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Association of Major Depression With Sexual Dysfunction in Men
Louis F. Fabre, M.D., Ph.D.; Anita H. Clayton, M.D.; Louis C. Smith, Ph.D.; Irwin M. Goldstein, M.D.; Leonard R. Derogatis, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:308-318. doi:10.1176/appi.neuropsych.12010004
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Louis F. Fabre, M.D., Ph.D.: employee of and shareholder in Fabre-Kramer Pharmaceuticals.

Anita Clayton, M.D.: Grants: BioSante Pharmaceuticals, Inc., Palatin Technologies, Pfizer, Inc., Repligen Corporation, Takeda; Advisory Board Fee/Consultant Fee: Astellas Pharma US, Inc., Bayer, Dey Pharma, Eli Lilly and Company, Euthymics, Fabre-Kramer Pharmaceuticals, Forest, GlaxoSmithKline, Palatin Technoogies, Pfizer, Inc., Sunovion, Takeda Global Research & Development; Royalties/copyrights: Changes in Sexual Functioning Questionnaire, Guilford Publications.

Louis C. Smith, Ph.D.: consultant with Fabre-Kramer Pharmaceuticals.

Irwin Goldstein, M.D.: Consultant: Alagin Research, Aperture; Ad Board: Boehringer Ingelheim, Johnson & Johnson, Medtronic, Plethora Solutions, Vivus; Speaker: Auxilium, Bayer, BioSante, Coloplast, Eli Lilly, Pfizer, Timm Medical; Grant: Pfizer; Contract: Boehringer Ingelheim.

Leonard R. DeRogatis, Ph.D.: consultant and investigator with Boehringer-Ingelheim, BioSante Inc., Johnson & Johnson, and Fabre-Kramer Pharmaceuticals.

From Fabre-Kramer Pharmaceuticals, Houston, TX (LFF, LCS); Dept. of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville VA (AHC); San Diego Sexual Medicine, Alvarado Hospital, San Diego CA (IMG); Sheppard Pratt Hospital, Baltimore MD (LRD).

Send correspondence to Dr. Fabre; e-mail: lfabre@fabrekramer.com

Copyright © 2013 by the American Psychiatric Association

Received January 06, 2012; Revised November 08, 2012; Accepted December 11, 2012.

Abstract

The effect of type and severity of depression on sexual functioning was examined before treatment in 591 men with Major Depression (MDD) or Atypical Depression, as determined by percentage of subjects meeting Diagnostic and Statistical Manual, 4th Edition (DSM-IV) sexual dysfunction criteria (A and B only), and percentage with Derogatis Inventory of Sexual Function (DISF) scores greater than 1 standard deviation below normal. Sexual dysfunction rates were higher for MDD than for Atypical Depression. Depression affected DISF domains differently: orgasm was most impaired, whereas sexual desire was preserved. More severe depression resulted in greater sexual dysfunction.

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FIGURE 1. Percentile Ranking of Male DISF Total Score and Domain Scores

DISF: DeRogatis Inventory of Sexual Function. The differences in domain scores between MDD and Atypical Depression are all statistically significant, with p values ranging from 0.005 to <0.0001. Lighter gray column: MDD+Atypical Depression groups; Black column: MDD group; Darker gray column: Atypical Depression group; The shaded region between T-scores 40 and 60 represents the normal range of sexual functioning of a non-patient population. A T-score of 40 (16th percentile) is 1 standard deviation (SD) below the mean of a non-patient population; a T-score of 30 (2nd percentile) is 2 SDs below the mean; and a T-score of 20 (0.1th percentile) is 3 SDs below the mean. The data are shown in Table 3.

FIGURE 2. Percentile Ranking of DISF Total Scores of MDD and Atypical Depression (AD) Groups Above and Below −1 SD Cut-Off Threshold

DISF: DeRogatis Inventory of Sexual Function. The differences in the Above and Below sample scores are all statistically significant, with p values <0.0001. Solid columns: total diagnostic group; Downward stripes: those below −1 SD cut-off threshold; Upward stripes: those above −1 SD cut-off threshold. The shaded region between T-scores 40 and 60 represents the normal range of sexual functioning of a non-patient population; 1 SD: T-score of 40 (16th percentile) is −1 SD below the mean; T-score of 30 (2nd percentile) is −2 SDs below the mean; T-score of 20 (0.1th percentile) is −3 SDs below the mean. The data are shown in Data Supplement Table 1.

FIGURE 3. Effect of Severity of Depression on Percentile Ranking of DISF Total Scores of MDD (Major Depressive Disorder) and Atypical Depression Samples

DISF: DeRogatis Inventory of Sexual Function. Lighter gray column: MDD+Atypical Depression population; Black column: MDD population; Darker gray column: Atypical Depression population. The shaded region between T-Scores 40 and 60 represents the normal range of sexual functioning. T-score of 40 (16th percentile) is 1 SD below the mean; T-Score of 30 (2nd percentile) is 2 SDs below the mean; T-score of 20 (0.1th percentile) is 3 SDs below the mean. The data are shown in Table 5.

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TABLE 1.Study Samples and Demographics of Male Patients
Table Footer Note

Values are mean (standard deviation), unless otherwise indicated.

Table Footer Note

*p=0.044 versus MDD.

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**p=0.006 versus MDD.

Table Footer Note

***p <0.0001 versus MDD.

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TABLE 2.Baseline DSM-IV Diagnoses (Criteria A and B only) in Men With Major Depression (MDD) and Atypical Depression
Table Footer Note

a N=426 (MDD+Atypical Depression), 180 (MDD), 246 (Atypical Depression).

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See Discussion for references.

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TABLE 3.Effect of Depression on Male Sexual Functioning
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The 50th percentile represents the mean score of the normed population.

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TABLE 4.Prevalence of Sexual Dysfunction Defined as at Least 1 SD Below the Mean DISF Score of a Non-Patient Population
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TABLE 5.Effect of Severity and Type of Depression on DeRogatis Inventory of Sexual Function (DISF) Total Score
Table Footer Note

Values are mean (standard deviation), unless otherwise indicated; MDD: major depression.

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