Look for Depression in Prostate Cancer Patients With ED

NEW YORK—Mood disorders may play a role in erectile dysfunction (ED) in prostate cancer patients, according to a report at the Pan American Congress of Psychosocial & Behavioral Oncology. Of 10 prostate cancer patients referred for erectile dysfunction and/or a suspected mood disorder, 7 were diagnosed as having depression and 3 were found to have preexisting relationship problems.

The patients were all referred by their primary oncologists to a pilot study conducted by Mary K. Hughes, MS, RN, psychiatric clinical nurse specialist, M.D. Anderson Cancer Center.

In cancer patients with ED, it is important to focus first on potential mood disorders, Ms. Hughes said. She noted that oncologists tend to give Viagra “for just any kind of sexual disorder,” even though the drug will not affect erectile dysfunction when the cause is low libido. “Several studies have shown that the main cause of decreased libido is depression,” she added, “and 25% of patients who survive cancer have depression.”

Assessment of the patients in the pilot study included a physical examination; liver function and electrolytes; a psychiatric diagnostic interview; a battery of psychiatric tests; and an extensive history, including sexual dysfunction and use of drugs, alcohol, and tobacco. Use of these substances, Ms. Hughes noted, “may lead to erectile dysfunction that has nothing to do with patients’ cancer treatment or their depression.”

Treatment of mood disorders in the study patients began with antidepressants selected because they are not linked to erectile dysfunction or low libido. Bupropion (Wellbutrin) and trazodone (Desyrel) were prescribed singly or in combination. Some patients were also given a psychostimulant such as methylphenidate (Ritalin). Psychotherapy counseling was recommended, with partners encouraged to participate as well.

Patients returned for follow-up after 2 weeks. “We evaluated whether we needed to change the antidepressant or change the dose,” Ms. Hughes said. At 6 weeks, another evaluation was performed, with dose adjustment if indicated.

“Mood improved in all patients who took antidepressants,” Ms. Hughes reported, and all responses occurred within 4 weeks of starting therapy.

“We continued to ask about their erectile dysfunction,” she said. Early in the study, alprostadil suppositories (MUSE) were often prescribed initially for patients whose ED continued even as mood improved, but Viagra is now generally the first choice, with a starting dose of 50 mg. In all, 8 patients were prescribed anti-impotence treatment, and 4 achieved erections successful for intercourse.

Although weekly sessions focusing on relationship issues enhanced the treatment of depression, continuing such counseling proved difficult. “When we got to the point where their depression was treated and they were getting some erections,” Ms. Hughes said, “it was very difficult to get them to continue in patient therapy.” She also noted that the patients’ partners were often not interested in counseling.

“The interesting part is that some men came for psychotherapy or counseling because their wives wanted them treated for depression, but once the depression was treated, the wives were not interested in coming to counseling with them to work on sexual problems,” she said.

Since the pilot study, Ms. Hughes and her colleagues have opened a sexuality clinic that operates 1 day a week for cancer patients with any type of dysfunction. “Women are coming in with vaginal dryness or stenosis,” she said. “This pilot project also helped physicians in other areas to be aware that we have a clinic for treating this quality-of-life issue.”