Depression, SRRIs may impair adolescents’ sexual functioning, orgasm

Adolescent depression appeared linked to lower sexual functioning and selective serotonin reuptake inhibitors with impaired orgasm, according to results of a prospective study published in Journal of Clinical Psychiatry.

“Although impaired sexual functioning is not a defining symptom of depressive episodes, it is quite prevalent, affecting more than 40% of adult women and 30% of men with [major depressive disorder (MDD)],” Emira Deumic Shultz, MD, of the department of psychiatry at the University of Iowa Hospitals and Clinics, and colleagues wrote. “Even in nonclinical samples, depression severity and sexual functioning are correlated, with desire being more affected than arousal or orgasm.

“In the only study that, to our knowledge, examined sexual functioning in adolescents and young adults, the presence of a major depressive episode (MDE) was associated with lower sexual functioning overall, as well as in the facets of desire, arousal and orgasm more specifically,” they added.

In the current study, the investigators aimed to assess the link the between sexual functioning, depression and anxiety severity, and SSRI use among adolescents. They analyzed data of 263 participants (59% female; mean age, 18.9 years; 70% with MDD) aged 15 to 20 years between September 2010 and December 2014 who were either unmedicated or within a month of initiating SSRI treatment. Participants completed the Beck Depression Inventory-II, Beck Anxiety Inventory and Changes in Sexual Functioning Questionnaire (CSFQ) at baseline and every 4 months for a maximum of 2 years. The researchers used DSM-IV-TR criteria to determine psychiatric disorder presence. They collected data related to medication and hormonal contraception use. The researchers also genotyped polymorphisms of the HTR2A and ABCB1 genes. Further, they used linear mixed-effects regression models that accounted for relevant covariates to assess the link between depression and anxiety symptom severity, SSRI use and sexual functioning.

Results showed an association between depression severity, but not anxiety severity, and lower CFSQ total scores (beta = 0.13; P < .0001) as well as lower arousal, orgasm and pleasurable scores all (beta = 0.03; P < .003), following adjustment for age, sex and duration in the study. The researchers noted an association between higher SSRI doses and lower orgasm subscale scores (beta =0.3; P < .03). Hormonal contraceptive use correlated with higher CSFQ total scores (beta = 0.97; P < .003) and higher arousal (beta = 0.25; P <.009), desire (beta = 0.24; P <.001), orgasm (beta =0.27; P <.02) and pleasure (beta =0.15; P <.004) subscale scores. They observed no significant genetic moderating effect.

“As adolescents mature, sexual functioning features more prominently in their lives, requiring clinicians to attend to this important facet of development,” Shultz and colleagues wrote. “Given the propensity of adolescents to avoid spontaneously reporting on their sexual functioning, it is imperative that providers initiate discussions about this topic.

“Proper assessment may result in treatment implications, including avoiding treatment nonadherence by reducing the dose, switching medications or even discontinuing psychotropic agents in favor of nonpharmacologic interventions,” they added.