Abstract
Objective: To describe effects of gepirone extended-release (ER), an azapirone, on sexual function in patients receiving treatment for major depressive disorder (MDD).
Methods: Sexual function was assessed in 1,767 patients (67% women) across five Phase 3 randomized controlled clinical trials comparing gepirone-ER against placebo or active treatment with selective serotonin reuptake inhibitors (SSRIs) for treatment of MDD. All five trials assessed sexual functioning in the short term (8 weeks), with three including long-term extensions of 16, 20, or 44 weeks. Sexual function was assessed prospectively and throughout trials via clinical interview and well-validated survey measures.
Results: Across studies, gepirone-ER was equivalent to placebo on sexual side effects and treatment-emergent sexual dysfunction. Relative to SSRIs, gepirone-ER was associated with significantly better effect on sexual function across time points studied. Evidence from patients without sexual dysfunction at baseline demonstrates superiority of gepirone-ER over SSRIs in the first few weeks of treatment, when patients are most vulnerable to the negative effects of sexual side effects on medication nonadherence/ discontinuation. Importantly, these benefits were maintained across treatment.
Conclusions: Gepirone-ER was not associated with sexual dysfunction in patients with MDD. Rates of sexual side effects and treatment-emergent sexual dysfunction with gepirone-ER were comparable to those reported for placebo and lower than sexual side effects reported for active treatment with SSRIs.
J Clin Psychiatry 2024;85(4):24m15357
Author affiliations are listed at the end of this article.
Continue Reading...
Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.
References (53)
- Kearns B, Cooper K, Orr M, et al. The incidence and costs of adverse events associated with antidepressants: results from a systematic review, network meta analysis and multi-country economic model. Neuropsychiatr Dis Treat. 2022;18:1133–1143. PubMed CrossRef
- Tarchi L, Merola GP, Baccaredda-Boy O, et al. Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction and persistent genital arousal disorder: a systematic review. Pharmacoepidemiol Drug Saf. 2023;32(10):1053–1067. PubMed CrossRef
- Trinchieri M, Trinchieri M, Perletti G, et al. Erectile and ejaculatory dysfunction associated with use of psychotropic drugs: a systematic review. J Sex Med. 2021;18(8):1354–1363. PubMed CrossRef
- Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259–266. PubMed CrossRef
- Stephenson JJ, Touya M, Chrones L, et al. Antidepressant use and treatment emergent sexual dysfunction among patients with major depressive disorder: results from an internet-based survey study. J Affect Disord Rep. 2024;16(11):100750.
- Braund TA, Tillman G, Palmer DM, et al. Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT D report. Transl Psychiatry. 2021;11(1):417. PubMed
- Dunn JA, Arakawa R, Greist JH, et al. Assessing the onset of antidepressant induced sexual dysfunction using interactive voice response technology. J Clin Psychiatry. 2007;68(4):525–532. PubMed CrossRef
- Golder S, Medaglio D, O’Connor K, et al. Reasons for discontinuation or change of selective serotonin reuptake inhibitors in online drug reviews. JAMA Netw Open. 2023;6(7):e2323746. PubMed CrossRef
- Khalifian CE, Knopp K, Wilks CR, et al. The association between sexual functioning and suicide risk in US Military veteran couples seeking treatment for post-traumatic stress disorder. Arch Sex Behav. 2020;49(5):1601–1613. PubMed CrossRef
- Blais RK, Xu B, Hoyt T, et al. Sexual compulsivity, erectile dysfunction, and suicidality among male survivors of military sexual violence. J Trauma Stress. 2022;35(6):1709–1720. PubMed CrossRef
- Hieronymus F, Lisinski A, Eriksson E, et al. Do side effects of antidepressants impact efficacy estimates based on the Hamilton Depression Rating Scale? A pooled patient-level analysis. Transl Psychiatry. 2021;11(1):249. PubMed CrossRef
- Jacobsen PL, Thorley EM, Curran C. Real-world patient experience with sexual dysfunction and antidepressant use in patients with self-reported depression: a cross-sectional survey study. Neurol Psychiatry Brain Res. 2020;36:57–64.
- Garcia-Marin LM, Mulcahy A, Byrne EM, et al. Discontinuation of antidepressant treatment: a retrospective cohort study on more than 20,000 participants. Ann Gen Psychiatry. 2023;22(1):49. PubMed CrossRef
- Winter J, Curtis K, Hu B, et al. Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management. Expert Opin Drug Saf. 2022;21(7):913–930. PubMed CrossRef
- Stahl SM. Mechanism of action of serotonin selective reuptake inhibitors: serotonin receptors and pathways mediate therapeutic effects and side effects. J Affect Disord. 1998;51(3):215–235. PubMed CrossRef
- Clayton AH, Croft HA, Handiwala L. Antidepressants and sexual dysfunction: mechanisms and clinical implications. Postgrad Med. 2014;126(2):91–99. PubMed CrossRef
- Lasker GF, Halis F, Gokce A. Selective serotonin reuptake inhibitors for premature ejaculation: review of erectile and ejaculatory side effects. Curr Drug Saf. 2014;9(2):118–126. PubMed CrossRef
- Bijlsma EY, Chan JSW, Olivier B, et al. Sexual side effects of serotonergic antidepressants: mediated by inhibition of serotonin on central dopamine release? Pharmacol Biochem Behav. 2014;121:88–101. PubMed CrossRef
- Luft MJ, Dobson ET, Levine A, et al. Pharmacologic interventions for antidepressant-induced sexual dysfunction: a systematic review and network meta-analysis of trials using the Arizona sexual experience scale. CNS Spectr. 2022;27(4):496–505.
- Olivier JDA, Esquivel-Franco DC, Waldinger MD, et al. Serotonin and sexual behavior. In: Tricklebank MD, Daly E, eds. The Serotonin System: History, Neuropharmacology, and Pathology. Elsevier; 2019:117–132.
- Reichenpfader U, Gartlehner G, Morgan LC, et al. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf. 2014;37(1):19–31. PubMed CrossRef
- Croft HA. Understanding the role of serotonin in female hypoactive sexual desire disorder and treatment options. J Sex Med. 2017;14(12):1575–1584. PubMed CrossRef
- Stahl SM. Mechanism of action of flibanserin, a multifunctional serotonin agonist and antagonist (MSAA), in hypoactive sexual desire disorder. CNS Spectr. 2015;20(1):1–6. PubMed CrossRef
- Smith ALW, Harmer CJ, Cowen PJ, et al. The serotonin 1A (5-HT1A) receptor as a pharmacological _target in depression. CNS Drugs. 2023;37(7):571–585. PubMed CrossRef
- Snoeren EMS, Veening JG, Olivier B, et al. Serotonin 1A receptors and sexual behavior in male rats: a review. Pharmacol Biochem Behav. 2014;121:102–114. PubMed CrossRef
- Montejo A, Llorca G, Izquierdo J, et al. [Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]. Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1996;24(6):311–321. PubMed
- Moreira ED, Glasser DB, Nicolosi A, et al; GSSAB Investigators’ Group. Sexual problems and help-seeking behaviour in adults in the United Kingdom and continental Europe. BJU Int. 2008;101(8):1005–1011. PubMed CrossRef
- Khin NA, Kronstein PD, Yang P, et al. Regulatory and scientific issues in studies to evaluate sexual dysfunction in antidepressant drug trials. J Clin Psychiatry. 2015;76(8):1060–1063. PubMed CrossRef
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Publishing, Inc; 1994.
- Fabre LF, Smith LC. The effect of major depression on sexual function in women. J Sex Med. 2012;9(1):231–239. PubMed CrossRef
- Fabre LF, Brown CS, Smith LC, et al. Gepirone-ER treatment of hypoactive sexual desire disorder (HSDD) associated with depression in women. J Sex Med. 2011;8(5):1411–1419. PubMed CrossRef
- Fabre LF, Clayton AH, Smith LC, et al. Association of major depression with sexual dysfunction in men. J Neuropsychiatry Clin Neurosci. 2013;25(4):308–318. PubMed CrossRef
- Keam SJ. Gepirone extended-release: first approval. Drugs. 2023;83(18):1723–1728. PubMed CrossRef
- Brown EG, Wood L, Wood S. The medical dictionary for regulatory activities (MedDRA). Drug Saf. 1999;20(2):109–117. PubMed CrossRef
- Derogatis LR. The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther. 1997;23(4):291–304. PubMed CrossRef
- Meston CM, Derogatis LR. Validated instruments for assessing female sexual function. J Sex Marital Ther. 2002;28(suppl 1):155–164. PubMed CrossRef
- Keller A, McGarvey EL, Clayton AH. Reliability and construct validity of the Changes in Sexual Functioning Questionnaire short-form (CSFQ-14). J Sex Marital Ther. 2006;32(1):43–52. PubMed CrossRef
- Clayton AH, McGarvey EL, Clavet GJ, et al. Comparison of sexual functioning in clinical and nonclinical populations using the Changes in Sexual Functioning Questionnaire (CSFQ). Psychopharmacol Bull. 1997;33(4):747–753. PubMed
- Clayton AH, McGarvey EL, Clavet GJ. The changes in sexual functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731–745. PubMed
- Jacobsen PL, Mahableshwarkar AR, Chen Y, et al. Effect of vortioxetine vs. escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. 2015;12(10):2036–2048. PubMed CrossRef
- Chauhan M, Parry R, Bobo WV. Vilazodone for major depression in adults: pharmacological profile and an updated review for clinical practice. Neuropsychiatr Dis Treat. 2022;18:1175–1193. PubMed CrossRef
- Gonçalves WS, Gherman BR, Abdo CHN, et al. Prevalence of sexual dysfunction in depressive and persistent depressive disorders: a systematic review and meta analysis. Int J Impot Res. 2023;35(4):340–349. PubMed
- Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. J Sex Med. 2012;9(6):1497–1507. PubMed CrossRef
- Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23(3):176–194. PubMed CrossRef
- Kronstein PD, Ishida E, Khin NA, et al. Summary of findings from the FDA regulatory science forum on measuring sexual dysfunction in depression trials. J Clin Psychiatry. 2015;76(8):1050–1059. PubMed CrossRef
- Dodd S, Mitchell PB, Bauer M, et al. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: an international consensus statement. World J Biol Psychiatry. 2018;19(5):330–348. PubMed CrossRef
- Katz AJ, Dusetzina SB, Farley JF, et al. Distressing adverse events after antidepressant switch in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial: influence of adverse events during initial treatment with citalopram on development of subsequent adverse events with an alternative antidepressant. J Hum Pharmacol Drug Ther. 2012;32(3):234–243. PubMed CrossRef
- Montejo AL, Prieto N, de Alarcón R, et al. Management strategies for antidepressant-related sexual dysfunction: a clinical approach. J Clin Med. 2019;8(10):1640. PubMed
- Lorenz T, Rullo J, Faubion S. Antidepressant-induced female sexual dysfunction. Mayo Clin Proc. 2016;91(9):1280–1286. PubMed CrossRef
- Sharma T, Guski LS, Freund N, et al. Drop-out rates in placebo-controlled trials of antidepressant drugs: a systematic review and meta-analysis based on clinical study reports. Int J Risk Saf Med. 2019;30(4):217–232. PubMed CrossRef
- Meyer-Bahlburg HFL, Dolezal C. The female sexual function index: a methodological critique and suggestions for improvement. J Sex Marital Ther. 2007;33(3):217–224. PubMed CrossRef
- Hyde JS, Mezulis AH. Gender differences in depression: biological, affective, cognitive, and sociocultural factors. Harv Rev Psychiatry. 2020;28(1):4–13. PubMed
- Godwin M, Ruhland L, Casson I, et al. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Med Res Methodol. 2003;3:28. PubMed CrossRef
Please sign in or purchase this PDF for $40.
Save
Cite
Already a member? Login