To the Editor: It is with great interest that we read the article in the January 2006 issue of the Journal by Raymond Rosen, Ph.D, and colleagues on depression-related improvement with vardenafil for erectile response (1). While we agree with the authors’ conclusions related to improved treatment outcomes and quality of life when physical symptoms associated with depression are managed, we argue that there are a number of issues that are not adequately addressed in their study.
Based upon our clinical experience and review of the literature and initial data, we feel that there are some populations that should be screened for nonprescription use of erectile dysfunction drugs (2, 3). In the study by Dr. Rosen and colleagues, no mention is made regarding the screening of participants for sexual compulsivity. In addition, the authors do not address the issue of medication diversion, which is a considerable matter for erectile dysfunction treatment. Patients with a history of 3,4-methylenedioxymethamphetamine or methamphetamine abuse commonly use diverted prescription drugs for erectile dysfunction, and prescription misuse is increasing. However, no national survey or surveillance system tracks the misuse of any erectile dysfunction medication.
Patients with a history of internet sex or sexual compulsivity are also in need of further evaluation. An increased number of patients are reporting a decline in their sexual performance co-occurring with problematic, compulsive online sexual behavior.
We feel that future studies should address the diversion and abuse potential of erectile dysfunction treatment and screen for sexual compulsivity problems in study populations.
1.Rosen R, Shabsigh R, Berber M, Assalian P, Menza M, Rodriguez-Vela L, Porto R, Bangerter K, Seger M, Montorsi F: Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study. Am J Psychiatry 2006; 163:79–87
2.Graham NA, Gold MS: Performance enhancing, non-prescription use of erectile dysfunction medications. J Addict Dis 2006 (in press)
3.Carnes PJ: Sexual addiction, in Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. Sadock BJ, Sadock VA (eds). Philadelphia, Lippincott, Williams, and Wilkins, 2004