NEW YORK (Reuters Health) – Among men with depression,
treatment with the antidepressant Cymbalta (duloxetine) does
not worsen sexual functioning, as is common for most
antidepressants, investigators reported this week at the
American Psychiatric Association 2006 annual meeting in
Toronto.
“When we take surveys of patients who take their
antidepressants only intermittently or discontinue them
altogether, about two-thirds of patients will say it is because
of side effects, of which the most common are sexual side
effects,” presenter Dr. Anita Clayton told Reuters Health.
Failure to take the antidepressant as prescribed is likely to
result in relapse, she added.
Clayton and her colleagues at the University of Virginia in
Charlottesville randomly assigned 684 patients with depression
to 60 milligrams per day of Cymbalta, or to 10 milligrams per
day of Lexapro (another antidepressant), or to placebo for 8
weeks. The patients completed the “Changes in Sexual
Functioning Questionnaire” at regular intervals.
Approximately 42 percent of patients on Cymbalta had an
antidepressant response, versus 35 percent of those treated
with Lexapro, with onset as early as 2 weeks and sustained
throughout the study.
At 4 and 8 weeks, Lexapro was associated with significant
worsening of sexual functioning compared with placebo. In
contrast, the effect of Cymbalta was similar to that of
placebo.
At 8 weeks, responses to the sexual functioning
questionnaire showed that 37 percent of men treated with
Cymbalta, 49 percent of those taking placebo, and 59 percent
among those taking Lexapro had worsening sexual functioning.
Among women, the rates of worse sexual dysfunction were similar
between the two drugs (36 percent and 38 percent, versus 26
percent for placebo).
The initial 8-week phase of the trial was followed by a
6-month, flexible dosing extension phase in which patients took
Cymbalta 60 to 120 mg daily or Lexapro 10 to 20 mg per day.
Those who discontinued placebo pills because of lack of
efficacy were randomly assigned to one of the two drugs.
By the end of the 8 months, there were no significant
differences between the two drugs in terms of their effect on
sexual function.
“We know that among people with sexual dysfunction
associated with SSRI (antidepressants), 5 percent to 10 percent
get over it. They become acclimated to it, but it takes about 4
to 6 months,” Clayton noted. The reported sexual side effects
in this study were also affected by attrition and dosing
flexibility, she added.
When asked if medications like sildenafil (Viagra) could
help reduce the sexual side effects, she answered, “Sildenafil
may be helpful in men with erectile dysfunction or arousal
problems related to antidepressant medication, but it has no
effect on reduced sexual desire or orgasmic dysfunction.”
This study was funded by Eli Lilly and Company.
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