Depression erectile dysfunction with

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FIGURE 14-10. Erectile dysfunction is associated with depression and increases in frequency as depression worsens. Among severely depressed men, some studies suggest that over 90% are impotent. 

What percentage of men with severe depression experience erectile dysfunction ... 

Apomorphine is a dopamine agonist with a variegated pattern of usage. Given parenter-ally as an emetic agent to aid elimination of orally ingested poisons, it is not without hazards (hypotension, respiratory depression). In akinetic motor disturbances, it is a back-up drug. Taken orally, it supposedly is beneficial in erectile dysfunction. 

Antidepressants do constitute the main cause for new sexual dysfunction seen in the average outpatient (Balon Harvey, 1995). Although various kinds of sexual dysfunction may be seen in the context of antidepressant therapy (Table 3.11), the most common manifestations seen in clinical practice are erectile dysfunction, partial or complete anorgasmia, and delayed ejaculation. Resolution of these side effects is critical to ensure treatment adherence and remission and to reduce the stress of the depressive episode on the patient s relationship with a spouse or significant other. When an antidepressant treatment achieves symptom remission but is complicated by sexual dysfunction as a side effect, several strategies have been used to deal with the problem, although the success of each varies from patient to patient (Table 3.12). 

Finally, patients must be in the proper mental frame of mind to be receptive to sexual stimuli. Patients who suffer from malaise, have reactive depression or performance anxiety, are sedated, have Alzheimer s disease, have hypothyroidism, or have mental disorders, commonly complain of erectile dysfunction. In most studies, patients with psychogenic erectile dysfunction generally exhibit a higher response rate to various interventions than do patients with organic erectile dysfunction, as their disease is often less severe. 

For patients with psychogenic erectile dysfunction, psychotherapy may be used as monotherapy, or as an adjunct to specific treatments for the disorder. To enhance the relevance of psychotherapy, both the patient and his partner should be included in the counseling sessions. Also, treatment should be individualized and should address those immediate factors that may be causing performance anxiety or depression, rather than the remote, deep-seated reasons for psychological disorders. The effectiveness of psychotherapy is generally low, and long-term psychotherapy is often necessary. 

The adverse effects of trazodone, when used for erectile dysfunction, are similar to those reported with trazodone when used to treat depression (see Chap. 67). 

Chronic renal failure is also frequently associated with diminished erectile function, impaired libido, and infertility. The mechanism is probably multifactorial low serum testosterone concentrations, diabetes mellitus, vascular insufficiency, multiple medications, autonomic and somatic neuropathy, and psychological stress. Men with angina, myocardial infarction, or heart failure may have erectile dysfunction from anxiety, depression, or concomitant penile arterial insufficiency. 

Shabsigh R, Klein LT, Seidman S et al (1998) Increased incidence of depressive symptoms in men with erectile dysfunction. Urology 52 848-852... 

Psychogenic dysfunction occurs if a patient does not respond to psychic arousal. It occurs in up to 30% of all cases of ED. Common causes include performance anxiety, strained relationships, lack of sexual arousability, and overt psychiatric disorders such as depression and schizophrenia.5 It is postulated that the anxious or nervous man will have excessive stimulation of the sympathetic system, leading to smooth muscle contraction of arterioles and vascular spaces within erectile tissue.6 O Many patients may initially have organic dysfunction, but develop a psychogenic component as they try to cope with their inability to achieve an erection. It has been estimated that up to 80% of ED cases have an organic cause, with many having a psychogenic component as well.1... 

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