Should anyone be expected to sacrifice sexual satisfaction or experience excessive weight gain in order to obtain psychological well-being? Participants attending the 154th American Psychiatric Association annual meeting, held recently in New Orleans, tackled these issues while exploring what can be done.
Researchers reported the findings from the first study to examine the rates of sexual dysfunction among users of the new-generation antidepressants. In the overall study population of nearly 6,300 patients, bupropion sustained-release tablets (Wellbutrin SR, GlaxoSmithKline) were associated with the lowest rate of sexual dysfunction (25%), followed by bupropion HCl (Wellbutrin) (22%). Those results compared with an average of 40% for all the selective serotonin reuptake inhibitors (SSRIs), venlafaxine (Effexor, Wyeth-Ayerst), and mirtazapine (Remeron, Organon).
Sexual dysfunction can greatly impinge on a patient's quality of life, affect medication compliance, and interfere with recovery from depression, said lead investigator Anita Clayton, M.D., associate professor and vice chair of the Department of Psychiatric Medicine at the University of Virginia.
The tendency for most of the atypical antipsychotics to induce weight gain was also a hot topic at the meeting. One study reported that olanzapine (Zyprexa, Lilly) tended to produce more weight gain as compared with ziprasidone (Geodon, Pfizer). Another study observed that olanzapine-- treated patients manifested increased weight gain, fasting insulin levels, total cholesterol levels, and triglyceride levels when compared with patients on ziprasidone. However, emerging data showed that olanzapine-induced weight gain is manageable with clinical and educational intervention.
Kimberly Littrell, M.S., A.P.R.N., president and CEO of the Promedica Research Center in Atlanta, reported the findings for her small pilot study. Schizophrenic patients who participated in a four-month, one-hour-- weekly education class on nutrition and exercise gained fewer pounds compared with those receiving no behavioral interventions.
Additional data were also presented on a retrospective study of 145 psychiatric outpatients treated with olanzapine. In this study, only nine patients discontinued olanzapine treatment because of weight gain.
"What we've seen here is that treatment efficacy is a very important factor as it relates to medical adherence and, ultimately, to a favorable treatment outcome," said L. Jan Findlay, R.N., C.N. …