Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale
Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking. To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction...
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| Veröffentlicht in: | CNS spectrums 2022-08, Vol.27 (4), p.496-505 |
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| creator | Luft, Marissa J. Dobson, Eric T. Levine, Amir Croarkin, Paul E. Strawn, Jeffrey R. |
| description | Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.
To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: -1.8, 95% credible interval [CrI]: [-3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: -1.2, 95% CrI [-2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions. |
| doi_str_mv | 10.1017/S1092852921000377 |
| format | Article |
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To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: -1.8, 95% credible interval [CrI]: [-3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: -1.2, 95% CrI [-2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.</description><identifier>ISSN: 1092-8529</identifier><identifier>EISSN: 2165-6509</identifier><identifier>DOI: 10.1017/S1092852921000377</identifier><identifier>PMID: 33843553</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Antidepressants ; Anxiety ; Bias ; Clinical trials ; Drug dosages ; Erectile dysfunction ; Meta-analysis ; Original Research ; Systematic review</subject><ispartof>CNS spectrums, 2022-08, Vol.27 (4), p.496-505</ispartof><rights>The Author(s), 2021. Published by Cambridge University Press</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-8b121d26f4508bce75b508f49abda546d59081a78896098d2f9738bf3be477503</citedby><cites>FETCH-LOGICAL-c373t-8b121d26f4508bce75b508f49abda546d59081a78896098d2f9738bf3be477503</cites><orcidid>0000-0001-6843-6503 ; 0000-0002-7526-2641</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1092852921000377/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,776,780,27901,27902,55603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33843553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luft, Marissa J.</creatorcontrib><creatorcontrib>Dobson, Eric T.</creatorcontrib><creatorcontrib>Levine, Amir</creatorcontrib><creatorcontrib>Croarkin, Paul E.</creatorcontrib><creatorcontrib>Strawn, Jeffrey R.</creatorcontrib><title>Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale</title><title>CNS spectrums</title><addtitle>CNS Spectr</addtitle><description>Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.
To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: -1.8, 95% credible interval [CrI]: [-3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: -1.2, 95% CrI [-2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.</description><subject>Antidepressants</subject><subject>Anxiety</subject><subject>Bias</subject><subject>Clinical trials</subject><subject>Drug dosages</subject><subject>Erectile dysfunction</subject><subject>Meta-analysis</subject><subject>Original Research</subject><subject>Systematic review</subject><issn>1092-8529</issn><issn>2165-6509</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kcFqFTEUhoMo9lp9ADcScONmNJlMJom7UtQWCgrqesgkJ7epM8k1ybS9PpMPaYbeKiiu8sP5_u8QDkLPKXlNCRVvPlOiWslb1VJCCBPiAdq0tOdNz4l6iDbruFnnR-hJzleEdExI9hgdMSY7xjnboJ-fLnWatYlT3HqDfSiQriEUH0PGLiasa7awS5BzjY0PdjFgcYbbRU_Y7rNbglnxt1jjvM8FZl2qKcG1h5tatzhAuYnpG56h6EYHPe2zzzg6XJLXU8ZL9mGLyyXgk-R_xKDv7XC7g-QhGMDZ6AmeokeuFuDZ4T1GX9-_-3J61lx8_HB-enLRGCZYaeRIW2rb3nWcyNGA4GMNrlN6tJp3veWKSKqFlKonStrWKcHk6NgInRCcsGP06s67S_H7ArkMs88GpkkHiEseWk6pVJIpVdGXf6FXcUn1j5WqCyiXnK8UvaNMijkncMMu-Vmn_UDJsJ5y-OeUtfPiYF7GGezvxv3tKsAOUj2Pydst_Nn9f-0vSwysYA</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Luft, Marissa J.</creator><creator>Dobson, Eric T.</creator><creator>Levine, Amir</creator><creator>Croarkin, Paul E.</creator><creator>Strawn, Jeffrey R.</creator><general>Cambridge University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6843-6503</orcidid><orcidid>https://orcid.org/0000-0002-7526-2641</orcidid></search><sort><creationdate>20220801</creationdate><title>Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale</title><author>Luft, Marissa J. ; Dobson, Eric T. ; Levine, Amir ; Croarkin, Paul E. ; Strawn, Jeffrey R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c373t-8b121d26f4508bce75b508f49abda546d59081a78896098d2f9738bf3be477503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Antidepressants</topic><topic>Anxiety</topic><topic>Bias</topic><topic>Clinical trials</topic><topic>Drug dosages</topic><topic>Erectile dysfunction</topic><topic>Meta-analysis</topic><topic>Original Research</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luft, Marissa J.</creatorcontrib><creatorcontrib>Dobson, Eric T.</creatorcontrib><creatorcontrib>Levine, Amir</creatorcontrib><creatorcontrib>Croarkin, Paul E.</creatorcontrib><creatorcontrib>Strawn, Jeffrey R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Psychology</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>CNS spectrums</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luft, Marissa J.</au><au>Dobson, Eric T.</au><au>Levine, Amir</au><au>Croarkin, Paul E.</au><au>Strawn, Jeffrey R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale</atitle><jtitle>CNS spectrums</jtitle><addtitle>CNS Spectr</addtitle><date>2022-08-01</date><risdate>2022</risdate><volume>27</volume><issue>4</issue><spage>496</spage><epage>505</epage><pages>496-505</pages><issn>1092-8529</issn><eissn>2165-6509</eissn><abstract>Despite the prevalence of antidepressant-related sexual side effects, comparisons of treatments for these problematic side effects are lacking.
To address this, we performed a systematic review and Bayesian network meta-analysis to compare interventions for antidepressant-induced sexual dysfunction in adults. Using PubMed and clinicaltrials.gov, we identified published and unpublished prospective treatment trials from 1985 to September 2020 (primary outcome: the Arizona sexual experience scale [ASEX] score). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We identified 57 citations (27 randomized controlled trials, 66 treatment arms, 27 open-label trials, and 3 crossover trials) that evaluated 33 interventions (3108 patients). In the systematic review, 44% (25/57) of trials reported successful interventions; this was more common in open-label (70%, 19/27) compared to placebo-controlled studies (22%, 6/27). In the meta-analysis of placebo-controlled studies that used the ASEX (N = 8), pycnogenol was superior to placebo (standardized mean difference: -1.8, 95% credible interval [CrI]: [-3.7 to 0.0]) and there was evidence that, at a 6% threshold, sildenafil improved sexual dysfunction (standardized mean difference: -1.2, 95% CrI [-2.5 to 0.1]). In the meta-analysis including single-arm studies (15 studies), treatment response was more common with sildenafil, tianeptine, maca, tiagabine, and mirtazapine compared to placebo, but these differences failed to reach statistical significance.
While heterogeneity across randomized controlled trials complicates identifying the single best intervention, multiple trials suggest that sildenafil ameliorates antidepressant-induced sexual dysfunction. More randomized controlled trials are needed to examine the putative efficacy of other interventions.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>33843553</pmid><doi>10.1017/S1092852921000377</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6843-6503</orcidid><orcidid>https://orcid.org/0000-0002-7526-2641</orcidid></addata></record> |
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| ispartof | CNS spectrums, 2022-08, Vol.27 (4), p.496-505 |
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| source | Cambridge Journals |
| subjects | Antidepressants Anxiety Bias Clinical trials Drug dosages Erectile dysfunction Meta-analysis Original Research Systematic review |
| title | Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale |
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