Documenti di Didattica
Documenti di Professioni
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in Primary Practice
Dr.Lahargo Kembaren, SpKJ
L_Kembaren@yahoo.com
Pertemuan Ilmiah Tahunan XII – IDI Kota Bogor, 20-21 Juli 2019
Introduction
Normal sexual function is a biopsychosocial process;
sexual dysfunction almost always has organic and
psychological components and requires multidisciplinary,
goal-directed evaluation and treatment.
Sexual dysfunction is a common symptom of depression.
Sexual dysfunction is also a frequent adverse effect of
treatment with most antidepressants and is one of the
predominant reasons for premature drug discontinuation.
Symptoms of Depression
Difficulty thinking,
Thoughts of suicide or Persistent physical
concentrating,
death or attempts at symptoms that do not
remembering or
suicide respond to treatment
making decisions
Stahl's Essential Psychopharmacology
How common are antidepressants used?
Arousal dysfunction
Low dopamine in the mesolimbic system.
Inhibition of peripheral spinal reflexes of the sympathetic
and parasympathetic systems which mediate erection and
clitoral engorgement and this is influenced by several
neurotransmitters including serotonin.
Segraves (1989), Bitran et al (1988) and Pollack (1992) in Serretti and Chiesa (2009).
Mechanisms by which antidepressants
cause sexual dysfunction
Orgasm dysfunction
related to low dopamine and noradrenaline levels caused
by 5-HT₂ activation.
Pollack et al (1992), Zajecka et al (1991) and Crenshaw (1996) in Serretti and Chiesa
(2009)
Those changes seems to alter the sympathetic and
parasympathetic systems, that are essential for orgasm
and ejaculation.
Bitran et al (1988) and Pollack et al (1992) in Serretti and Chiesa (2009)
Managements of Sexual Dysfunction
Antidepressant-
Medical-Surgical
Drugs and Medicines Psychological induced sexual
Condition
dysfunction
• Endocrine • Cardiovascular • Predisposising • Wait for
• Vascular • Psychotropics factors spontaneous
• Neurological • Gastrointestinal • Precipitating factors resolution.
• Local genital disease • Maintaning factors • Drug holiday.
• Systemic disease • Decrease the dose.
• Surgical post • Switch to another
operative antidepressants.
• Augmentation with
(add) another
agent.
Medical and Surgical Condition
Shafer L (2016)
Medical and Surgical Condition
Shafer L (2016)
Drugs and Medicines
Shafer L (2016)
Drugs and Medicines
Shafer L (2016)
Psychological
Shafer L (2016)
How to treat Antidepressant-induced
sexual dysfunction
Bupropion
Agomelatine
Mirtazapine
Nefazodone
Moclobemide
Selegiline
Augmentation:
Phosphodiesterase-
Bupropion
5 inhibitors
Others
Bupropion:
L_kembaren@yahoo.com
@LahargoKembaren
www.LahargoKembaren.com