Sexual functioning in depressed outpatients taking mirtazapine

Area of Science:

• Psychiatry
• Pharmacology
• Sexual Medicine

Background:

• Depression significantly impacts sexual function, with up to one-third of untreated patients experiencing decreased libido, erectile dysfunction, or delayed ejaculation.
• Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed for depression, can exacerbate sexual dysfunction due to their action on serotonin 5HT2 receptors.
• Mirtazapine, an atypical antidepressant, possesses unique pharmacological properties including alpha 2 adrenergic antagonism and blockade of serotonin 5-HT2 and 5-HT3 receptors, suggesting a potentially neutral or beneficial effect on sexual function.

Purpose of the Study:

• To investigate the effects of mirtazapine on sexual functioning in patients diagnosed with major depressive disorder.
• To assess the antidepressant activity of mirtazapine in the study population.

Main Methods:

• A 12-week, open-label, flexible-dosing pilot study involving 25 sexually active adult outpatients with major depressive episode.
• Sexual functioning was evaluated using the Arizona Sexual Experiences Scale (ASEX).
• Depressive symptoms were assessed using the Hamilton Depression Rating Scale (HAM-D) on a bimonthly basis.

Main Results:

• Significant improvements were observed in sexual desire, arousal, and orgasm ease/satisfaction in women (41%, 52%, and 48% respectively) and men (10%, 23%, and 14% respectively).
• Mirtazapine treatment led to improvements in depression scores (HAM-D, CGI, SDS, SCL-90) in both genders.
• Despite a 50% dropout rate among women by week six, both early and later completers showed similar improvements in ASEX and HAM-D scores.

Conclusions:

• Mirtazapine demonstrates a positive impact on sexual functioning in both depressed women and men.
• Further long-term, double-blind research comparing mirtazapine with other antidepressants regarding sexual function is warranted.