Abstract
Objetivo
Valorar la incidencia de disfunciones sexuales (DS) inducidas por los antidepresivos inhibidores de la recaptación de serotonina (IRS) y comparar las diferencias entre éstos, lo que puede repercutir en su manejo práctico.
Diseño
Estudio naturalista, prospectivo, observacional.
Emplazamiento
Dos centros de salud urbanos.
Pacientes
Doscientos treinta y cinco pacientes (164 mujeres y 71 varones) ambulatorios que iniciaron tratamiento con alguno de los siguientes IRS: fluoxetina, sertralina, paroxetina, citalopram y venlafaxina, con relaciones sexuales habituales con pareja estable, con un diagnóstico psiquiátrico susceptible de tratamiento con IRS. La asignación a cada grupo se realizó según criterios clínicos. Intervenciones. Cuestionario autoadministrado que evaluaba DS inducida por el tratamiento, valorando la presencia de alteraciones de la libido, la excitación sexual o el orgasmo. Los pacientes fueron seguidos durante 6 meses.
Resultados
Un 62,6% (147 pacientes) de los casos comunicó alguna DS inducida por los IRS. Había diferencias entre los distintos antidepresivos con las siguientes incidencias: 39% con fluoxetina, 75,5% con paroxetina, 78,8% con sertralina, 28,9% con citalopram y 80% con venlafaxina. En un 78,2% de los casos la DS persistió o empeoró durante el seguimiento. En un modelo de regresión logística predictivo de la presencia de DS inducida por los IRS, las categorías mujer y la presencia de problemas sexuales previos tuvieron un efecto protector y el tratamiento con paroxetina, sertralina o venlafaxina incrementaron el riesgo de provocarla.
Conclusiones
La DS es posiblemente uno de los efectos adversos más frecuentes y persistentes de los IRS, por lo que es necesario valorar su presencia de forma sistemática en pacientes sexualmente activos en tratamiento con IRS. Además pueden existir diferencias entre los distintos IRS en su capacidad de inducir estas DS, lo que tiene relevancia en el momento de seleccionar un antidepresivo.
Palabras clave: Antidepresivos, Disfunción sexuales, Inhibidores recaptación serotonina, Tolerancia
Abstract
Objective
To assess the incidence of serotonin reuptake inhibitor (SRI) antidepressant-induced sexual dysfunction (SD) and to compare the sexual side effects of SRI.
Design
Naturalistic, prospective, observational study.
Setting
Two urban health centers.
Patients
235 outpatients (164 women, 71 males) who began treatment with some of the following SRI: fluoxetine, sertraline, paroxetine, citalopram and venlafaxine, who had engaged in regular sexual practices with stable partner, who were suffering from different mental disorders who were being treated with SRI. The assignment to each group was according to clinical criteria.
Interventions
Patients completed questionnaires that allowed reporting of both SD induced by the illness and the treatment, evaluating changes in libido, arousal, and orgasm. The patients were observed over 6 months of treatment.
Results
147 patients (62.6%) reported one or more SD related to SRI treatment. There were differences in the incidence between the different SRI: 39% with fluoxetine, 75.5% with paroxetine, 78,8% with sertraline, 28.9% with citalopram and 80% with venlafaxine. In 78.2% of patients the SD showed no improvement by the end of this period. In a predictive logistical regression model of the presence of SD induced by the SRI, the female category and the presence of previous sexual problems were favourable predictors and the treatment with paroxetine, sertraline or venlafaxine were increased the risk of SD.
Conclusions
SD is one of the most frequent and persistent SRI adverse effect.We recomended to inquiry about SD in patients who were treated with SRI. Significant differences were found in the occurrence of SD between the different SRI. Such data would be particularly valuable to physicians when choosing a specific antidepressant from this therapeutic group.
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