One reason for this difference is a lack of clear understanding of sexual dysfunction caused by depression itself. Mitchell and Popkin showed that difficulty with arousal, ejaculation and change in sexual interest after antidepressant use have been reported by patients, although no related cases of priapism have been noted [Mitchell and Popkin, 1983]. The sexual experience can broadly be divided into three stages: stage 1, interest and desire (libido); stage 2, physiologic arousal; and stage 3, orgasm. Neurotransmitters and

hormones are believed to influence Inhibitors,research,lifescience,medical SSRI-associated sexual dysfunction. Dopamine, serotonin [5-hydroxytryptamine (5HT)], testosterone and oestrogen all have an influence on sexual interest and desire (libido). Nitric oxide, acetylcholine and 5HT are important modulators of physiological sexual arousal. Finally, norepinephrine and 5HT play important roles in orgasm. Recent evidence suggests that additional neurotransmitters such as glutamate may

also be involved Inhibitors,research,lifescience,medical in sexual physiology [Perlis et al. 2009]. Among the antidepressants, SSRIs cause delayed ejaculation and interfere with orgasm [Arjmand and Sadeghi, 2005]. Precise statistics are not available but difficulty Inhibitors,research,lifescience,medical with orgasm has been reported in 15–50% of men and women in most studies. Sexual dysfunction with use of MAOI and TCA drugs were first reported in the 1960s. With the introduction of new Histone Demethylase inhibitor antidepressants in Inhibitors,research,lifescience,medical the 1980s and 1990s, these reports have increased in number. Patients on SSRIs have reported more problems than those taking TCA medications and other antidepressants. SSRIs may have a negative effect on one or all stages of sexual functioning, difficulty

with ejaculation or delayed orgasm, but delayed ejaculation or orgasm are the most commonly reported side effects [Baonm, 2006]. One of the obstacles that make it difficult to evaluate the prevalence of sexual dysfunction in relation to antidepressants is that patients who have Inhibitors,research,lifescience,medical psychiatric disorders are more likely to have sexual dysfunction due to the effect of their illness on their behaviour and relationships [Corretti et al. 2006]. In one study, the prevalence of sexual dysfunction Calpain in relation to antidepressant use (SSRIs and others) in England and France was estimated at 39% and 27%, respectively [Williams et al. 2006]. Some other research has shown that up to 60% of patients who use SSRIs have sexual problems [Zajecka et al. 1997]. Since many patients discontinue SSRIs due to their impact on sexual function, developing strategies to predict who may be at highest risk of adverse changes in their wellbeing is an important step in improving the quality of life and treatment of patients who require antidepressant therapy.

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