Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors
Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors
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DOI：
10.1111/j.1743-6109.2007.00630.x
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发表时间：
2008-01-01
影响因子：
3.5
通讯作者：
Mehtonen, Olli-Pekka
中科院分区：
文献类型：
--
作者：
Csoka, Antonei;Bahrick, Audrey;Mehtonen, Olli-Pekka
导言。在服用选择性5-羟色胺再摄取抑制剂(SSRI)的患者中，性功能障碍非常常见，如性欲低下、性高潮、生殖器麻醉和勃起功能障碍。人们一直认为，这些副作用在停止治疗后总是会消失的，但最近，有4例患者的性功能没有恢复到基线水平。在这里，我们描述了另外三个病例。病例1：29岁，在1996年连续4个月每天服用20毫克氟西汀后出现明显的永久性勃起功能障碍。病例2：44岁男性，在每天服用20毫克西酞普兰18个月后持续性欲减退、生殖器麻醉、射精乏力和勃起功能障碍。病例3：28岁男性，在2003-2005两年间服用多种不同的SSRIs后持续性欲减退、生殖器麻醉和射精缺乏。结果：在这三个病例中都没有发现与性有关的心理问题，所有导致性功能障碍的常见原因都被排除在外，如睾丸激素减少、催乳素增加或糖尿病。注射前列地尔的病例1和口服西地那非的病例2的勃起能力暂时恢复，但他们的其他症状仍然存在。病例3使用缓释哌甲酸甲酯后症状有所好转，但目前尚不清楚停药后这些促性作用是否会持续。SSRI可能会对性反应周期的各个方面造成长期影响，这些影响在停用后可能会持续下去。简要讨论了包括持续性内分泌和表观基因表达改变在内的机制假说。
Introduction. Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function did not return to baseline. Here, we describe three more cases.Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for a 4-month period in 1996.Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile dysfunction after taking 20-mg once daily citalopram for 18 months.Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003-2005.Results. No psychological issues related to sexuality were found in any of the three cases, and all common causes of sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it is not yet known if these prosexual effects will persist when the drug is discontinued.Conclusion. SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations were briefly discussed.