and supports previous reports that effective treat- visits between HDRS17 and Sex FX total (Week 0, 2, 4, 6, and ment for depression is more likely to be associated with 8), Desire (Week 0, 4, 6 and 8) (see Figure 1), Arousal (Week improved SF in women (5). In men, SF is more likely to be 6), Orgasm (Week 8), and overall satisfaction (Week 0, 2, 4, 6, influenced by the type of antidepressant selected rather than and 8) scores. There was no significant relation between Sex FX and HDRS17 scores at any visit for men.
To be included in the study, patients were required to have We found significant differences between women responders experienced sexual interest and activity within the month and nonresponders who received paroxetine on Desire (Week prior to the study. This was a clinical trial designed to evaluate 6, P < 0.04), Arousal (Week 4, P < 0.05), and overall satisfac- improvement or worsening of SF with 2 antidepressant tion (Week 6, P > 0.01; Week 8, P < 0.04). Among those who agents. Conversely, it did not allow an examination of received bupropion, significant differences were observed on depression patients who reported neither sexual interest nor Sex FX total (Week 2, P < 0.01; Week 8, P < 0.01) and arousal activity prior to antidepressant treatment or an examination of (Week 2, P < 0.02; Week 8, P < 0.01).
those who might have been sexually interested and active We observed significant differences between female remitters and nonremitters in the paroxetine group on Desire (Week 2, The effect of antidepressants on SF appears to be influenced P < 0.01) and overall satisfaction (Week 6, P < 0.02; Week 8 by the extent to which each drug effects serotonin, P < 0.05). Among those who received bupropion, significant norepinephrine, and dopamine reuptake inhibition; prolactin differences were observed on Sex FX total (Week 8, P < 0.01) release; and inhibition of NO synthetase (20,21). Among and desire (Week 2, P < 0.01; Week 8, P < 0.02). There was a commonly prescribed antidepressants, SSRIs are most likely significant relation between improved SF and response or to be associated with impaired SF (22,23). Paroxetine has greater selectivity for serotonin reuptake relative to dopamine For men, there was only a significant difference between reuptake and increased cholinergic receptor blockade. It is responders and nonresponders on overall satisfaction (Week also an inhibitor of NO synthetase, which may explain the 6, P < 0.02) in the paroxetine group, and, no significant differ- increased rate of impaired SF, compared with other SSRIs (5, ences were observed across the Sex FX total and subscale 24). Conversely, bupropion, with a novel mechanism of scores between responders and nonresponders in the action involving dual inhibition of norepinephrine and dopa- mine reuptake, is devoid of any direct effects on the serotonin Significant differences between remitters and nonremitters in the paroxetine group were observed on Sex FX Total (Week There are several limitations to this study. Numerous factors 2, P < 0.03; Week 6, P < 0.01; Week 8, P < 0.02), Desire (P < may influence the reporting of SF, including age, relationship 0.01), Arousal (Week 6 P < 0.01; Week 8, P < 0.01) and over- status, comorbid illness, concomitant medications, and vary- all satisfaction (Week 6, P < 0.01; Week 8, P < 0.01). We ing dosages of medication. The diagnosis of MDD and sever- observed significant differences on overall satisfaction ity of depression, rather than impaired SF, were the primary (Week 6, P < 0.04; Week 8, P < 0.02). In both cases male entry criteria, and this coincidentally resulted in significantly nonresponders and nonremitters reported worse levels of SF.
lower baseline Sex FX scores for women in the paroxetinegroup. Although this study excluded patients with comorbid Discussion
psychiatric disorders, it is possible that anxiety symptoms The Sex FX scale identified differences in scores between may have been unevenly distributed between treatment men and women with depression prior to antidepressant treat- groups, which may have influenced the distribution of SF ment, and differences between bupropion and paroxetine on among women at baseline. There were roughly equal numbers reported sexual side effects in men but not in women. Prior to of men (53%) and women (47%) recruited to the study. While treatment, women reported significantly lower levels of SF this facilitated statistical comparisons between men and than men. Men displayed deterioration in SF during treatment women, it does not reflect the twofold increase in prevalence with paroxetine but not during treatment with bupropion SR, of MDD among women, compared with men, in the commu- whereas there was no change in SF with either drug in women.
nity. Intimacy, stability of relationships, and sexual prefer- Men and women also differed in the relation between antide- ence are among the other factors for which we did not control.
pressant response and SF. Although there was no difference in Although patients were randomized and treated under W Can J Psychiatry, Vol 51, No 4, March 2006 Sexual Function During Bupropion or Paroxetine Treatment of Major Depressive Disorder
double-blind conditions, there was no placebo control. We are 8. Montejo AL, Llorca G, Izquierdo JA, Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter therefore unable to report the extent to which differences in study of 1022 outpatients. J Clin Psychiatry 2001;62(Suppl 3):10 –21.
Sex FX scores between paroxetine and bupropion SR are in 9. Rivas-Vazquez RA, Rey GJ, Blais MA. SD associated with antidepressant treatment. Professional Psychology: Research and Practice 2000;31:641–51.
excess of a placebo treatment effect.
10. Segraves RT, Kavoussi R, Hughes AR, Batey SR, Johnston JA, Donahue R, and others. Evaluation of sexual functioning in depressed outpatients: a double-blind These results support the importance of establishing baseline comparison of sustained-release bupropion and sertraline treatment. J Clin levels of SF and repeating the assessments systematically over 11. Zajecka J, Dunner DL, Gelenberg AJ,Hirschfeld RM, Kornstein SG, Ninan PT, the course of treatment (9,26,15). The study also suggests that and others. Sexual function and satisfaction in the treatment of chronic major men and women with depression differ in SF before starting depression with nefazodone, psychotherapy, and their combination. J ClinPsychiatry 2002;63:709–16.
antidepressant therapy and are affected differently in terms of 12. Kennedy SH, Fulton KA, Rasmussen JGC. Sex FX: estimation of normative SF during treatment. Future studies designed to compare the values and comparison with values from patients with major depressive disorder.
Vancouver (BC): Canadian Psychiatric Association; 2005.
effects on SF of different antidepressant or other psychotropic 13. Kennedy SH, McCann SM, Masellis M, McIntyre RS, Raskin J, McKay G, and drugs need to take these factors into account.
others. Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine:a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunctioneffects. J Clin Psychiatry 2002;63:181–6.
Funding and Support
14. Croft H, Settle E Jr, Houser T. A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release Funding was provided by Boehringer Ingelheim, Canada.
bupropion and sertraline. Clin Ther 1999;21:643–8.
15. Fava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, Johnston JA.15 years of clinical experience with bupropion HCl: from bupropion to bupropion Acknowledgments
SR to bupropion XL. Prim Care Companion J Clin Psychiatry.
This study was completed across 15 Canadian sites. The following principal investigators contributed to recruitment: John Angel, 16. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry St Johns, Newfoundland; Pierre Assalian, Montreal General 17. Canadian Pharmacists Association. The compendium of pharmaceuticals and Hospital, Montreal, Quebec; Vern Bennett, MD, Royal University specialties. Ottawa (ON): Canadian Pharmacist Association; 2004.
Hospital, Saskatoon, Saskatchewan; Pierre Chue, 18. Mallinckrodt CH, Sanger TM, Dube S, DeBrota DJ, Molenberghs G, Carroll RJ, Psychopharmacology Research Unit, Alberta; David Johnston, and others. Assessing and interpreting treatment effects in longitudinal clinical Calgary General Hospital, Peter Louhgeed Centre, Calgary, trials with missing data. Biol Psychiatry 2003;53:754–60.
Alberta; Hanumantha Koka, Sudbury Algoma Hospital Network 19. Piazza LA, Markowitz JC, Kocsis JH and others. Sexual functioning in North, Sudbury, Ontario; Stanley Kutcher, Queen Elizabeth II chronically depressed patients treated with SSRI antidepressants: A pilot study.
Am J Psychiatry 1997;154:1757–9.
Health Sciences Centre, Halifax, Nova Scotia; Raymond Lam, 20. Pomerantz SM, Hepner BC, Wertz JM. 5-HTIA and 5-HT IC/ID receptor agonists MD, University of British Columbia, Mood Disorders Clinic, produce reciprocal effects on male behaviour of rhesus monkeys. Eur J Vancouver, British Columbia; Daniel Lefcoe, London Health Sciences Centre, London, Ontario; Lee Rasmusen, Inova Health 21. Pollack MH, Reiter S, Hammerness P. Genitourinary and sexual adverse effects Research, Kelowna, British Columbia; Arun Ravindran, The of psychotropic medication. Int J Psychiatry Med 1992;22:305–27.
Royal Ottawa Health Care Group, Royal Ottawa Hospital, Ottawa, 22. Rosen R, Lane RM, Menza M. Effects of SSRI on sexual function: a critical review. J Clin Psychopharmacol 1999;19:67–85.
Ontario; Amarendra Singh, Kingston Psychiatric Hospital, 23. Weiner DN, Rosen RC. Medications and their impact on sexual function. In: Kingston, Ontario; Meir Steiner, St. Joseph’s Hospital, Hamilton, Sipski ML, Alexander CJ, editors. Sexual function in people with disability and Ontario; and Pierre Vincent, and Robert Giffard, Quebec City, chronic illness. Gaithersburg (MD): Aspen Publishers; 1997. p 85–118.
Quebec. The authors would also like to extend appreciation to 24. Montego-Gonzalez AL, Llorca G, Izquierdo JA, Ledesma A, Bousono M, Claire O’Donovan, Queen Elizabeth II Health Sciences Centre, Calcedo A, and others. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, Halifax, Nova Scotia and Beata Eisfeld, University Health sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinicalstudy of 344 patients. J Sex Marital Ther 1997;23:176–94.
Network, Toronto, Ontario, for comments on an earlier version of 25. Stahl SM, Pradko JF, Haight BR, Modell JG, Rockett CB, Learned-Coughlin S.
A review of the neuropharmcology of bupropion, a dual norepinephrine anddopamine reuptake inhibitor. Prim Care Companion J Clin Psychiatry2004;6:159–65.
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Professor of Psychiatry, University of Toronto, Toronto, Ontario; 3. McIntyre RS, Kennedy SH, Bagby RM, Bakish D. Assessing full remission.
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Can J Psychiatry, Vol 51, No 4, March 2006 W The Canadian Journal of Psychiatry—Original Research
Résumé : La fonction sexuelle durant un traitement au bupropion ou à la paroxétine
Objectif : L’objectif principal était d’évaluer la fonction sexuelle séparément chez les hommes et
les femmes souffrant de trouble dépressif majeur (TDM) avant et durant un traitement au bupropion
à libération prolongée (LP) ou à la paroxétine. Les objectifs secondaires comprenaient une
évaluation comparée de l’échelle des effets sexuels (Sex FX) et de l’échelle de désir et de
fonctionnement sexuel évalués par l’enquêteur (IRSD-F), ainsi qu’une comparaison des résultats
des antidépresseurs et un examen de la relation entre le niveau de dépression et la FS avec le temps.
Méthode : Il y avait 141 patients (68 femmes, 73 hommes) qui satisfaisaient aux critères du
DSM-IV pour un épisode courant de dépression majeure. Ils ont été affectés au hasard à recevoir du
bupropion LP (150 à 300 mg par jour) ou de la paroxétine (20 à 40 mg par jour) dans des conditions
d’essai à double insu. Les patients ont été évalués à la ligne de départ, aux 2e, 4e, 6e et 8e semaines
au moyen de l’échelle de dépression d’Hamilton en 17 items (HDRS17), de la Sex FX et de
l’IRSD-F.
Résultats : Avant le traitement, les femmes ont déclaré une FS significativement plus faible aux
deux échelles, Sex FX et IRSD-F, comparativement aux hommes. Durant le traitement, il n’y avait
pas de différence significative entre les médicaments aux mesures de la FS avec le temps chez les
femmes; cependant, les hommes traités à la paroxétine ont déclaré une aggravation de la FS, tandis
que le bupropion LP n’altérait pas significativement la FS. Tant le bupropion LP que la paroxétine
produisaient des réductions cliniquement et statistiquement significatives des scores au HDRS17,
ainsi que des taux comparables de réponse et de rémission. Il y avait une corrélation inverse
significative entre la dépression et la FS chez les femmes, mais pas chez les hommes, sans égard
aux médicaments.
Conclusion : Selon l’échelle Sex FX, une différence significative de la dysfonction sexuelle liée
aux antidépresseurs a été détectée chez les hommes, mais pas chez les femmes, durant le traitement
au bupropion LP ou à la paroxétine.
W Can J Psychiatry, Vol 51, No 4, March 2006

Source: http://ww1.cpa-apc.org/Publications/Archives/CJP/2006/march2/cjp-mar-2-06-kennedy-OR.pdf