Mirtazapine and sexual dysfunction in depressed outpatients with PTSD

Background and Aims:Sexual dysfunction or difficulties(SDOD) exist in one-third of patients with untreated depressed outpatients with PTSD(posttraumatic stress disorder).SDOD manifested by decreased libido, erectile dysfunction or delayed ejaculation.Methods:This study investigated antidepressant activity and sexual functioning in depressed patients with PTSD taking mirtazapine. In our open-label study mirtazapine was administered for 6-10 weeks to 56 (11 women and 45 men) sexually active adult outpatients. Mirtazapine was titrated from 7,5 mg to 45 mg daily. Efficacy was assessed weekly by 21-item HAMD (Hamilton Depression Rating Scale). Sexual functioning was assessed weekly using Arizona Sexual Experiences Scale (ASEX), 5-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm.Results:In start of treatment individual HAMD scores were between 18 and 29, none of them experienced any sexual dysfunction prior to treatment.After 6 weeks of treatment, the individual HAMD scores were between 9 and 17, after 10 weeks HAMD scores were between 7 and 14, indicating significant improvement in depressive symptoms.None of the patients reported any sexual dysfunction symptoms. Five of the patients reported some unspecific sexsual difficulties and weight gain in three patient.Conclusions:treatment with mirtazapine was effective in both depressed women and men and no effect on sexual function.