Introduction. Erectile dysfunction and comorbid depression: prevalence, treatment strategies, and associated medical conditions.

From the Department of Psychiatry, Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, N.M. Support was provided by Pfizer Inc, New York, N.Y. Corresponding author and reprints: H. George Nurnberg, M.D., Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, Albuquerque, NM 87131-52886 (e-mail: [email protected]). E percent of men aged 40 to 70 years may be expected to have some degree of erectile dysfunction (mild, moderate, or complete), including 10% with complete erectile dysfunction (total absence of erections). Lifetime prevalence estimates of 16% for major depression and 10% for minor depression, determined from a nationally representative survey of persons aged 15 to 54 years living in the United States, suggest that depression is also highly prevalent. Men who have depression have a nearly 2-fold greater likelihood of having erectile dysfunction compared with men with no depression. Several studies have determined that major depressive disorder is associated with decreased libido, erectile dysfunction, and decreased sexual activity. In addition, sexual dysfunction, including erectile dysfunction, is a well-described side effect in patients taking serotonin reuptake inhibitor (SRI) antidepressants. Occurrence of sexual dysfunction as well as other common adverse events associated with SRIs (e.g., weight gain and sleep disturbance) frequently result in compromise of patient adherence to treatment regimens. Therefore, although depression is readily treatable, with up to 90% of patients responding to their first or second antidepressant, typically less than 30% of patients complete the recommended 6 to 9 months of antidepressant therapy following an acute episode. Frequently, patients discontinue treatment because of side effects such as weight gain, sleep disturbances, and sexual problems, including erectile dysfunction. Such premature discontinuation of antidepressant therapy may result in recurrence or relapse, exposing the patient to increased morbidity or mortality. The articles in this supplement examine conventional and newer treatment strategies for antidepressant-associated sexual dysfunction and investigate further the interrelationships between erectile dysfunction and depression.