Serotonergic targets in the treatment of antidepressant induced sexual dysfunction: a pilot study of granisetron and sumatriptan

Antidepressant induced sexual dysfunction is a common adverse event that is particularly evident with serotonergic antidepressants. There is a paucity of clinical trial evidence on the treatment of this problem. While there i s some evidence of involvement of the serotonin (5-HT2) receptor subtype in this phenomenon, other serotonergic receptor systems are not well studied. In this trial, 35 patients on maintenance therapy with a variety of seroto nergic antidepressants, who reported antidepressant induced sexual dysfunct ion, were enrolled. Patients were given both granisetron 1 mg, and sumatrip tan 100 mg, in a crossover design, to be used 1 h before intercourse. Sexua l dysfunction was measured using the Feiger scale. There was a high dropout rate in the trial, reflecting both embarrassment with the pharmacological treatment of sexual dysfunction and difficulties with planning and timing t he medication. Nevertheless, there was a significant effect of granisetron in this study, with scores decreasing from 23.7 (SD 2.52) to 16.0 (SD 6.42) on the Feiger scale (n = 14, P = 0.001, Wilcoxon sign rank test). Sumatrip tan failed to show a significant change from baseline at the 0.01 level of significance. While the small sample size, high dropout rates and open labe l design are limitations to this study, it suggests efficacy of the granise tron in antidepressant induced sexual dysfunction and the role of the 5-HT3 receptor in this phenomenon. (C) 2000 Lippincott Williams & Wilkins.