Bupropion

immediaterelease and nefazodone were found to have the lowest rate of sexual dysfunction in a study of more than 6000 individuals on SSRIs, bupropion, mirtazapine, nefazodone, rcboxetine, and venlafaxine.29 Studies comparing SSRIs with mirtazapine are inconclusive, some showing higher rates of sexual dysfunction with SSRIs and others with mirtazpine.30-35 Among the SSRIs, paroxetine has been found to have the highest rates of sexual dysfunction.35 Management of sexual dysfunction, like all side effects, begins with a thorough assessment during the initial Inhibitors,research,lifescience,medical evaluation to establish a baseline, including discussion of whether the patient, is sexually active and the degree of satisfaction with sexual function prior to treatment, and to discuss concerns about possible sexual dysfunction related to anticipated treatment. It is important to reassess sexual function periodically during the course of therapy, and also to recognize Inhibitors,research,lifescience,medical that sexual function may become increasingly Inhibitors,research,lifescience,medical important to patients as their depressive symptoms improve.36 Prior to the introduction of sildenafil and similar agents, many methods and medications were used in an attempt to treat the sexual side effects of antidepressants. These included dose reduction, timing of sexual activity toward the end of a dosing interval,

several days’ drug holiday,37 and antidote therapy with medicine such as psychostimulants38 and dopamine Inhibitors,research,lifescience,medical (DA) agonists such as amantadine, pramipexole and Dexedrine, norepinephrine (NE)/DA agents such as bupropion, serotonin (5-HT)2 receptor antagonists such as nefazodone, and a2-adrenergic receptor antagonists such as yohimbine.39-40 As sildenafil has proven effective in placebo-controlled trials in the treatment of sexual performance,41 this agent, and related phosphdiesterase V inhibitors have become the mainstay of management, of sexual function. A recent trial42 also demonstrated that sildenafil is effective at. Inhibitors,research,lifescience,medical decreasing adverse sexual effects in women taking SSRIs, including improvement in desire, arousal-sensation, arousal-lubrication,

orgasm, and enjoyment. Nevertheless, many patients do not respond sufficiently well to sildenafil and related agents or other attempted why antidotes, and efforts to identify other remedies continue. These include complementary and alternative treatments such as maca root, arginine-containing compounds, and ginkgo biloba. When sexual dysfunction persists Selleckchem CDK inhibitor despite efforts at dose adjustments and antidote therapy, the principal option is to consider switching to agents with lesser degrees of sexual dysfunction, typically bupropion, or, where available, rcboxetine. Nefazodone is another option, though its use has been limited by risk of rare but. serious hepatotoxicity. Gastrointestinal problems Nausea and stomach upset.