Mental health problems
Depression: Depression and its treatments are strongly associated with ED and other sexual dysfunctions. Sometimes depression causes these problems and sometimes the problems cause depression. Taking a careful history may help clarify the situation. Both problems warrant treatment and should be managed concurrently. There is evidence that treating ED can improve depressive symptoms. However, depression is a serious, potentially lifc’threatening condition and should be treated aggressively.
All antidepressants have the potential to cause sexual dysfunction. Modern tricyclic antidepressants (TCAs) are probably no worse than selective serotonin reuptake inhibitors (SSRIs) in this respect. Older TCAs, with marked sedative and anticholinergic effects, are more likely to cause ED. SSRIs are known to delay orgasm or even cause anorgasmia. They are sometimes used as a treatment for premature ejaculation. They can also cause loss of sexual drive and, less frequently, ED. Newer antidepressant agents, particularly those not working through the serotonin system (e.g. mirtazepine, nefazodone, and reboxetine) may be less prone to cause sexual side effects.
Patients who are depressed or who are receiving treatment for depression should be routinely questioned about sexual function while reviewing the management of their depressive illness. For some, sexual intimacy allows them to escape from the pain of their depressive illness. It is both appropriate and a kindness to offer treatment for ED to affected men w i t h depression. Schizophrenia and other psychoses: Sexual function in men with schizophrenia and other psychotic illness is often neglected while attention is paid to their mental health problems. Most men with relapsing psychotic disorders remain well for most of the time and wish to enjoy sexual relationships. The majority of antipsychotic agents, including several atypical antipsychotics, are centrally acting dopamine antagonists and cause hyperprolactinemia. This can, in turn, cause loss of sexual drive and ED.
The atypical antipsychotic quetiapine seems less prone to cause sexual side effects. Anticholinergics, used to ameliorate other side effects, can add to the problem. Modification of dosage or drug can improve sexual function, but this should only be attempted in collaboration with a psychiatrist.
Men with schizophrenia and other psychotic illness should be routinely asked about sexual function and, where appropriate, treatment should be offered.
Cognitive impairment and dementia: The development of cognitive impairment and dementia often has a devastating effect on a relationship. However, some couples continue to enjoy a satisfactory sexual relationship and, provided that the rights of the cognitively impaired partner are respected and protected, treatment for ED should be offered.
Tags: Anticholinergic Effects, Antidepressant Agents, Antipsychotic Agents, Atypical Antipsychotics, Careful History, Cause Depression, Dopamine Antagonists, Mental Health Problems, Nefazodone, Premature Ejaculation, Psychotic Disorders, Psychotic Illness, Selective Serotonin Reuptake Inhibitors, Serotonin Reuptake Inhibitors, Serotonin System, Sexual Dysfunctions, Sexual Intimacy, Sexual Relationships, Sexual Side Effects, Treatment For Depression