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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 32  |  Issue : 2  |  Page : 84-86

Sexual dysfunction among drug-naïve depressive disorder patient in a multidisciplinary teaching hospital


Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication25-Oct-2018

Correspondence Address:
Dr. Senilo Magh
Room 9, PG Gents Hostel-1, Regional Institute of Medical Sciences, Lamphelpat, Imphal West - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_8_17

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  Abstract 

Background: Little is known about the prevalence, typology and natural course of non-drug-induced sexual dysfunction in patients with depressive disorders. The degree of sexual dysfunction and its prevalence appears to be correlated with the severity of disease.
Aims: The aim of the study is to find the prevalence and pattern of sexual dysfunction among drug naïve patient having depressive disorder and its correlation.
Settings and Design: 2 years (September 2013- August 2015), cross-sectional study, out-patient department, Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur.
Materials and Methods: Depressive disorder was established according to ICD-10 criteria. Patients fulfilling inclusion criteria were subjected to Hamilton Rating Scale for Depression to assess the severity of their depression and Arizona Sexual Experience Scale questionnaire to assess sexual dysfunction if any in confidentiality.
Statistical Analysis Used: statistical package for the social sciences (SPSS) version 21. Chi square test was used and p value of less than 0.05 was taken as statistically significant.
Result: 50 patients with depressive disorder were enrolled for the study. 44 percent of them were found to have sexual dysfunction. More problems were found with sexual desire and arousal phases of sexual life. A positive correlation was established between the severity of illness and the degree of sexual dysfunction.
Conclusion: This study showed that majority of such patients has sexual problems especially with regard to desire for sex and arousability. The degree of sexual dysfunction was found to be proportional to the severity of depression and hence maybe an important predictor of sexual dysfunction among depressed patients.

Keywords: Depressive disorder, sex, sexual dysfunction


How to cite this article:
Singh RL, Puia L, Magh S. Sexual dysfunction among drug-naïve depressive disorder patient in a multidisciplinary teaching hospital. J Med Soc 2018;32:84-6

How to cite this URL:
Singh RL, Puia L, Magh S. Sexual dysfunction among drug-naïve depressive disorder patient in a multidisciplinary teaching hospital. J Med Soc [serial online] 2018 [cited 2018 Nov 17];32:84-6. Available from: http://www.jmedsoc.org/text.asp?2018/32/2/84/236149


  Introduction Top


Interest in human sexual function has increased considerably in the recent years, and this shift in social attitudes has increased the number of people who wonder whether their sexual performance is less than ideal and has consequently increased the need to consult a health professional.[1] The introduction of sildenafil (Viagra), the first orally active drug for male erectile disorder, created a widespread comment and increased public awareness of sexual dysfunction, which is now often regarded as a medical condition that is treatable.[2] Epidemiological and clinical studies show that untreated depressive disorder is associated with impairment of sexual function and satisfaction.[3] The normal sexual response is conventionally divided into the three or four phases (namely, libido, arousal, orgasm, and resolution), and the Diagnostic and Statistical Manual of Mental Disorders-5 defines sexual dysfunction as disturbances in one or more of these phases.[4],[5]

Depressive disorders are among the most prevalent psychiatric disorder.[6] Sexual dysfunction is commonly associated with depression, and loss of libido is frequently associated with major depression.[3] Sexual dysfunction is a source of additional suffering for depressed patients and may contribute to poor compliance.[7] The relationship between sexual dysfunction and depression seems to be bidirectional, the presence of either one of these conditions may trigger or exacerbate the other, and the treatment of one condition may improve the other.[8] Although sexual dysfunction and depression are highly comorbid, the causal relationship is unclear. Men who have depression have a nearly 2-fold greater likelihood of having erectile dysfunction compared with nondepressed men.[9] Several studies have determined that major depressive disorder is associated with decreased libido, erectile dysfunction, and decreased sexual activity.[10]


  Materials and Methods Top


The study was conducted in a multispecialty teaching cum tertiary care hospital of Northeast India. It was a cross-sectional study over 2 years (September 2013–August 2015) aimed to document the prevalence and pattern of sexual dysfunction among patients with depressive disorder. Patients diagnosed with depressive disorder according to the International Classification of Diseases-10 for the first time and fulfilling the inclusion criteria were enrolled for the study.

Patients were subjected to the Hamilton Rating Scale for Depression (HRSD)[11] to assess the severity of depression. Sexual functioning was then evaluated using the Arizona Sexual Experiences Scale (ASEX) in local language translated from the original English version.[12],[13] Reliability of the translated version was established by doing a pilot study. Collected data were analyzed using Statistical Package for Social Sciences version 21 (Armonk, NY, IBM Corp). The association between the variables was calculated using the Chi-square test. P < 0.05 was considered as statistically significant.


  Results Top


A total of 50 newly diagnosed patients with depressive disorder were enrolled for the study. The age of the study population ranged from 23 to 55 years. The mean age was 38.2 years with a standard deviation of 8.1 years. Majority of them were females (52%) and belonged to the Hindu religion (70%). Eighty-eight percent of depressed patients belonged to the reproductive age group of 20–50 years [Table 1].
Table 1: Demographic distribution of depressed patients (n=50)

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The duration of illness ranged from 1 to 24 months. Forty-eight percent of them had been suffering from depression for more than a year. A majority of them were found to have sexual dysfunction (52%). Majority of those suffering from depression for <6 months were found to be have sexual dysfunction (71.4% vs. 28.6%), while a majority of those who had been depressed for more than a year did not have any sexual dysfunction (57.3% vs. 42.7%). However, statistically, no significant association was found between duration of depression and sexual dysfunction (P = 0.206) [Table 2].
Table 2: Duration of illness and its correlation with sexual dysfunction (n=50)

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Considering separately on the pattern of sexual dysfunction on individual score (i.e. score >3 in ASEX in the particular area), 38% had problems in desire and arousal phases while 26% had problems in achieving orgasm and 22% were not satisfied with sex [Table 3].
Table 3: Pattern of sexual dysfunction on the four phases of sexual cycle (n=50)

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Among depressed patients, 24% were mildly depressed according to the HRSD while 30% had a moderate level of depression, 26% had very severe depression, and 20% had severe depression. A majority (69.23%) of those with very severe depression had sexual dysfunction, while half of those with severe depression had sexual dysfunction. Less than half of those who were moderately depressed and 8.8% of those with mild depression had sexual dysfunctions. The severity of depression was statistically found to be significantly associated with sexual dysfunction (P = 0.002) [Table 4].
Table 4: Association between severity of depression and sexual dysfunction (n=50)

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  Discussion Top


The prevalence of sexual dysfunction among depressive disorder patients was found to be 44%. This finding is consistent with the findings reported by Bonierbale et al.[7] and Kennedy et al.[9] which reported the prevalence of sexual dysfunction between 40% and 52.8% among patients with depressive disorder.

Considering separately on the pattern of sexual dysfunction on individual score, our finding is consistent with the findings of Seidman and Roose et al.,[8] Araujo et al.,[10] and Kennedy and Rizvi[14] who reported a higher prevalence of loss of interest and arousal problems in untreated patients with depressive disorder.

Sexual dysfunction was found to be more common among those who were severely depressed, and this association was found to be statistically significant. The studies conducted by Cyranowski et al.[15] and Schreiner-Engel and Schiavi et al.[16] also reported a higher prevalence of sexual dysfunction with greater levels of depression.

Limitations of the study

The sample size and cross-sectional nature of the study are limiting factors. In addition, the study was conducted in a hospital setting with no sample from community or control group for comparison. The above limitations may act as a bias in our results.


  Conclusion Top


Little is known about the prevalence, typology, and the natural course of sexual dysfunction among the drug-naïve depressed patients. This study showed that majority of such patients has sexual problems, especially with regard to the desire for sex and arousability. The degree of sexual dysfunction was found to be proportional to the severity of depression and hence may be an important predictor of sexual dysfunction among depressed patients. Future research needs to explore the various biological, psychological, and social factors that are likely to be involved for its high prevalence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Moreira ED, Glasser DB, Nicolosi A, Duarte FG, Gingell C; GSSAB Investigators' Group. Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe. BJU Int 2008;101:1005-11.  Back to cited text no. 1
    
2.
Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: Prevalence and predictors. JAMA 1999;281:537-44.  Back to cited text no. 2
    
3.
Bartlik B, Kocsis JH, Legere R, Villaluz J, Kossoy A, Gelenberg AJ. Sexual dysfunction secondary to depressive disorders. J Gend Specif Med 1999;2:52-60.  Back to cited text no. 3
    
4.
Schiavi RC, Segraves RT. The biology of sexual function. Psychiatr Clin North Am 1995;18:7-23.  Back to cited text no. 4
    
5.
Stahl SM. The psychopharmacology of sex, Part 1: Neurotransmitters and the 3 phases of the human sexual response. J Clin Psychiatry 2001;62:80-1.  Back to cited text no. 5
    
6.
Weismann MM, Livingston BM, Leaf PJ, Flori LP, Holzer C, Robins LN, et al. Psychiatric disorders in America: the epidemiologic catchment area study. New York: Free Press, 1991.  Back to cited text no. 6
    
7.
Bonierbale M, Lançon C, Tignol J. The ELIXIR study: Evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Med Res Opin 2003;19:114-24.  Back to cited text no. 7
    
8.
Seidman SN, Roose SP. The relationship between depression and erectile dysfunction. Curr Psychiatry Rep 2000;2:201-5.  Back to cited text no. 8
    
9.
Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord 1999;56:201-8.  Back to cited text no. 9
    
10.
Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: Cross-sectional results from the Massachusetts male aging study. Psychosom Med 1998;60:458-65.  Back to cited text no. 10
    
11.
Hedlund JL, Viewig BW. The Hamilton rating scale for depression: A comprehensive review. J Oper Psychiatry 1979;10:149-65.  Back to cited text no. 11
    
12.
McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther 2000;26:25-40.  Back to cited text no. 12
    
13.
Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res 2004;16:531-4.  Back to cited text no. 13
    
14.
Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol 2009;29:157-64.  Back to cited text no. 14
    
15.
Cyranowski JM, Frank E, Cherry C, Houck P, Kupfer DJ. Prospective assessment of sexual function in women treated for recurrent major depression. J Psychiatr Res 2004;38:267-73.  Back to cited text no. 15
    
16.
Schreiner-Engel P, Schiavi RC. Lifetime psychopathology in individuals with low sexual desire. J Nerv Ment Dis 1986;174:646-51.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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