I. Hindmarch, THE BEHAVIORAL TOXICITY OF ANTIDEPRESSANTS - EFFECTS ON COGNITION ANDSEXUAL FUNCTION, International clinical psychopharmacology, 13, 1998, pp. 5-8
The cognitive system is structured from sets of schema, patterns of ne
ural activity that allow the assimilation or accommodation of new expe
riences and so, by a process of consolidation, the gradual development
of knowledge and understanding,As well as schema for purely cognitive
processes, there are similar structures that enable individuals to de
al with sexual behaviour and affectual relationships (e,g. hedonia, se
lf-esteem, personal preferences and body image), In depression, there
is a well established disruption of cognitive function that results in
anhedonia and a loss of pleasure, including that from sexual activiti
es. Many antidepressants also have a direct pharmacological action on
the central nervous system and disrupt cognitive function, so increasi
ng anhedonia and impairing sexual function, Drug actions on cognitive
structures, which in turn increase anhedonia and reduce sexual libido,
are over and above any direct pharmacological effects on the more ove
rt behavioural activities associated with sex, including orgasm, erect
ile function, potency and ejaculation. The tricyclic antidepressants,
for example, destroy the cognitive structures that are vital to mainta
in normal libido as well as disturbing overt sexual behaviours, Some s
elective serotonin reuptake inhibitors (SSRIs; paroxetine and sertrali
ne) are associated with behavioural activation that is also responsibl
e for an impairment of sexual function. However, there are clear diffe
rences between the SSRIs, and fluvoxamine (relative to the other SSRIs
) has little effect on objective measures of cognition or on cerebral
and behavioural components of sexual function. Int Clin Psychopharmaco
l 13 (suppl 6)S5-S8.