100 - References

References

430 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References

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Depression and anxiety disorders CHAPTER 3 38. Luft MJ, 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 2021; doi: 10.1017/S1092852921000377. 39. Safarinejad MR. The effects of the adjunctive bupropion on male sexual dysfunction induced by a selective serotonin reuptake inhibitor: a double-­blind placebo-­controlled and randomized study. BJU Int 2010; 106:840–847. 40. Montejo AL, et al. Sexual side-­effects of antidepressant and antipsychotic drugs. Curr Opin Psychiatry 2015; 28:418–423. 41. Amiaz R, et al. Testosterone gel replacement improves sexual function in depressed men taking serotonergic antidepressants: a randomized, placebo-­controlled clinical trial. J Sex Marital Ther 2011; 37:243–254. 42. Barakeh D, et al. Pharmacotherapy of hypoactive sexual desire disorder in premenopausal women. Ann Pharmacother 2025; 59:148–161. 43. Clayton AH, et al. Effect of brexpiprazole on prolactin and sexual functioning: an analysis of short-­ and long-­term study data in major depressive disorder. J Clin Psychopharmacol 2020; 40:560–567. 44. Freeman MP, et al. Improvement of sexual functioning during treatment of MDD with adjunctive pimavanserin: a secondary analysis. Depress Anxiety 2020; 37:485–495. 45. Bala A, et al. Post-­SSRI sexual dysfunction: a literature review. Sex Med Rev 2018; 6:29–34. 46. Peleg LC, et al. Post-­SSRI sexual dysfunction (PSSD): biological plausibility, symptoms, diagnosis, and presumed risk factors. Sex Med Rev 2022; 10:91–98. 47. Ben-­Sheetrit J, et al. Estimating the risk of irreversible post-­SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry 2023; 22:15. 48. Healy D, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022; 33:65–76.

432 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 SSRIs and bleeding Serotonin is released from platelets in response to vascular injury, promoting vasoconstriction and morphological changes in platelets that lead to aggregation.1 SSRIs inhibit the serotonin transporter, which is responsible for the uptake of serotonin into platelets (Table 3.19). The resultant depletion of platelet serotonin leads to a reduced ability to form clots and a subsequent increase in the risk of bleeding. Broadly speaking, the relative risk of any bleeding event compared with no use of SSRI/SNRI is around 1.4, with the absolute risk being between around 0.5% and 6%2 (depending on numerous factors). SSRIs may also increase gastric acid secretion and therefore may be indirectly irritant to the gastric mucosa,3 increasing the risk of peptic ulcer.4 The risk of abnormal bleeding of any kind with SSRIs is highest during the first 30 days of treatment.5,6 The effect on bleeding is probably related to the affinity of individual SSRIs for the serotonin transporter.7,8 Table 3.19  Antidepressants and degree of serotonin reuptake inhibition.6,9 Degree of serotonin reuptake inhibition Antidepressant Strong Sertraline, paroxetine, fluoxetine, duloxetine, clomipramine Intermediate Citalopram, escitalopram, fluvoxamine, vilazodone, vortioxetine, venlafaxine Amitriptyline, imipramine Weak or none Agomelatine, dosulepin, doxepin, lofepramine, mirtazapine, moclobemide, nortriptyline, reboxetine, mianserin Risk factors for bleeding with SSRIs ■ ■Age, particularly those over 65 years ■ ■Alcohol misuse ■ ■Coronary artery disease ■ ■Drug misuse ■ ■Hypertension ■ ■History of GI bleed ■ ■History of stroke ■ ■History of major bleeding ■ ■Liver disease ■ ■Labile international normalised ratio (INR) ■ ■Medication predisposing to bleeding ■ ■Peptic ulcer ■ ■Renal disease ■ ■Smoking