Antidepressant-Induced Sexual Dysfunction (AISD) is one of the most common yet underreported side effects of antidepressants, affecting up to 70% of patients.
AISD can impact libido, arousal, and orgasm, leading to distress, relationship strain, and non-adherence (Montejo et al., 2019).
Here’s how to assess, manage, and treat AISD. 🧵👇
What Causes Antidepressant-Induced Sexual Dysfunction?
Neurotransmitter Imbalance:
🔼 Serotonin → inhibits sexual response (5HT2/5HT3 activation).
🔽Dopamine & Noradrenaline → impairs desire and arousal.
Adrenergic & Cholinergic Effects → interfere with orgasm and ejaculation.
Conditioned cues may trigger more potent dopamine (DA) responses than the drug itself, shifting reinforcement from the substance to the cues. (Volkow et al., 2019)
Here’s how this process fuels persistent substance use. 🧵👇
The Reinforcement Shift
🔹 Conditioned cues surpass the dopamine response to the drug, reinforcing addictive behaviours.
🔹 Anticipated drug effects often fail to match the actual response, leading to repeated use in search of the expected high.
🔹 The anti-reward system engages over time, reducing DA & serotonin while increasing stress-related neurochemicals, causing withdrawal symptoms.
The Cycle of Withdrawal & Relapse
🔹 Withdrawal is marked by reduced D2 receptor levels in the striatum, impairing motivation for natural rewards & increasing relapse risk.
🔹 Sensitivity to both natural rewards & negative reinforcers diminishes, making treatment outcomes more challenging.
🔹 This contributes to compulsive drug-seeking behaviours, even in the face of negative consequences.
SNRIs like Venlafaxine & Desvenlafaxine are widely used in Major Depressive Disorder (MDD) & anxiety disorders, but their pharmacokinetics & mechanisms differ—impacting efficacy & tolerability.
A meta-analysis found both to be effective in depression, with Desvenlafaxine showing a linear dose response. (Norman & Olver, 2021)
Here’s what clinicians need to know about their differences in metabolism, clinical effects & prescribing considerations. 🧵👇
Receptor Binding & Neurotransmitter Effects
1️⃣ Venlafaxine: 30:1 serotonin (5-HT) to norepinephrine (NE) ratio, acting mainly as an SSRI at low doses and an SNRI at higher doses (>225 mg).
2️⃣ Desvenlafaxine: 10:1 5-HT:NE ratio, meaning it acts as a dual reuptake inhibitor at standard doses (50 mg+). (Liebowitz & Tourian, 2010)
Pharmacokinetics & Metabolism
1️⃣Venlafaxine XR: Metabolised via CYP2D6 to Desvenlafaxine, with a half-life of ~15±6 hrs.
2️⃣Desvenlafaxine: Minimal CYP metabolism, primarily conjugated by UGT enzymes, with a half-life of ~11 hrs.
💡 Psych Scene Tip: Desvenlafaxine is less affected by CYP2D6 polymorphisms, making plasma levels more predictable.
Approximately 1 in 9 U.S. children have been diagnosed with ADHD, yet traditional stimulant medications often fall short in efficacy and tolerability. (CHADD, 2021)
Recent advancements have introduced novel therapies targeting multiple neurotransmitter systems, expanding treatment options and potentially improving outcomes. (Neurolaunch, 2023)
Here are 4 emerging treatments that could improve ADHD management by offering alternatives to stimulants and addressing broader neurochemical pathways 🧵👇
The Cortico-Striatal-Thalamo-Cortical (CSTC) Loop & ADHD
ADHD is linked to dopaminergic & noradrenergic dysfunction in CSTC circuits, affecting:
- Attention
- Impulse control
- Executive function
Targeting these circuits is key to optimising treatment strategies.
1. Viloxazine (Qelbree) – A serotonin-norepinephrine modulating agent (SNMA)
- Increases serotonin in the prefrontal cortex
- Modulates norepinephrine & dopamine
- FDA-approved (2021) for ages 6-17
📌 Effective for inattention & impulsivity but carries a black box warning for suicidality.
💡 Psych Scene Tip: Consider Viloxazine for stimulant non-responders, but monitor closely for mood changes.