It has now been proved that erectile dysfunction is usually accompanied by depression. 52% of men aged 40 to 70 may be expected to have some degree of erectile dysfunction, including 10% with complete erectile dysfunction (total absence of erections).

One lifetime prevalence estimates of 16% for major depression and 10% for minor depression, determined from a nationally representative survey of persons aged 15 to 54 years living in the United States. Although depression is readily treatable, with up to 90% of patients responding to the anti-depressants, typically less than 30% of patients complete the full anti-depressant therapy. It is so, because patients can not deal with side effects, such as weight gain, sleep disturbances, and sexual problems, including erectile dysfunction.

Labbate, Croft, and Oleshansky talk about the empirical evidence for the current strategies of pharmacotherapy commonly used in the management of anti-depressants associated with sexual dysfunction. These strategies include avoidance of the problem by selecting an anti-depressant that has little or no associated sexual dysfunction,switching to such an anti-depressant, use of adjunctive antidote pharmacotherapy with an antagonist/agonist or non-SRI antidepressant that has little or no associated dysfunction and adaptation.

Sildenafil citrate, a selective and competitive inhibitor of phosphodiesterase type 5, possesses many of the qualities that are considered ideal for an antidote therapy to treat antidepressant-associated erectile dysfunction. These include a peripheral site of action, a novel mechanism that is not competitive with the primary treatment, administration on an as-needed basis, significant efficacy, high tolerability, and a relatively short duration of action.

However, before treating erectile dysfunction, physicians should consider the impact of resuming sexual activity and the mild and transient vasodilatory effects of sildenafil on bloodpressure. They should also carefully consider whether patients with underlying cardiovascular disease or other unusual conditions could bead versely affected by vasodilatory effects, especially in combination with sexual activity.

Associations

Associations between depression, ischemic heart disease, erectile dysfunction and depression have also been established.

Roose discusses these complex and multifaceted relationships, presenting the current clinical and research findings that suggest a more substantial role for depression in the development of IHD and its treatment outcome and point to a growing list of risk factors shared by all 3 medical conditions.

The increasing prevalence of erectile dysfunction with age parallels age-related changes in androgen levels. Consequently, age-related declines in testosterone have been suggested as a possible explanation for some symptoms (e.g., weakness, reduced muscle and bone mass, sexual dysfunction, depression) experienced by elderly men , and testosterone replacement has been proposed as a potential therapy for some of these symptoms.