جستجوی مقالات مرتبط با کلیدواژه "مهارکننده های انتخابی بازجذب سروتونین" در نشریات گروه "پزشکی"

Selective serotonin reuptake inhibitors (SSRIs) are effective in patients with premature ejaculation (PE), but the effect of combination therapy with tadalafil as a phosphodiesterase-5 inhibitor (PDE5I) and sertraline (an SSRI) in these patients has been less studied. The aim of this study was to evaluate the safety and efficacy of tadalafil with sertraline compared with sertraline and placebo.

107 patients with lifelong PE and no erectile dysfunction (ED) and an intravaginal ejaculation latency time (IELT) of less than 60s were treated for 6 weeks. Subjects were randomly divided into two groups: the placebo group (n=51) and the tadalafil group (n=51), who received  sertraline 50 mg daily plus placebo on demand or sertraline 50 mg daily plus tadalafil 10 mg on demand . Premature ejaculation profile (PEP) and IELT were used to evaluate PE. The change in mean IELT, mean change in all four measures of PEP, and adverse effects in 2 groups were recorded.

Mean IELT before and after treatment was 35 .29sand 87 .55s, respectively, in the placebo group (P<0 ,0001) and 40 .1s and 153.63s, respectively, in the tadalafil group (P<0 .0001). Mean IELT improved significantly in the tadalafil group compared with the placebo group (113.53s vs. 52.25s, P<0.0001). All four measures of PEP scores also improved in the tadalafil group compared with the placebo group. Drug-related adverse events occurred more frequently in group B than in group A.

Combination therapy with tadalafil and sertraline in the treatment of premature ejaculation is more effective than sertraline alone despite more side effects.

 Sertraline is one of the most commonly used selective serotonin-reuptake inhibitors for patients with major depressive disorder. The prevalence of sexual dysfunction among patients who use selective serotonin-reuptake inhibitors is 40%–45% for women and 20%–30% for men. A strategy to prevent this side effect is combination therapy with medications such as buspiron and Ritalin. The aim of this study was to compare the effects of bupropion and Ritalin on sexual dysfunction among patients who use sertraline.

 This single-blind randomized controlled trial was conducted in 2018. Fifty eligible women aged 20–45 years old were purposefully selected from the psychiatric clinics of Yahyanejad and Ruhani hospitals, Babol, Iran. Structured interview was used to screen participants for major depressive disorder, sertraline use, and sexual dysfunction. All participants completed the Arizona Sexual Experience Scale and were randomly allocated to the bupropion and the Ritalin group through block randomization. All participants re-completed the Scale one month after the intervention. Data were analyzed through SPSS software by repeated measure analysis of variance.

 All fifty participants (25 in each group) completed the study. The mean of participants’ age was 36.38±5.64 years and the mean score of their sexual dysfunction was 23.44±3.14 at pretest and 19.52±4.92 at posttest. Between-group differences respecting the mean scores of sexual dysfunction and all its items were insignificant both at pretest (P= 0.886) and posttest (P= 0.872). However, within-group comparisons revealed that the mean score of sexual dysfunction significantly decreased in both groups (P<0.001).

 This study concludes the same efficacy of sustained release bupropion and Ritalin in significantly reducing sexual dysfunction among patients who used sertraline.

Practical Implications: 

 According to the results of the present study and the similar efficacy of slow-release bupropion and Ritalin in improving sexual dysfunction caused by sertraline, it seems that Ritalin, due to its effectiveness in treatment, is an easier drug to use. It is more cost-effective and a better alternative to bupropion in improving sexual dysfunction in patients who are candidates for treatment with serotonin- reuptake inhibitors.