伟哥改善抗忧郁药引起的女性性功能障碍

    据世界卫生组织估计，世界上至少有一亿二千万人患有忧郁症，而这种常见病大多是可以用药物治疗的。但是药物治疗经常带有副作用，例如头痛、恶心、失眠和性欲减弱等,而导致治疗失败。

    近年来，据新墨西哥大学医学院的心理学家乔治·纳恩堡发表在美国医药协会杂志上的研究表明，伟哥（西地那非）可改善抗忧郁药物产生的女性性功能障碍的副作用。
    98名18岁到54岁的妇女参加了这项研究，她们都在服用一种叫做SSRI的抗忧郁药物。研究人员让她们之中的一半人服用伟哥，另一半服用糖片。按照世界通用的评估标准，参加试验妇女的性功能全部得到改善，尤其对忧郁症抑制药带来的性高潮延迟问题，亦获得明显改善。

    研究人员告诉参加试验的女性患者，她们要在性行为前一个小时服用伟哥，每次50或100mg。一些女性说她们在服药后常出现头痛、颜面潮红，但没有发现其它导致停药的副作用。

Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction

A Randomized Controlled Trial

H. George Nurnberg, MD; Paula L. Hensley, MD; Julia R. Heiman, PhD; Harry A. Croft, MD; Charles Debattista, MD; Susan Paine, MPH

JAMA. 2008;300(4):395-404.

Context  Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in premature medication treatment discontinuation and for which no treatment has demonstrated efficacy in women.

Objective  To evaluate the efficacy of sildenafil for sexual dysfunction associated with selective and nonselective serotonin reuptake inhibitors (SRIs) in women.

Design, Setting, and Participants  An 8-week prospective, parallel-group, randomized, double-blind, placebo-controlled clinical trial conducted between September 1, 2003, and January 1, 2007, at 7 US research centers that included 98 previously sexually functioning, premenopausal women (mean [SD] age 37.1 [6] years) whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction.

Intervention  Forty-nine patients were randomly assigned to take sildenafil or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity.

Main Outcome Measures  The primary outcome measure was the mean difference in change from baseline to study end (ie, lower ordinal score) on the Clinical Global Impression sexual function scale. Secondary measures included the Female Sexual Function Questionnaire, the Arizona Sexual Experience scale-female version, the University of New Mexico Sexual Function Inventory-female version, a sexual activity event log, and the Hamilton Depression Rating scale. Hormone levels were also assessed.

Results  In an intention-to-treat analysis, women treated with sildenafil had a mean Clinical Global Impression–sexual function score of 1.9 (95% confidence interval [CI], 1.6-2.3) compared with those taking placebo (1.1; 95% CI, 0.8-1.5), with a mean end point difference of 0.8 (95% CI, 0.6-1.0; P = .001). Assigning baseline values carried forward to the 22% of patients who prematurely discontinued resulted in a mean end point in the sexual function score of 1.5 (95% CI, 1.1-1.9) among women taking sildenafil compared with 0.9 (95% CI, 0.6-1.3) among women taking placebo with a mean end point difference of 0.6 (95% CI, 0.3-0.8; P = .03). Baseline endocrine levels were within normal limits and did not differ between groups. The mean (SD) Hamilton scores for depression remained consistent with remission in both groups (4.0 [3.6]; P = .90). Headache, flushing, and dyspepsia were reported frequently during treatment, but no patients withdrew because of serious adverse effects.