(018) Negative Perceptions Among Young Adult Males Towards Antidepressants and Their Sexual Side Effects: A Case For Atypical Agents?
Authors: Rabinowitz M , Eaton C , Haney N , Kohn T , Li O , Pil E , Herati A 
Published: May 2023

Abstract

Introduction
The prevalence of depression and anxiety among young adults (YA) rose precipitously in the last decade, along with a rise in the provision of first-line antidepressants known as selective serotonin reuptake inhibiters (SSRIs). SSRIs are associated with extremely high rates of nonadherence - above 50% for all patients and accentuated in those under 35 years old. Concurrently, sexual dysfunction is estimated to affect as many as 65% of patients treated with an SSRI. Despite this, the association between sexual dysfunction and medication nonadherence in YA males has been poorly characterized. Further, there is limited research comparing the opinions of YAs towards SSRIs to newer, effective, sexual function-sparing antidepressants like Bupropion and Mirtazapine.

Objective
To determine if YA males are less willing to adhere to antidepressant treatment due to intolerable side effects, such as sexual dysfunction. Moreover, to characterize the attitudes of YA males towards first- and second-line antidepressants.

Methods
A cross-sectional, deidentified, compensated survey was designed using Qualtrics XM (Provo, UT). A participation flyer was distributed via social media to recruit biological males ages 18 to 35. Participants were asked to indicate their perceptions of three deidentified medications (SSRI-class, Bupropion, and Mirtazapine) after being prompted with their most common side effects. Respondents also rated the potential negative impact of common antidepressant side effects (1=no impact; 10=worst possible impact) and whether these side effects, if experienced weekly, would trigger nonadherence. Parametric statistical tests were conducted using Stata (College Station, TX).

Results
From 665 surveys delivered via email, we received 505 completed forms (response rate: 76%), of which 486 were included after excluding those submitted in under 180 seconds. Age was normally distributed with a mean of 27.4 years (SD: 3.6). Participants were 40% non-white, 21% LGBTQ+, and 89% sexually active. The majority of our respondents were employed full-time (60%), while 36% were graduate or undergraduate students. As illustrated by Figure 1, participants' willingness to take Bupropion or Mirtazapine was significantly greater than an SSRI when compared by paired t-test (P&lt;0.0001) with no significant difference between the atypical agents (P=0.26). Further, 73% of YA males preferred sexual function-sparing medications to an SSRI (P&lt;0.0001). Additionally, the negative impact of sexual side effects, such as erectile dysfunction (6.2) or anorgasmia (6.0), scored significantly higher than other common antidepressant side effects like weight gain (5.4), nausea (5.3), and dry mouth (4.8). Finally, participants indicated that experiencing any weekly sexual dysfunction while taking an antidepressant medication would lead to medication nonadherence at a higher frequency than any other common side effect assessed (erectile dysfunction: 71%; anorgasmia: 71%; low libido: 70%).

Conclusions
To our knowledge, our study is the largest investigation to date of YA males’ perceptions of antidepressant medications. Our findings indicate that the risk of experiencing sexual side effects when taking antidepressants could lead YA males to become nonadherent to these medications. As mental illness and suicide continue to rise dramatically among YA males, strategies to augment the effectiveness of antidepressants, such as shared decision-making and the use of sexual function-sparing agents, are critical.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi, Teleflex, Lina.