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題名：性功能障礙與抗憂鬱劑關係之探討
作者：蔡景宏
作者(外文)：Ching-Hong Tsai
校院名稱：樹德科技大學
系所名稱：人類性學研究所
指導教授：林燕卿
朱元祥
學位類別：博士
出版日期：2011
主題關鍵詞：憂鬱症；抗憂鬱劑；性功能障礙；depressive disorder；antidepressants；sexual dysfunction
原始連結：連回原系統網址new window
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憂鬱症是二十一世紀，僅次於心臟血管疾患，為影響人類健康及醫療支出之重要疾病。台灣健保用藥的盛行率研究顯示憂鬱劑的處方占所有藥物比例逐年增高，這顯示抗憂鬱劑在台灣已廣泛被使用，其作用與副作用需進一步被注意。其中，造成性功能障礙之副作用是需要加以重視的，因為此一副作用會降低憂鬱症病人用藥意願，造成疾病的復發，且醫師較少主動詢問治療期間性功能之變化，病人亦很少主動告知或與醫師討論。雖然性功能受到影響是診斷憂鬱症的症狀之一，而如何與使用抗憂鬱劑所造成的性功能影響有時難以清楚區分。本研究目的企圖釐清憂鬱症、抗憂鬱劑及性功能障礙三者間的相互關係，提高臨床工作人員對抗憂鬱劑影響性功能之認識。
本研究共招募93位首次接受抗憂鬱劑治療之重度憂鬱症病人（符合DSM-IV診斷標準）為對象，分別接受用藥後次數不一的評估，並排除如下情況:（1）其他共併之精神疾病，如恐慌症、強迫症、創傷後壓力症候症、飲食障礙，特別如藥癮與酒癮個案。（2）可能影響性功能之身體疾病，如糖尿病、高血壓、心肌梗塞，高血壓藥物及腦血管疾病。（3）同時使用其他內外科用藥。（4）其他重大精神疾病，包括精神分裂症、雙極性精神病及其他精神疾病。（5）懷孕中，也建議在研究中避免懷孕。在符合上述收案條件後，詳細解釋研究流程，經病人同意後填寫受試者同意書。在資料收上除一般人口學資料外，先於剛收案時使用漢氏憂鬱量表、貝氏憂鬱量表、亞利桑那性經驗量表、性需求量表、性滿意度量及艾氏人格量表表建立基礎資料（baseline data）。然後在使用抗憂鬱劑（SSRI）治療後，分別於用藥後第一、二、三、四、八及十二週時再度以漢氏憂鬱量表、貝氏憂鬱量表、亞利桑那性經驗量表、性需求量表及性滿意度量表連續評量共六次，來觀察憂鬱症狀改變情況與性功能改變情況之關係，企圖找出性功能改變、憂鬱症狀及抗憂鬱劑三者間之關係。因以多次重複性方式進行，用各評估前後變化情況為考量的指標，統計方法使用廣義估計方程式（Generalized Estimating Equation, GEE）來處理控制憂鬱症狀及性功能變化。結果發現性需求量表分數方面，分數愈高代表性需求愈高，男性平均26.79（±7.06）分，女性平均8.49（±2.65）分；亞利桑那性經驗量表分數方面，分數愈高代表性功能障礙愈嚴重，男性平均17.46（±6.23）分，女性平均21.69（±6.00）分；性滿意度量表分數方面，分數愈高代表性滿意度愈低，男性平均32.89（±6.05）分，女性平均38.95（±8.32）分。三種不同向度男性均較女性有較高性需求、較低性功能障礙及較高性滿意度，並皆達統計顯著意義（p＜.001）。
另有三點重要結果：第一點、女性在性需求層面低於男性，女性性功能障礙程度高於男性，在性滿意度層面也低於男性，並皆達統計顯著（p＜.001）；第二點、在維期十二周藥物治療過程中，性需求層面與憂鬱症狀高低沒有相關，但性滿意度層面與憂鬱症狀息息相關。同時，研究也發現控制用藥過程中憂鬱症狀時，性需求前四周增高，但增高程度隨時間漸減少，且第五周起性需求便出現減少並持續下降趨勢，顯示可能的抗憂鬱劑影響；另一方面，性滿意度不受藥物影響，卻與憂鬱症狀息息相關，並達統計顯著。第三點、亞利桑那性經驗量表與性需求量表及性滿意度量表間有顯著統計相關，其施測簡單、方便且快速，值得推薦在臨床使用。
Depressive disorder is an important disease and second only to cardiovascular disease in affecting human health and medical expenditures in the 21st century. Bureau of National Health Insurance data on the prevalence of drug use has demonstrated that the prescription of antidepressants accounts for the majority of medicines prescribed annually. This shows that antidepressants are widely used in Taiwan, so their function and side effects require further attention. Among them, the side effect that involves the hindering of sexual functioning needs more attention, because this side effect will reduce the patient’s drug compliance, leading to the recurrence of depressive episodes. Physicians seldom inquire about changes in sexual functioning during treatment, and patients, as well, seldom take the initiative to make this known or discuss this with the doctor. Although impairment of sexual functioning has been noted as a symptom of clinical depression, it is difficult to clearly demarcate when the sexual dysfunctioning is a side effect of the antidepressant medication. The majority of studies assess sexual dysfunction with SSRIs, but it is difficult to interpret these findings, as the study populations including patients with varying degrees of depression. Our study attempts to clarify the relationships among depressive disorder, antidepressant agents and sexual function.
In this 12-week study, 93 adult inpatients or outpatients with DSM-IV defined major depressive disorder(MDD) were assigned to receive Paroxetine 20-40mg.This represented all available data from studies in which the 24-item Hamilton RatingScale for Depression, 21-item Beck Depression Inventory, Sexual Desire Scale, Arizona Sexual Experience Scale, Chinese version were administered at baseline and then to evaluate any changes at the first, second, third, fourth, eighth, and twelfth week after beginning medication, in order to understand the impact of antidepressants.
There were three important results: First, females subjectively perceive a greater severity of depression than males, women have a lower level of sexual need than men, the level of female sexual dysfunctioning is higher than that of males, and the level of female sexual satisfaction is lower than that of males. Second, there was no association between the levels of sexual need and the severity of depression during the 12-week period, but sexual satisfaction and depressive symptoms were closely related. At the same time, the study also found that during the first four weeks of the controlled drug use period, sexual needs increased, but the degree of increase was gradually reduced with time. Four weeks later, sexual needs appeared to be decreasing, and became a continuing trend, thus demonstrating the possible effect of the antidepressant. On the other hand, sexual satisfaction was less influenced by the medication, but was strongly associated with depressive severity; the environmental factor also affected sexual satisfaction. Third, in exploring the correlation of the Beck Depression Inventory and the Sexual Function Questionnaires, it was found that the sensitivity of the former surpassed that of the Hamilton Depression Rating Scale. There is an apparent correlation among the Arizona Sexual Experience Scale, the Sexual Desire Scale and the Sexual Satisfaction Scale, and they are worthy of recommending for clinical use.
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