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| |  'Dramatic' Differences In Side Effects Emerge Among SSRIs, Say Experts NICE, FRANCE -- July 21, 1997 -- Although a group of new drugs now available can successfully combat depression and other disorders such as obsessions and compulsions, there are "dramatic" differences between them in regard to sexual dysfunction, says a Dutch researcher. Depression is a serious mental illness that is now widespread in populations throughout the world, the World Health Organization has warned. Thought to be linked to the difficulties and stresses of modern life, depression is one of a wide range of mental disorders associated with falling levels of the brain chemical, serotonin. Others include compulsive behaviours such as shopping or gambling, eating disorders such as bulimia, and phobias such as fear and avoidance of social interaction with other people. Drugs now available, including fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) help restore the balance. However, a Dutch scientist, Dr. Marcel Waldinger, of Leyenburg Hospital, The Hague, Netherlands, has warned that three of them, fluoxetine, paroxetine and sertraline, can cause serious delay of the male orgasm. In the first head-to-head double-blind controlled trial of the four compounds, known as selective serotonin reuptake inhibitors (SSRIS), fluvoxamine emerged with a clear advantage compared with either fluoxetine, sertraline, or paroxetine. The gap between fluvoxamine and other compounds may indicate that it operates by different mechanisms in the brain, said scientists. Details of the study were reported at the 6th World Congress of Biological Psychiatry meeting in Nice, France, June 23-26. A group of 60 volunteers in an age range from 22 to 60 participated in the six-week study, directed by Dr. Waldinger, who is head of the department of psychiatry and neurosexology, Leyenburg Hospital, The Hague, Netherlands. The men were all in good physical, mental and sexual health and generally experienced rapid ejaculation. Selection criteria included an average ejaculatory time of less than one minute at baseline. All were randomized either to placebo, an inert substance, or to one of the four SSRIs at standard dosages. Meanwhile, the men continued normal sexual relations with their wives, who were responsible for timing The results were "dramatic", said Dr. Waldinger. Delay in ejaculation with fluvoxamine was about equivalent to placebo (time to orgasm increased 1.9-fold compared to 1.5 for placebo). The other three compounds clustered at much higher ratios, ie 4.4-fold for sertraline, 6.6-folds for fluoxetine, and 7.8-fold for paroxetine). Since their normal ejaculation times were quite short, these delays were easily tolerated by the participants. But as Dr. Waldinger noted, if a group with higher regular ejaculation times had been selected, the delay in orgasm and ejaculation would have escalated. "For many men, the baseline time to ejaculation is in fact about 10-15 minutes," he commented. "Applying these ratios would have delayed the male orgasm so long that most couples would have probably ceased intercourse." Commenting on the findings, a U.K. specialist, Professor Stuart Montgomery, said a recent country survey in Europe indicated that sexual dysfunction is frequent in depression patients but that physicians seldom inquire about it. The problems can include reduced libido, delayed orgasm or orgasm failure, and erectile dysfunction. The survey was carried out in France, Germany, The Netherlands, and Portugal. In view of the significance of these symptoms for patient compliance, appropriate selection of medication is very important, said Montgomery, of the Department of Psychiatry at St Mary's Hospital Medical School in London. If patients stop taking their medication, their condition many relapse and require hospitalization. Apart from the patient's personal suffering, there is a big increase in medical care costs as a consequence. More information on: Luvox, Prozac, Paxil, Zoloft
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