Sexual Dysfunction in Major Depression

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S9) ◽  
pp. 19-23 ◽  
Author(s):  
Katherine Williams ◽  
Margaret F. Reynolds
Keyword(s):  
Major Depression ◽  
Sexual Dysfunction ◽  
Antidepressant Medication ◽  
Unipolar Depression ◽  
Future Research ◽  
Drug Induced ◽  
Depression Disorders ◽  
Severity Of Depression ◽  
Loss Of Libido ◽  
Disorders Of Arousal

AbstractLittle is known about the prevalence, typology, and natural course of non—drug-induced sexual dysfunction in patients with depression. Loss of libido has been reported in various studies to affect from 25% to 75% of patients with unipolar depression, and its prevalence appears to be correlated with the severity of depression. Disorders of arousal also appear to be relatively common in both men and women with major depression, of whom ~25% may experience problems with erection or lubrication. The scant available data regarding orgasmic difficulties in patients with depression who have not yet taken antidepressant medication suggest that they are more common than in the general population. The potential causes of sexual dysfunction in patients with depression are complex and little investigated, and future research must distinguish and explore the various biological, psychological, and psychosocial factors that are likely to be involved.

Pharmacological Treatments for Unipolar Depression

2007 ◽  
pp. 271-288 ◽  
Author(s):  
Charles B. Nemeroff ◽  
Alan F. Schatzberg
Keyword(s):  
Major Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Safety Margin ◽  
Antidepressant Medication ◽  
Unipolar Depression ◽  
Controlled Trials ◽  
Adverse Side Effect ◽  
Drug Induced

The treatment of unipolar major depression with antidepressant medication is well established on the basis of scores of randomized placebo-controlled trials involving thousands of patients. Tricyclic antidepressants (TCAs) were the first to be studied extensively; meta-analyses of placebo-controlled trials show them to be consistently and significantly more efficacious than a placebo. Because of a narrow safety margin and significant drug-induced adverse side effect problems, TCAs have now largely been replaced as the first-line treatment of depression by selective serotonin reuptake inhibitors (SSRIs)—fluoxetine, sertraline, paroxetine, citalopram, and escitalopram; serotonin norepinephrine reuptake inhibitors (SNRIs)—venlafaxine and duloxetine; as well as other compounds, including, for example, bupropion and mirtazapine. Each of these agents has been shown to be superior to a placebo and as effective as comparator TCAs or SSRIs in controlled trials. Clinical trials consistently show them to be better tolerated than TCAs, and they clearly have a wider margin of safety. However, there is a controversy concerning whether TCAs are more effective than SSRIs for the treatment of the most severely ill depressed patients. Monoamine oxidase inhibitors (MAOIs), while also more effective than placebo, have generally been reserved for treatment-refractory patients; however, a recently released transdermally delivered selegiline may be used in less refractory patients. It is now generally recognized that patients with recurrent major depression benefit from continued antidepressant treatment, and there is evidence that TCAs, SSRIs, SNRIs, and so forth are all effective for the long-term management of recurrent major depression. An important issue in evaluating the antidepressant literature is to distinguish between response rated as a reduction in the level of symptoms on a rating scale and response rated as true remission from illness.

Depressive Disorders in Cancer

2021 ◽  
pp. 320-328
Author(s):  
Christian Schulz-Quach ◽  
Madeline Li ◽  
Kimberley Miller ◽  
Gary Rodin
Keyword(s):  
Major Depression ◽  
Cancer Patients ◽  
Depressive Disorders ◽  
Antidepressant Medication ◽  
Adjustment Disorder ◽  
Evidence Base ◽  
Future Research ◽  
Subthreshold Depression ◽  
Care Models ◽  
Significant Impairment

The prevalence, clinical features, pathophysiology, and diagnostic and treatment approaches for the spectrum of depressive disorders in cancer patients are reviewed here. At the more severe end of the continuum, major depression is a serious comorbidity with a prevalence of 8–24% in cancer patients and associated with significant impairment in quality of life and engagement in cancer treatment. Subthreshold depressive disorders are even more common and can be associated with substantial functional impairment. The distinction among these disorders can be difficult to make but has important implications for treatment. Milder depressive symptoms, such as those associated with an adjustment disorder or subthreshold depression, may not be responsive to antidepressant medication, while moderate to severe major depression often does respond. Biological factors contributing to depression should be addressed and psychological interventions may be beneficial across the spectrum of depression. Psychotherapeutic and pharmacologic interventions have been shown to be effective in cancer, and collaborative care models may enhance their delivery. Future research is needed to better define the phenomenology of subthreshold depression in cancer patients and to strengthen the evidence base for both the pharmacotherapy and psychotherapy of depression in cancer.

The Evaluation of Depression in Inpatients with HIV Disease

1999 ◽  
Vol 33 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Alexandra Cockram ◽  
Fiona K. Judd ◽  
Anne Mijch ◽  
Trevor Norman
Keyword(s):  
Major Depression ◽  
Rating Scales ◽  
Rating Scale ◽  
Immune Deficiency Syndrome ◽  
Epidemiological Studies ◽  
Deficiency Syndrome ◽  
Hiv Disease ◽  
Loss Of Weight ◽  
Severity Of Depression ◽  
Loss Of Libido

Objectives: The aim of this paper is: to compare the utility of four approaches to the diagnosis of depression in patients with human immunodeficiency virus (HIV) disease; to examine the utility of four rating scales to assess the presence and severity of depression; and to devise a set of substitutive criteria that would be appropriate in patients with HIV disease. Method: A group of inpatients was assessed using standard clinical interview. Patients found to have major depression using DSM-III-R (aetiological) criteria were assessed using inclusive, substitutive and exclusive criteria for the diagnosis of depression. Severity was assessed using the Hamilton Depression Rating Scale (HDRS), the Montgomery Asberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), and the Centre for Epidemiological Studies Depression Rating Scale (CES-D). Agroup of control patients were matched for age and severity of HIV illness. Results: Seventeen patients met DSM-III-R (aetiological criteria) for major depression. All were male; they had a mean age of 40.6 years and one-third had acquired immune deficiency syndrome (AIDS). Using alternative approaches to the diagnosis of depression, up to five additional ‘depressed’ patients were identified (‘false positives’). All 17 patients meeting the DSM-III-R criteria also met the substitutive and exclusive criteria but only 15 exclusive criteria. Of the 17 controls (not meeting DSM-III-R criteria), two met substitutive, five inclusive and one exclusive criteria for depression. The mean (±SD) scores for the patients and controls were significantly different on all four rating scales. Analysis of individual items on the rating scales revealed that a number did not show significant differences between the depressed and non-depressed groups: on the MADRS the items lassitude and inner tension; on the HDRS the three items depicting anxiety symptoms, loss of libido, hypochondriasis, loss of weight, and maintenance of insight; on the BDI a sense of being punished, disappointed in self, being self-critical, a feeling of looking unattractive, fatigue, weight loss, worried about health and loss of libido; on the CES-D I felt just as good as others, hopeful, talk less, people unfriendly and felt people dislike me. Conclusions: The aetiological approach used by clinicians familiar with the features of HIV disease, was found to be useful. All four rating scales differentiated equally well between depressed and non-depressed groups.

scholarly journals Attachment in Patients with Bipolar and Unipolar Depression: A Comparison with Clinical and Non-clinical Controls

2019 ◽  
Vol 15 (1) ◽  
pp. 143-152
Author(s):  
Angelo Picardi ◽  
Mauro Pallagrosi ◽  
Laura Fonzi ◽  
Giovanni Martinotti ◽  
Emanuele Caroppo ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Attachment Style ◽  
Bipolar Depression ◽  
Unipolar Depression ◽  
Clinical Severity ◽  
Future Research ◽  
Attachment Insecurity ◽  
Adult Attachment Style ◽  
Severity Of Depression ◽  
Patients With Epilepsy

Background: A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce. Objective: We aimed at testing the association between attachment insecurity and unipolar and bipolar depression. Methods: We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style. Results: Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression. Conclusion: Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.

Investigating the Dynamics of Suicidal Ideation

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Nina Hallensleben ◽  
Lena Spangenberg ◽  
Thomas Forkmann ◽  
Dajana Rath ◽  
Ulrich Hegerl ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Small Sample Size ◽  
Unipolar Depression ◽  
Small Sample ◽  
History Of ◽  
Severity Of Depression ◽  
Ecological Momentary ◽  
Depressive Episodes ◽  
Ema Method ◽  
Shed Light

Abstract. Background: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. Aim: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). Method: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. Results: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. Limitations: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. Conclusion: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.

scholarly journals The Catecholaldehyde Hypothesis for the Pathogenesis of Catecholaminergic Neurodegeneration: What We Know and What We Do Not Know

2021 ◽  
Vol 22 (11) ◽  
pp. 5999
Author(s):  
David S. Goldstein
Keyword(s):  
Lewy Bodies ◽  
Alpha Synuclein ◽  
Future Research ◽  
Catecholamine Metabolism ◽  
Secondary Effects ◽  
Drug Induced ◽  
Neuronal Homeostasis ◽  
Mitochondrial Functions ◽  
Environmental Agents ◽  
Spontaneous Oxidation

3,4-Dihydroxyphenylacetaldehyde (DOPAL) is the focus of the catecholaldehyde hypothesis for the pathogenesis of Parkinson’s disease and other Lewy body diseases. The catecholaldehyde is produced via oxidative deamination catalyzed by monoamine oxidase (MAO) acting on cytoplasmic dopamine. DOPAL is autotoxic, in that it can harm the same cells in which it is produced. Normally, DOPAL is detoxified by aldehyde dehydrogenase (ALDH)-mediated conversion to 3,4-dihydroxyphenylacetic acid (DOPAC), which rapidly exits the neurons. Genetic, environmental, or drug-induced manipulations of ALDH that build up DOPAL promote catecholaminergic neurodegeneration. A concept derived from the catecholaldehyde hypothesis imputes deleterious interactions between DOPAL and the protein alpha-synuclein (αS), a major component of Lewy bodies. DOPAL potently oligomerizes αS, and αS oligomers impede vesicular and mitochondrial functions, shifting the fate of cytoplasmic dopamine toward the MAO-catalyzed formation of DOPAL—destabilizing vicious cycles. Direct and indirect effects of DOPAL and of DOPAL-induced misfolded proteins could “freeze” intraneuronal reactions, plasticity of which is required for neuronal homeostasis. The extent to which DOPAL toxicity is mediated by interactions with αS, and vice versa, is poorly understood. Because of numerous secondary effects such as augmented spontaneous oxidation of dopamine by MAO inhibition, there has been insufficient testing of the catecholaldehyde hypothesis in animal models. The clinical pathophysiological significance of genetics, emotional stress, environmental agents, and interactions with numerous proteins relevant to the catecholaldehyde hypothesis are matters for future research. The imposing complexity of intraneuronal catecholamine metabolism seems to require a computational modeling approach to elucidate clinical pathogenetic mechanisms and devise pathophysiology-based, individualized treatments.

scholarly journals HIV and Sexual Dysfunction in Men

2021 ◽  
Vol 10 (5) ◽  
pp. 1088
Author(s):  
Sara De Vincentis ◽  
Giulia Tartaro ◽  
Vincenzo Rochira ◽  
Daniele Santi
Keyword(s):  
Sexual Dysfunction ◽  
Current Knowledge ◽  
Virus Transmission ◽  
Sexual Problem ◽  
People Living With Hiv ◽  
Clinical Approach ◽  
Hiv Patients ◽  
Hiv Management ◽  
Loss Of Libido ◽  
Living With Hiv

Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.

scholarly journals Black Cumin (Nigella sativa L.): A Comprehensive Review on Phytochemistry, Health Benefits, Molecular Pharmacology, and Safety

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1784
Author(s):  
Md. Abdul Hannan ◽  
Md. Ataur Rahman ◽  
Abdullah Al Mamun Sohag ◽  
Md. Jamal Uddin ◽  
Raju Dash ◽  
...  
Keyword(s):  
Nigella Sativa ◽  
Health Benefits ◽  
Underlying Mechanism ◽  
Future Research ◽  
Molecular Pharmacology ◽  
Active Components ◽  
Drug Induced ◽  
Current Effort ◽  
Black Cumin ◽  
Pharmaceutical Industries

Mounting evidence support the potential benefits of functional foods or nutraceuticals for human health and diseases. Black cumin (Nigella sativa L.), a highly valued nutraceutical herb with a wide array of health benefits, has attracted growing interest from health-conscious individuals, the scientific community, and pharmaceutical industries. The pleiotropic pharmacological effects of black cumin, and its main bioactive component thymoquinone (TQ), have been manifested by their ability to attenuate oxidative stress and inflammation, and to promote immunity, cell survival, and energy metabolism, which underlie diverse health benefits, including protection against metabolic, cardiovascular, digestive, hepatic, renal, respiratory, reproductive, and neurological disorders, cancer, and so on. Furthermore, black cumin acts as an antidote, mitigating various toxicities and drug-induced side effects. Despite significant advances in pharmacological benefits, this miracle herb and its active components are still far from their clinical application. This review begins with highlighting the research trends in black cumin and revisiting phytochemical profiles. Subsequently, pharmacological attributes and health benefits of black cumin and TQ are critically reviewed. We overview molecular pharmacology to gain insight into the underlying mechanism of health benefits. Issues related to pharmacokinetic herb–drug interactions, drug delivery, and safety are also addressed. Identifying knowledge gaps, our current effort will direct future research to advance potential applications of black cumin and TQ in health and diseases.

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