Imipramine and sexual dysfunction during the long-term treatment of recurrent depression

Ninety patients in the maintenance therapy phase of the Pittsburgh Study of Maintenance Therapies in Recurrent Depression (Frank et al., 1990) were studied to determine possible relationships between the type of therapy (imipramine versus no drug) and the level of sexual functioning. The level of sexual functioning was determined by a composite subscale score of the Social Adjustment Scale which assessed (1) current level of enjoyment and interest in sex; (2) change in interest; (3) current frequency of sexual intercourse; (4) change in frequency; and (5) pain and/or difficulty reaching orgasm. Loss of libido was assessed by both the Hamilton Rating Scale for Depression and the SCL-90. Logistic regression analysis revealed no relationship between treatment with active imipramine and sexual functioning for the total group, or for females alone. Analysis of males alone revealed a decreased interest in sex among those treated with imipramine, but no significant differences in frequency or problems. The implications for maintenance pharmacotherapy and the cost/benefit ratio of unacceptable side effects versus drug efficacy are discussed.