性功能障碍
中止
5-羟色胺能
医学
勃起功能障碍
文拉法辛
精神科
奈法唑酮
膀胱过度活动
心理学
重症监护医学
氟西汀
焦虑
内科学
替代医学
抗抑郁药
受体
病理
血清素
作者
Samantha Klaas,Jessica Barbut Siva,Maarten Bak,Mark Govers,Rudy Schreiber
标识
DOI:10.1016/j.biopha.2022.114166
摘要
Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated.Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options.We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient's symptoms.The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, 'brain zaps', overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems.The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic - and possibly noradrenergic - mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes.
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