Anxiety Disorders and Stress Q 18
Nurse Kenzo is teaching a client about sertraline (Zoloft), which has been prescribed for depression. A significant side effect is an interference with sexual arousal by inhibiting erectile function. How should Nurse Kenzo approach this topic?
A. Nurse Kenzo should avoid mentioning the sexual side effects to prevent the client from having anxiety about potential erectile problems.
B. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
C. Nurse Kenzo should explain that the client's sexual desire will probably decrease while on this medication.
D. Nurse Kenzo should tell the client that sexual side effects are expected, but that they will decrease when his depression lifts.
Correct Answer: B. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
Clients commonly discontinue medications to avoid or correct sexual side effects, but they are less likely to do that when health professionals offer assistance with sexual issues. Generally, clients avoid discussing sexual issues unless health professionals give permission by raising the issue first. Sexual dysfunction is a common side effect of antidepressants and can have a significant impact on the person’s quality of life, relationships, mental health, and recovery. The reported incidence of sexual dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidence or prevalence.
Option A: Overall, 73% of the SSRI-treated clients reported adverse sexual side effects; in contrast, to 14% of clients treated with bupropion. The three SSRIs, to an equal degree, significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm below levels experienced pre-morbidly. In comparison, bupropion-treated clients reported significant increases in libido, level of arousal, intensity of orgasm, and duration of orgasm beyond levels experienced premorbidly.
Option C: The sexual problems reported range from decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, to erection or delayed ejaculation problems. There are a number of case reports of sexual side effects, such as priapism, painful ejaculation, penile anesthesia, loss of sensation in the vagina and nipples, persistent genital arousal, and nonpuerperal lactation in women.
Option D: Because most antidepressants modulate serotonin concentration, it is generally thought that elevated serotonin levels diminish sexual function. Serotonergic nerve terminals target dopamine and norepinephrine pathways in the brain and inhibit their activity, both of these neurotransmitters having a role in the desire and arousal phases of the sexual response cycle. 80% of serotonin is localized in the periphery, where when elevated, it directly reduces sensation in the anatomical structures of the reproductive system as well as diminishing erection, vaginal lubrication, ejaculation, and orgasm.