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Mental Health
Sexual Dysfunction with Antidepressants
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<blockquote data-quote="madman" data-source="post: 261105" data-attributes="member: 13851"><p><strong>Neurobiological Mechanisms of Sexual Dysfunction with Antidepressants </strong></p><p></p><p><em>Keeping antidepressant agents in focus, there is evidence to show that they are probable to cause sexual side effects through their mechanism of action.5<strong> In such scenarios also, there are certain excitatory and inhibitory factors that play a role in the mechanism of action of psychotropics in general. <u>The excitatory factors include dopamine, melanocortins, noradrenaline, testosterone, estrogen, and oxytocin, while the inhibitory factors include serotonin, prolactin, and opioids</u>.6</strong></em></p><p><em></em></p><p><em>When we discuss the sexual cycle and the role of antidepressants in altering it, it becomes useful to first understand the physiology of the sexual cycle and the neurotransmitters affecting it. <strong>Among the neurotransmitters concerned with psychiatry, the following have a role to play in the sexual response cycle as well. In chronological order, <u>desire is promoted by dopamine, norepinephrine (NE), and estrogen, while it is inhibited by serotonin and prolactin</u>.</strong> <strong><u>When it comes to arousal, nitric oxide, dopamine, NE, estrogen and testosterone, oxytocin, acetylcholine, and melanocortin enhance it, while serotonin brings down the arousal</u>.</strong> <strong><u>In the stage of orgasm, dopamine and nitric oxide help in enhancing the orgasm while serotonin dampens it</u>.</strong> <strong><u>When D1 and D5 receptors are stimulated, they help in facilitating sexual arousal in the form of erection in males and receptivity in females</u>. <u>On stimulation of D2 receptors, orgasm comes to fruition, while serotonin reduces sexual activity by blocking dopamine</u>.7</strong></em></p><p><em></em></p><p><em>The mechanism by which psychotropic medications affect the sexual cycle is through the interaction between medications and the various above-mentioned neurotransmitters.<strong> Sexual dysfunction occurs with the use of antidepressants because of increases and decreases in the levels of various neurotransmitters caused by these drugs.</strong> <strong><u>The main mechanism of action of most antidepressants is through modulation of the levels of neurotransmitters and their receptors in the synapses of the central nervous system</u>.8</strong></em></p><p><em></em></p><p><em>Prolactin is a hormone released by the anterior pituitary gland that is responsible for milk production during lactation. <strong>However, prolactin also suppresses ovulation and sexual desire and function.9 Antipsychotics cause blockade of dopamine receptors (their mechanism of action), and hence there is an increase in prolactin levels which causes sexual dysfunction.10 Also, one must remember that these medications interact with muscarinic and histaminergic neurotransmitters and receptors too. Delayed ejaculation/orgasm is caused by the use of selective serotonin reuptake inhibitors (SSRIs) – this is due to the increase in serotonin levels produced by these drugs, which interfere with the pathways of ejaculation and erection.8</strong> <strong>Tricyclic antidepressants interfere with serotonin, dopamine, noradrenaline, acetylcholine, and other neurotransmitters, all of which contribute to sexual dysfunction.11</strong> <strong>Selective serotonin reuptake inhibitors can reduce the function of the hypothalamic–pituitary–testis axis and lower levels of LH, FSH, and testosterone, which leads to impaired sexual function.8 </strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 261105, member: 13851"] [B]Neurobiological Mechanisms of Sexual Dysfunction with Antidepressants [/B] [I]Keeping antidepressant agents in focus, there is evidence to show that they are probable to cause sexual side effects through their mechanism of action.5[B] In such scenarios also, there are certain excitatory and inhibitory factors that play a role in the mechanism of action of psychotropics in general. [U]The excitatory factors include dopamine, melanocortins, noradrenaline, testosterone, estrogen, and oxytocin, while the inhibitory factors include serotonin, prolactin, and opioids[/U].6[/B] When we discuss the sexual cycle and the role of antidepressants in altering it, it becomes useful to first understand the physiology of the sexual cycle and the neurotransmitters affecting it. [B]Among the neurotransmitters concerned with psychiatry, the following have a role to play in the sexual response cycle as well. In chronological order, [U]desire is promoted by dopamine, norepinephrine (NE), and estrogen, while it is inhibited by serotonin and prolactin[/U].[/B] [B][U]When it comes to arousal, nitric oxide, dopamine, NE, estrogen and testosterone, oxytocin, acetylcholine, and melanocortin enhance it, while serotonin brings down the arousal[/U].[/B] [B][U]In the stage of orgasm, dopamine and nitric oxide help in enhancing the orgasm while serotonin dampens it[/U].[/B] [B][U]When D1 and D5 receptors are stimulated, they help in facilitating sexual arousal in the form of erection in males and receptivity in females[/U]. [U]On stimulation of D2 receptors, orgasm comes to fruition, while serotonin reduces sexual activity by blocking dopamine[/U].7[/B] The mechanism by which psychotropic medications affect the sexual cycle is through the interaction between medications and the various above-mentioned neurotransmitters.[B] Sexual dysfunction occurs with the use of antidepressants because of increases and decreases in the levels of various neurotransmitters caused by these drugs.[/B] [B][U]The main mechanism of action of most antidepressants is through modulation of the levels of neurotransmitters and their receptors in the synapses of the central nervous system[/U].8[/B] Prolactin is a hormone released by the anterior pituitary gland that is responsible for milk production during lactation. [B]However, prolactin also suppresses ovulation and sexual desire and function.9 Antipsychotics cause blockade of dopamine receptors (their mechanism of action), and hence there is an increase in prolactin levels which causes sexual dysfunction.10 Also, one must remember that these medications interact with muscarinic and histaminergic neurotransmitters and receptors too. Delayed ejaculation/orgasm is caused by the use of selective serotonin reuptake inhibitors (SSRIs) – this is due to the increase in serotonin levels produced by these drugs, which interfere with the pathways of ejaculation and erection.8[/B] [B]Tricyclic antidepressants interfere with serotonin, dopamine, noradrenaline, acetylcholine, and other neurotransmitters, all of which contribute to sexual dysfunction.11[/B] [B]Selective serotonin reuptake inhibitors can reduce the function of the hypothalamic–pituitary–testis axis and lower levels of LH, FSH, and testosterone, which leads to impaired sexual function.8 [/B][/I] [/QUOTE]
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Mental Health
Sexual Dysfunction with Antidepressants
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