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Switching to moclobemide to reverse fluoxetine-induced sexual dysfunction in patients with depression
1Department of Psychiatry, University of Ottawa, Ont. RRamasub@rohcg.on.ca
Objective:
To determine the efficacy of substituting moclobemide, a reversible monoamine oxidase-A inhibitor, for fluoxetine to reverse fluoxetine-induced sexual dysfunction in patients with depression.
Design:
Prospective open trial.
Setting:
Outpatient treatment.
Participants:
Five patients with depressive disorder who experienced sexual side effects during treatment with standard doses of fluoxetine (20 to 40 mg per day).
Intervention:
Discontinuation of fluoxetine and replacement with moclobemide (300 to 600 mg per day) after a 2-week washout period.
Outcome Measures:
Libido, orgasmic function (in women) or erectile and ejaculatory function (in men), and overall improvement in sexual function during a follow-up period of 2 months to 3 years.
Results:
Among patients receiving fluoxetine questioned about sexual side effects, 4 (1 man and 3 women) had treatment-related diminished libido with poor orgasmic response or partial erectile failure, and 1 female patient had enhanced sexual desire with intense clitoral stimulation. In all patients, sexual disturbances resolved completely after a 2-week washout period and a switch to treatment with moclobemide. Moclobemide was well tolerated. The antidepressant effect of moclobemide was comparable to that of fluoxetine.
Conclusions:
Moclobemide may be preferred as a treatment for depression in patients with fluoxetine-induced sexual dysfunction.