Gepirone-ER treatment of low sexual desire associated with depression in women as measured by the DeRogatis Inventory of Sexual Function (DISF) fantasy/cognition (desire) domain--a post hoc analysis.

INTRODUCTION: Gepirone-extended release (ER) is effective in treating hypoactive sexual desire disorder (HSDD), as measured by the percent of females with HSDD that no longer met criteria for HSDD treatment. Another approach is to determine treatment effect on sexual desire using a recognized rating scale for sexual function. Because gepirone-ER has antidepressant and anxiolytic effects, investigation of these effects on sexual desire is appropriate. AIM: The aim of this study was to determine whether gepirone-ER has positive effects on sexual desire as measured by the DeRogatis Inventory of Sexual Function (DISF) in a post hoc analysis of 8- and 24-week studies and if this gepirone effect is independent of its antidepressant or anxiolytic activity. MAIN OUTCOME MEASURES: The main outcome measures used for this study were the Hamilton Depression Rating Scale (HAMD-25), change from baseline (CFB), and DISF CFB. METHODS: Three hundred thirty-four women selected for depressive symptoms, not sexual dysfunction, received gepirone-ER (40-80 mg/day) in a controlled study of atypical depression using the HAMD-25 to measure antidepressant efficacy and a DISF subscale (domain I) to measure sexual cognition/fantasy (desire). After treatment, a 50% reduction from baseline HAMD-25 score identified antidepressant responders. Item 12 of HAMD scale (psychic anxiety) was used to define anxiolytic response scores of 0, 1 as responders, and scores of 2, 3, and 4 as nonresponders. RESULTS: Gepirone-ER had no significant antidepressant or an anxiolytic effect in study 134006; however, DISF results demonstrate that gepirone-ER improves sexual desire in short term (P=0.043) and long term (P=0.006). Both gepirone-ER antidepressant and anxiolytic responders have statistically significant improved sexual desire. Gepirone-ER antidepressant and anxiolytic nonresponders also show statistically significant improvement. CONCLUSIONS: In depressed women, gepirone-ER has three mechanisms of action affecting sexual desire: an antidepressant effect, an anxiolytic effect, and a pro-sexual effect. Gepirone-ER improves sexual desire from the 24th to the 50th percentile according to population norms for the DISF.