Jon Birtwistle

Effects of antidepressant drugs on sexual function

Adequate sexual expression is an essential part of human relationships, enhancing quality of life and providing a sense of physical, psychological and social well-being. Unfortunately, depression is associated with impairments of sexual function and satisfaction. These problems can worsen a quality of life that is already reduced by the effects of depressive illness. The existing antidepressant drugs are far from ideal, most having adverse effects on sexual function. Unfortunately, the exact incidence of sexual dysfunction during treatment with many antidepressants is not known. Disturbances of sexual interest and performance will only be detected in a reliable fashion when systematic enquiries are made during the course of the standard clinical interview. Growing awareness of the adverse effects of many antidepressants on sexual function has led to some re-evaluation of the earlier claims for the good tolerability of many of the newer drugs. There is a clear need for further well-designed controlled studies of the effects of antidepressants on sexual function, so that this aspect of the tolerability of differing drugs can be assessed more reliably. (IntJ Psych Clin Pract 1997; 1: 47-58).

The psychological aspects of bereavement

Each year the average general practitioner will have approximately 20 patient deaths. Those that are bereaved may suffer both physical and mental health problems as a consequence of their loss. Approaches to the assessment of the health needs of bereaved patients and the impact of primary care team interventions in this area need to be evaluated in order to ensure that resources are used effectively. This article reviews bereavement-related issues from a primary care perspective.

Selective serotonin re-uptake inhibitors in anxiety disorders: room for improvement

As a group, the SSRIs have been found efficacious in double-blind placebo-controlled studies across a range of depressive disorders, both in short-term and long-term treatment. The efficacy of SSRIs is similar to that of tricyclic antidepressants (TCAs) in patients with major depression, apart from in the subgroup of hospitalised in-patients, where TCAs are marginally, but significantly, more effective [1]. In randomised controlled trials, the tolerability of SSRIs is better than that of TCAs, there being significantly fewer drop-outs from treatment because of adverse effects, but the magnitude of this difference is rather small [2]. SSRIs are clearly safer than most TCAs, when taken in overdose; and being less sedative, are less likely to interfere with many aspects of everyday life. For these reasons, the SSRIs have gained widespread acceptance in the treatment of depression, both in primary and secondary care settings.

More scrutiny required: an audit of the distribution of the Royal College of Psychiatrists' 'Help is at Hand' leaflet on social phobia

AbstractOn 12th December 1995 the Royal College of Psychiatrists launched the ‘Help is at Hand’ leaflet entitled Social Phobias. In an attempt to gauge its success and distribution an audit was performed on the number of leaflets requested from the College between December 1995 and December 1996. Between those dates approximately 37,500 leaflets were distributed, 10,138 to varying organisations and approximately 27,360 to members of the public. From the total distribution the launch of the leaflet appears to have been successful. Unfortunately little is known about the value of information provided to organisations or individuals requesting the leaflet. More feedback is needed regarding the distribution and effectiveness of public education leaflets to ensure that the appropriate groups are effectively targeted.