Sexual Desire, Depressive Symptoms and Medication Use Among Women With Fibromyalgia in Flanders, 2021, Van Overmeire et al

Discussion in ''Conditions related to ME/CFS' news and research' started by Andy, Dec 1, 2021.

  1. Andy

    Andy Committee Member

    Messages:
    22,411
    Location:
    Hampshire, UK
    ABSTRACT

    Background
    Fibromyalgia (FM) is associated with sexual dysfunction, though much less is known about the sexual desire, and especially dyadic and solitary sexual desire, among women with fibromyalgia.

    Aim

    To investigate on the one hand the global sexual desire, the dyadic sexual and solitary sexual desire, and on the other hand the association with depressive symptoms, fibromyalgia symptoms and medication use among women with fibromyalgia in Flanders, Belgium.

    Methods

    An online survey was spread through the Flemish league for Fibromyalgia Patients to be completed by women with fibromyalgia. The sexual desire inventory-2 (SDI-2) was used to measure sexual desire (global, dyadic, solitary), the VASFIQ for fibromyalgia symptoms, and the PHQ-2 for depressive symptoms, while also including questions on demographic factors (time since FM, age) and medication usage (antidepressants, pain medication, sleeping medication).

    Main Outcome Measure

    Global sexual desire, dyadic sexual desire and solitary sexual desire were studied in relation to depressive symptoms, medication use and fibromyalgia symptoms.

    Results

    One hundred and three women with FM answered the survey. Depressive symptoms were significantly associated with a lower global, dyadic and solitary sexual desire, as was the use of antidepressant medication. The association between solitary sexual desire and depressive symptoms disappeared when controlled for antidepressant medication. Age, fibromyalgia symptoms nor time since diagnosis were significantly associated with any form of sexual desire.

    Conclusion

    Depressive symptoms and antidepressant medication, and not fibromyalgia symptoms, were associated with decreased sexual desire of women with FM. As antidepressant medication and depressive symptoms are associated with a decreased sexual desire, more attention should be paid towards the mental health issues associated with fibromyalgia, as well as the prescription of antidepressant medication. This study is the first to investigate sexual desire among women with fibromyalgia in Flanders, and one of the few internationally to have done so. It is limited by its cross-sectional design, and for not providing information on men with FM.

    Open access, https://www.smoa.jsexmed.org/article/S2050-1161(21)00137-9/fulltext
     
  2. Blueskytoo

    Blueskytoo Senior Member (Voting Rights)

    Messages:
    155
    Is it just me, or does there seem to be a whole slew of fibro/psych/women interaction studies at the moment? Could fibro be one of the new battlegrounds, along with LC, for the BPS cabal now that they’ve lost the fight over ME, perchance?
     
  3. rvallee

    rvallee Senior Member (Voting Rights)

    Messages:
    13,012
    Location:
    Canada
    Yes, sick people, famous for having lots of sex. Could have been informative if they had asked about sexual habits and whether they are affected by their being ill. But that would have been informative and would not have allowed to opine about how sick people with a broken sexual life have less sex: it's because they're moody, of course that's why, can't possibly be because they're sick because the researchers don't believe they are and are therefore studying their own interpretation of reality.

    Research detached from context is just pointless. They don't accept the context, making everything that follows useless. Like asking people experiencing a famine why they're not eating and just refusing to consider the context of... you know... the freaking famine.
     
    Chezboo, oldtimer, DokaGirl and 12 others like this.
  4. CRG

    CRG Senior Member (Voting Rights)

    Messages:
    1,860
    Location:
    UK
    Too early for research prompted by the NICE outcome to be being published. I think researchers across a number of fields would probably say that the impact of illness and disability on sexual function has been a neglected area and that needs to change, it's inevitable that there would be a gender split in research approaches.

    In this particular case it would have been clinically interesting if the reported dysfunction had been shown to be associated with physical status rather than mental health status. Nevertheless the results are helpful because they suggest where additional support or changes in medication might help patients and are likely less worrisome than some arcane effect of FM physiopathology. Changes in desire and/or capacity can have a major impact on the very relationships that a chronically ill person most needs to maintain in good health, as such it's area of health worth investing in.
     
  5. Hutan

    Hutan Moderator Staff Member

    Messages:
    28,022
    Location:
    Aotearoa New Zealand
    Yeah, I think CRG's right. I was thinking 'here, we go' when I read the title, but actually, the conclusions I drew were, 'be careful about the use of anti-depressants in fibromyalgia, as they may have unhelpful effects, and maybe depressive symptoms related to this chronic illness can be managed better without them' and 'with the level of fibromyalgia symptoms not being related to sexual desire, there's no good reason to apply any Freudian sort of nonsense to women diagnosed with the condition'.

    I haven't read the full study, cos, well, other things to do. But, I didn't think the abstract was bad.
     
    Last edited: Dec 1, 2021
    DokaGirl, Tia, Peter Trewhitt and 7 others like this.
  6. Lilas

    Lilas Senior Member (Voting Rights)

    Messages:
    364
    Location:
    Canada
    It reminds me of a neurologist I consulted at the start of my ME. He knew that I had chronic generalized pain, among other symptoms. Well, he urged me, not without boldness, to have a more active sex life :jawdrop: (without knowing anything about my privacy !), because that would lessen my pain (and implying that it would almost cure me !). He was clearly satisfied with the benefits of his own sex life (being his first Monday morning patient) so much, that I was worried he would end up giving me details. Needless to say I was shocked at such a lack of understanding of the impact a disease like ours has on all areas of our lives.
     
    Ash, Tia, ukxmrv and 8 others like this.
  7. 5vforest

    5vforest Senior Member (Voting Rights)

    Messages:
    201
    Location:
    San Francisco, CA
    Is this a gendered thing? It really seems like it. I can't recall one time a doctor has asked me (male) about my sex life. (in relation to my illness)
     
    Chezboo, lunarainbows, Ash and 10 others like this.
  8. hibiscuswahine

    hibiscuswahine Senior Member (Voting Rights)

    Messages:
    483
    That’s a lot of study and not matched with aged controls. They seem to have a psychological model for FM (depressive origin). They even found the obvious, the more pain the less likely you have sexual desire and antidepressants make it worse.

    Problems with pain in all chronic illnesses can have big impacts on relationships in many people. Might be useful for education of partners.

    In mental health I did ask people about their libido as it is a common symptom of depression, often can be very distressing and often get’s partner’s bringing them to their GP for investigation. I didn’t ask any more than than that as they would normally volunteer this was a problem but I would also inform them of the likely sexual SE’s of the medication.
     
    ukxmrv, Amw66, Peter Trewhitt and 3 others like this.
  9. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    6,537
    I havnt read the paper so could be off track but could the antidepressants not be being primarily used for neuropathic pain?
     
    Hutan and Peter Trewhitt like this.
  10. Hutan

    Hutan Moderator Staff Member

    Messages:
    28,022
    Location:
    Aotearoa New Zealand
    Yes, they could be (although I don't think the paper talked about that). There was quite a high use of anti-depressants among women who did not qualify for a depression diagnosis according to the screening questionnaire.

    Screen Shot 2021-12-02 at 6.12.25 PM.png
    So, maybe the anti-depressants are being used to control pain. And/or maybe the depression questionnaire isn't very accurate at diagnosing depression. And/or doctors just assume women with fibromyalgia are depressed and need anti-depressants.
     
  11. Amw66

    Amw66 Senior Member (Voting Rights)

    Messages:
    6,537
    I would guess the latter option ....
     
  12. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    3,664
    :thumbup: and :laugh:
     
    alktipping, Chezboo, oldtimer and 2 others like this.
  13. hibiscuswahine

    hibiscuswahine Senior Member (Voting Rights)

    Messages:
    483
    Sometimes people are offered a trial of antidepressants for other depressive disorders not just MDD (Major Depressive Disorder), e.g. Dysthymic Disorder, many antidepressants work on pain pathways e.g. tricyclic antidepressants like low dose nortriptyline have good effect. Many people use them for pain and sleep and once used to the side effects, hopefully after a few days/week or so are very pleased with the outcome in my clinical experience.

    There have been some trials of moclobemide with FM that have shown some effects for people fulfilling criteria for these disorders but does not work on pwFM without psych disorder. It is up to the patient to decide if they want a trial it is not an assumption that they don’t have a genuine medical illness.

    Unfortunately, this female with pain trope is as embedded as anxious housewives needing benzo’s in the 60’s. Now they have thought up CSS, this Central Sensitisation Syndrome, which also has stigmatising effects.
     
    Wyva, Michelle, DokaGirl and 5 others like this.
  14. NelliePledge

    NelliePledge Moderator Staff Member

    Messages:
    13,959
    Location:
    UK West Midlands
    Is there any actual evidence that anti depressants SSRIs Tricyclics work in Fibro tho. I think people should absolutely get pain relief. HowI question whether given the significant sedation effects possible interactions and difficulty getting off these medications they are appropriate as a standard approach.
     
    Michelle, DokaGirl, oldtimer and 2 others like this.
  15. Mij

    Mij Senior Member (Voting Rights)

    Messages:
    8,796
    HRT and antidepressants are the only treatments available for menopause.
     
    Michelle, DokaGirl and Peter Trewhitt like this.
  16. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    Messages:
    3,664
    Yes....we haven't really come a long way....
     
  17. shak8

    shak8 Senior Member (Voting Rights)

    Messages:
    2,309
    Location:
    California
    Anti-depressants (milnacipran--FDA approved for FM, and amyltriptylline) are used to treat FM pain, a first-line treatment, not because FM patients are depressed but rather the anti-depressants can dampen pain sensations. But not in all patients.

    Now because of the anti-opioid prescribing guidelines in the US, we are back to anti-depressant use uber alles for FM pain.

    The FDA approved drugs for FM pain (Cymbalta--pregabalin; Savella--milnacipran; etc) are not that useful in the majority of patients from the studies I've read. A lot of discontinuation due to weight gain and other side effects plus not much reduction (if any) in pain.

    Opioids are not the ideal drug either, so back to the drawing board.
     
  18. CRG

    CRG Senior Member (Voting Rights)

    Messages:
    1,860
    Location:
    UK
    There's certainly some evidence to support SSRI use in pain management, though there appears to be different pain reducing effects depending which particular drug is used https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947493/

    There is said to be (by online unreferenced sources !) a lot of difference between SSRI's in terms of sedating effect; it is something that can be managed by taking the pill at night, and for those with sleep problems it can be actively helpful.

    As far as getting off SSRI's there is a problem for some people, the following paper suggests around a quarter will experience some kind of problem - but then no long term pain killers are risk free so it's a lottery around what helps and what is a source of subsequent problems. https://sci-hub.se/10.1192/bjp.2019.269
     
    alktipping and Peter Trewhitt like this.

Share This Page