NEW YORK (Reuters Health) Jan 17 - Short-term treatment with selegiline transdermal system (STS), a dermally administered monoamine oxidase inhibitor, does not impair sexual function in patients with major depressive disorder, results of a meta-analysis published in the December issue of the Journal of Clinical Psychiatry suggest.
According to Dr. Anita H. Clayton, of the University of Virginia Health System, Charlottesville, and colleagues, product labeling indicates that the incidence of spontaneously reported sexual side effects of antidepressants is relatively low. However, recent studies "using patient-completed or clinician-administered questionnaires have found rates ranging from 22% to 73%."
The researchers examined the impact of STS 6 mg/24 hours on various domains of sexual function in four short-term (6 to 8 weeks), randomized, double-blind, placebo-controlled trials of STS in patients with major depressive disorder (STS, n = 389; placebo, n = 400). A standardized patient-rated questionnaire was used to assess sexual interest, arousal, maintenance of interest, orgasm, and satisfaction.
The patients had a mean age of 42 years, and 62% were female.
Estimates of differences between STS and placebo revealed a nonsignificant trend toward a positive treatment effect of STS on most domains of sexual function, overall.
A significant positive effect was observed for women on the domains of interest, maintaining interest during sex, and satisfaction. No differences between STS and placebo were found for men.
A multivariate regression analysis was conducted to differentiate a direct effect of STS on changes in sexual function from an indirect effect mediated through improvement of depressive symptoms. "Differences between STS and placebo were not significant in this analysis, indicating that STS treatment did not worsen any domain of sexual function in either women or men after controlling for improvement in depression," Dr. Clayton's team reports.
J Clin Psychiatry 2007;68:1860-1866.
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Monday, January 21, 2008
Terrorism, Acute Stress, and Cardiovascular Health
A 3-Year National Study Following the September 11th Attacks E. Alison Holman, FNP, PhD; Roxane Cohen Silver, PhD; Michael Poulin, PhD; Judith Andersen, PhD; Virginia Gil-Rivas, PhD; Daniel N. McIntosh, PhD Arch Gen Psychiatry. 2008;65(1):73-80. Context The terrorist attacks of 9/11 (September 11, 2001) present an unusual opportunity to examine prospectively the physical health impact of extreme stress in a national sample. Objective To examine the degree to which acute stress reactions to the 9/11 terrorist attacks predict cardiovascular outcomes in a national probability sample over the subsequent 3 years. Design, Setting, and Participants A national probability sample of 2729 adults (78.1% participation rate), 95.0% of whom had completed a health survey before 9/11 (final health sample, 2592), completed a Web-based assessment of acute stress responses approximately 9 to 14 days after the terrorist attacks. Follow-up health surveys reassessed physician-diagnosed cardiovascular ailments 1 (n = 1923, 84.3% participation rate), 2 (n = 1576, 74.2% participation rate), and 3 (n = 1950, 78.9% participation rate) years following the attacks. Main Outcome Measures Reports of physician-diagnosed cardiovascular ailments over the 3 years following the attacks. Results Acute stress responses to the 9/11 attacks were associated with a 53% increased incidence of cardiovascular ailments over the 3 subsequent years, even after adjusting for pre-9/11 cardiovascular and mental health status, degree of exposure to the attacks, cardiovascular risk factors (ie, smoking, body mass index, and number of endocrine ailments), total number of physical health ailments, somatization, and demographics. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of physician-diagnosed hypertension (rate ratios, 2.15 at 1 year and 1.75 at 2 years) and heart problems (rate ratios, 2.98 at 1 year and 3.12 at 2 years) over 2 years. Among individuals reporting ongoing worry about terrorism post-9/11, high 9/11-related acute stress symptoms predicted increased risk of physician-diagnosed heart problems 2 to 3 years following the attacks (rate ratios, 4.67 at 2 years and 3.22 at 3 years). Conclusion Using health data collected before 9/11 as a baseline, acute stress response to the terrorist attacks predicted increased reports of physician-diagnosed cardiovascular ailments over 3 years following the attacks. Author Affiliations: Program in Nursing Science (Dr Holman) and Departments of Psychology and Social Behavior and Medicine (Dr Silver), University of California, Irvine; Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor (Dr Poulin); Department of Veterans Affairs Medical Center, Syracuse, New York (Dr Andersen); and Departments of Psychology, University of North Carolina, Charlotte (Dr Gil-Rivas), and University of Denver, Denver, Colorado (Dr McIntosh).
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