Effectiveness of cognitive behavioral therapy and fluoxetine on sexual function of women with obsessive compulsive disorder
A double-blind randomized controlled trial
Keywords:
Cognitive behavior therapy, Obsessive-compulsive disorder, Fluoxetine, Sexual behaviorAbstract
Background: Obsessive compulsive disorder (OCD) is a mental health concern due to its various negative consequences, especially in sexual function. Therefore, the treatment of sexual dysfunction in women with OCD is important in order to improve the patient’s marital function and mental health.
Objectives: To compare the sexual behavior and sexual and marital satisfaction in women with obsessive-compulsive disorder (OCD) before and after treatment with fluoxetine and cognitive behavior therapy
Methods: This randomized clinical trial was conducted at psychiatric and psychological counseling centers in Kashan (Iran) from January 2, 2014, to December 29, 2014. Fifty-eight women with OCD were included in the study. In order to compare the effectiveness of pharmacological treatment (fluoxetine) and psychological treatment, cognitive behavior therapy (CBT), 58 female patients with OCD (diagnosed based on DSM-IV-T criteria) were randomized equally to either fluoxetine (at a dose of 60–80 mg daily for 3 months) or CBT (10 45-minute sessions). OCD and sexual behavior status of the patients before and after the intervention was assessed with the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and Female Sexual Function Index (FSFI) questionnaire, respectively. The data were analyzed using SPSS version 22. To compare changes between the two groups, an independent T-test was used. Finally, the effects of all potential factors on treatment outcome were analyzed using factorial ANCOVA.
Results: The mean score for OCD in the fluoxetine group was 25.6 ± 4.8 at the beginning of the experiment and 18.79 ± 4.26 at the end of the study, while in the CBT group it was 25.6 ± 4.8 and 18.79 ± 4.26, respectively. No significant differences were found between two groups regarding obsession score changes. These scores in fluoxetine group were 58.1 and 52.8, respectively (p=0.046). There was a significant difference between the two groups in terms of sexual performance (p=0.003).
Conclusion: In this study, our findings demonstrate a significant reduction in symptom severity of OCD after treatment with fluoxetine and CBT, indicating CBT can be an alternative for fluoxetine therapy in such patients. Therefore, both pharmacotherapy and CBT can be used for this purpose in clinical practices, but more studies are needed.
Clinical trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2013091014619N1.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
References
Sadock BJ, Sadock VA. Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical
psychiatry. Lippincott Williams & Wilkins. 2011.
Olatunji BO, Davis ML, Powers MB, Smits JA. Cognitive-behavioral therapy for obsessive-compulsive
disorder: A meta-analysis of treatment outcome and moderators. J Psychiatr Res. 2013; 47(1): 33-41. doi:
1016/j.jpsychires.2012.08.020. PMID: 22999486.
Kendurkar A, Kaur B. Major depressive disorder, obsessive-compulsive disorder, and generalized anxiety
disorder: do the sexual dysfunctions differ? Prim Care Companion J Clin Psychiatry. 2008; 10(4): 299-305.
PMID: 18787674, PMCID: PMC2528235.
Sadock BJ, Sadock V, Ruiz P. Comprehensive textbook of psychiatry. 9th. Philadelphia: Volkmar, Klin,
Robert, Schultz & Mathew. 2009; 3540.
Storch EA, Merlo LJ, Lehmkuhl H, Geffken GR, Jacob M, Ricketts E, et al. Cognitive-behavioral therapy
for obsessive–compulsive disorder: A non-randomized comparison of intensive and weekly approaches. J
Anxiety Disord. 2008; 22(7): 1146-58. doi: 10.1016/j.janxdis.2007.12.001. PMID: 18242950.
Akrami N, kalantari M, Arizi HR, Abedi MR, Maroufi M. Comparison of the Effectiveness of Behavioral- Cognitive and Behavioral Meta Cognitive Approaches in Patient with Obsessive-Compulsive Disorder
(OCD). Journal of Clinical Psycology. 2010; 2(2): 59-71.
Arroll B, Macgillivray S, Ogston S, Reid I, Sullivan F, Williams B, et al. Efficacy and tolerability of
tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a
meta-analysis. Ann Fam Med. 2005; 3(5): 449-56. doi: 10.1370/afm.349. PMID: 16189062, PMCID:
PMC1466912.
Bishop JR, Chae SS, Patel S, Moline J, Ellingrod VL. Pharmacogenetics of glutamate system genes and
SSRI-associated sexual dysfunction. Psychiatry Res. 2012; 199(1): 74-6. doi:
1016/j.psychres.2012.03.048. PMID: 22534499, PMCID: PMC3458139.
Aukst-Margetić B, Margetić B. An open-label series using loratadine for the treatment of sexual
dysfunction associated with selective serotonin reuptake inhibitors. Prog Neuropsychopharmacol Biol
Psychiatry. 2005; 29(5): 754-6. doi: 10.1016/j.pnpbp.2005.04.007. PMID: 15913872.
Ziaee T, Jannati Y, Mobasheri E, Taghavi T, Abdollahi H, Modanloo M, et al. The relationship between
marital and sexual satisfaction among married women employees at Golestan University of Medical
Sciences, Iran. Iran J Psychiatry Behav Sci. 2014; 8(2): 44-51. PMID: 25053956, PMCID: PMC4105603.
Zohar J. Obsessive Compulsive Disorder: Current Science and Clinical Practice. John Wiley & Sons. 2012. doi: 10.1002/9781119941125.
Kaplan SL. A Self-Rated Scale for Obsessive-Compulsive Disorder. J Clin Psychol. 1994; 50(4): 564-74.
doi: 10.3928/0048-5713-19890201-07. PMID: 7983204.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index
(FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex
Marital Ther. 2000; 26(2): 191-208. doi: 10.1080/009262300278597. PMID: 10782451.
Ghassamia M, Asghari A, Shaeiri MR, Safarinejad MR. Validation of psychometric properties of the
Persian version of the Female Sexual Function Index. Urol J. 2012; 10(2): 878-85. PMID: 23801471.
Kupfer DJ, Hales RE, Yudofsky SC, Roberts LW. The American Psychiatric Publishing Textbook of
Psychiatry, Sixth Edition. American Psychiatric Pub. 2014. doi: 10.1176/appi.books.9781585625031.
Ferguson JM. SSRI antidepressant medications: adverse effects and tolerability. Prim Care Companion J
Clin Psychiatry. 2001; 3(1): 22-7. doi: 10.4088/PCC.v03n0105. PMID:15014625, PMCID: PMC181155.
Irons J. Fluvoxamine in the treatment of anxiety disorders. Neuropsychiatr Dis Treat. 2005; 1(4): 289-99.
PMID: 18568110, PMCID: PMC2424117.
Ackerman DL, Greenland S, Bystritsky A. Side effects as predictors of drug response in obsessive- compulsive disorder. J Clin Psychopharmacol. 1999; 19(5): 459-65. doi: 10.1097/00004714-199910000- 00010. PMID: 10505588.
Rosen RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin
Psychopharmacol. 1999; 19(1): 67-85. doi: 10.1097/00004714-199902000-00013. PMID: 9934946.
Kingsberg SA, Woodard T. Female sexual dysfunction: focus on low desire. Obstet Gynecol. 2015; 125(2):
-86. doi: 10.1097/AOG.0000000000000620. PMID: 25569014.
Stevenson JM, Bishop JR. Genetic determinants of selective serotonin reuptake inhibitor related sexual
dysfunction. Pharmacogenomics. 2014; 15(14): 1791-806. doi: 10.2217/pgs.14.114. PMID: 25493571.
Khazaie H, Rezaie L, Rezaei Payam N, Najafi F. Antidepressant-induced sexual dysfunction during
treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial. Gen Hosp Psychiatry.
; 37(1): 40-5. doi: 10.1016/j.genhosppsych.2014.10.010. PMID: 25467077.
Bergh SJ, Giraldi A. Sexual dysfunction associated with antidepressant agents. Ugeskrift for laeger. 2014;
(22). PMID: 25352006.
Waldinger MD, Zwinderman AH, Olivier B. Antidepressants and ejaculation: a double-blind, randomized,
fixed-dose study with mirtazapine and paroxetine. J Clin Psychopharmacol. 2003; 23(5): 467-70. doi:
1097/01.jcp.0000088904.24613.e4. PMID: 14520123.
Prabhakar D, Balon R. How do SSRIs cause sexual dysfunction? Current Psychiatry. 2010; 9(12): 30.
Uphouse L. Pharmacology of serotonin and female sexual behavior. Pharmacol Biochem Behav. 2014;
: 31-42. doi: 10.1016/j.pbb.2013.11.008. PMID: 24239784, PMCID: PMC4022722.
Ahrold TK, Meston CM. Effects of SNS activation on SSRI-induced sexual side effects differ by SSRI. J
Sex Marital Ther. 2009; 35(4): 311-9. doi: 10.1080/00926230902851322. PMID: 19466669, PMCID:
PMC4426856.
Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006; 163(9): 1504-9. doi:
1176/ajp.2006.163.9.1504. PMID: 16946173.
Franklin ME, Abramowitz JS, Bux Jr DA, Zoellner LA, Feeny NC. Cognitive-behavioral therapy with and
without medication in the treatment of obsessive-compulsive disorder. Professional Psychology: Research
and Practice. 2002; 33(2): 162. doi: 10.1037/0735-7028.33.2.162.
Vulink NC, Denys D, Bus L, Westenberg HG. Sexual pleasure in women with obsessive-compulsive
disorder? J Affect Disord. 2006; 91(1): 19-25. doi: 10.1016/j.jad.2005.12.006. PMID: 16434108.
Aksaray G, Yelken B, Kaptanoğlu C, Oflu S, Ozaltin M. Sexuality in women with obsessive compulsive
disorder. J Sex Marital Ther. 2001; 27(3): 273-7. PMID: 11354932.
Laurent SM, Simons AD. Sexual dysfunction in depression and anxiety: conceptualizing sexual
dysfunction as part of an internalizing dimension. Clin Psychol Rev. 2009; 29(7): 573-85. doi:
1016/j.cpr.2009.06.007. PMID: 19632022.
Aksoy UM, Aksoy ŞG, Maner F, Gokalp P, Yanik M. Sexual dysfunction in obsessive compulsive disorder
and panic disorder. Psychiatr Danub. 2012; 24(4): 381-5. PMID: 23132189.
Asoodeh MH, Daneshpour M, Khalili S, Lavasani MG, Shabani MA, Dadras I. Iranian successful family
functioning: Communication. Procedia-Social and Behavioral Sciences. 2011; 30: 367-71. doi:
1016/j.sbspro.2011.10.072.
Van Minnen A, Kampman M. The interaction between anxiety and sexual functioning: a controlled study
of sexual functioning in women with anxiety disorders. Sexual and Relationship Therapy. 2000; 15(1): 47- 57. doi: 10.1080/14681990050001556.
Montejo AL, Prieto N, Terleira A, Matias J, Alonso S, Paniagua G, et al. Better sexual acceptability of
agomelatine (25 and 50 mg) compared with paroxetine (20 mg) in healthy male volunteers. An 8-week,
placebo-controlled study using the PRSEXDQ-SALSEX scale. J Psychopharmacol. 2010; 24(1): 111-20.
doi: 10.1177/0269881108096507. PMID: 18801825.
Rosen-Grandon JR, Myers JE, Hattie JA. The relationship between marital characteristics, marital
interaction processes, and marital sastisfaction. Journal of Counseling and Development: JCD. 2004; 82(1):
-68. doi: 10.1002/j.1556-6678.2004.tb00286.x.
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