NCDEU Poster Session 2012

Sexual Satisfaction in Major Depressive Disorder Before and After Treatment With SSRI in the STAR*D Study

Waguih William IsHak, MD, FAPA; Scott Christensen, BS; Gregory Sayer, MD; Khanh Ha, MD; Ning Li, PhD; Jamie Miller, PhD; Jaidyn Mai Nguyen, BS; and Robert M. Cohen, PhD, MD
From Cedars-Sinai Medical Center and the University of California, Los Angeles.

This poster presentation was supported by NIMH Contract #N01MH90003 awarded to the University of Texas Southwestern Medical Center.

Background: Major Depressive Disorder (MDD) is a highly prevalent psychiatric illness that significantly affects mood, sexual satisfaction, and quality of life (QOL). The first line treatment for MDD is Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs have been associated with sexual dysfunction, which often compromises patient medication compliance and QOL. We examined the impact of MDD and SSRI treatment for MDD on sexual satisfaction and QOL in efforts to help physicians better address SSRI associated sexual side-effects.

Methods: We analyzed baseline and post-treatment data for 2,324 patients with MDD that completed treatment with citalopram, an SSRI, in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. We focused on three outcome measures: severity of depression, QOL, and sexual satisfaction as measured by the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Q-LES-Q item#9, respectively.

Results: Impairment in sexual satisfaction (ISS) was reported in 63.8% of patients before and 46.8% after treatment (p<0.0001). Less severely depressed patients experienced less ISS before and after treatment. Males who did not achieve remission from MDD with citalopram had an ISS prevalence of 62.1% as compared to 20.5% (P< 0.0001) in males that achieved remission. Similarly, the prevalence of ISS was 60.7% in females that did not achieve remission compared to 21.9% (P<0.0001) of females that achieved remission. Regression models showed that depressive symptom severity predicted ISS (p<0.0001), and that the latter predicted impairment in QOL (p<0.0001).

Conclusions: Citalopram treatment significantly improved sexual satisfaction and QOL, especially in patients who achieved remission. These results highlight the need for physicians to be cognizant of patient sexual satisfaction and to treat MDD rigorously until remission.

Conclusions:
Learn the difference between the Sexual Satisfaction and Sexual Dysfunction

Understand the concept of Sexual Satisfaction and how to measure it

Acquire knowledge about how to improve Sexual Satisfaction in treatment of Major Depression

Appreciate the importance of treating depression to remission and impact on sexual satisfaction and QOL

References
Rush AJ, Fava M, Wisniewski SR, et al, for the STAR*D Investigators Group. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004;25(1):119–142. PubMed

IsHak WW, Greenberg JM, Balayan K, et al. Quality of life: the ultimate outcome measure of interventions in major depressive disorder. Harv Rev Psychiatry. 2011;19(5):229–239. PubMed

Clayton AH, Montejo AL. Major depressive disorder, antidepressants, and sexual dysfunction. J Clin Psychiatry. 2006;67(suppl 6):33–37. PubMed

Daly EJ, Trivedi MH, Wisniewski SR, et al. Health-related quality of life in depression: a STAR*D report. Ann Clin Psychiatry. 2010;22(1):43-55. PubMed

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