***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A triple-blind ( investigator , patient , statistician ) , r and omized , placebo-controlled , trial of Ginkgo biloba 240 mg daily was carried out . Following a 1-week control , it was given to 24 patients with sexual impairment due to antidepressant drugs . Efficacy analysis was carried out on eight males and five females on placebo and six males and five females on Ginkgo , completing the full 12 weeks of treatment . Not included were three subjects who dropped out after 6 weeks . A vali date d , sex (gender)-orientated question naire was recorded at - 1 , 0 , 1 , 3 , 6 , 9 and 12 weeks , and a non-blind follow-up for a further 6-weeks on Ginkgo .  Hamilton anxiety and depression ratings were made at 0 , 6 and 12 weeks and simple global assessment s of alertness and memory . There were some spectacular individual responses in both groups , but no statistically significant differences , and no differences in side-effects Fifty partial and non-responders ( Clinical Global Impression-Sexual Function ( CGI-SF ) score>2 ) , out of 76 men who completed a 6-week , double-blind , placebo-controlled trial of sildenafil treatment for serotonergic antidepressant – associated sexual dysfunction , were eligible for an additional 6-week trial of open-label sildenafil ( 50 mg adjustable to 100 mg ) under the same protocol , with blind maintained to initial assignment . Participation ( double-blind and open-label ) required major depressive disorder in remission ( MDD-R ) and continuing antidepressant medication . Forty-three entered open-label study : 16/17 initially r and omized to sildenafil ( sildenafil/sildenafil ) and 27/33 initially r and omized to placebo ( placebo/sildenafil ) . Thirty-five of 43 ( 81 % ) achieved full response ( CGI-SF⩽2 ) : placebo/sildenafil 23/27 ( 85 % ) ; sildenafil/sildenafil 12/16 ( 75 % ) ; P<0.0001 for changes and P=0.4 between groups . Secondary measures of erectile function and overall satisfaction improved in both groups ( P<0.03 ) . Hamilton Depression Rating Scale scores improved ( placebo/sildenafil ; P⩽0.05 ) or remained stable ( sildenafil/sildenafil ) . In men with MDD-R who maintained antidepressant adherence , 81 % of double-blind partial and non-responders treated with open-label sildenafil responded fully BACKGROUND Sexual side effects are among the common reasons patients discontinue selective serotonin reuptake inhibitors ( SSRIs ) . While many antidotes have been proposed , few have been subjected to double-blind trials . Some evidence has suggested that bupropion may be an effective antidote for SSRI-induced sexual dysfunction . In this double-blind trial , the efficacy of a st and ard dose of bupropion sustained release ( SR ) is evaluated in the treatment of SSRI-induced sexual dysfunction . METHOD Patients with a history of SSRI-induced sexual side effects were r and omly assigned to adjunctive treatment with either bupropion SR 150 mg daily or placebo for 6 weeks . Assessment s of sexual function and interest included the Arizona Sexual Experiences Scale ( ASEX ) , Brief Index of Sexual Functioning , and a 10-point visual analogue scale . Efficacy was defined as a 50 % improvement on the ASEX at the end of 6 weeks . Data were collected from January 1999 to March 2001 . RESULTS Forty-one patients entered the study and completed the 6-week trial . No significant differences were seen between placebo and bupropion SR on the ASEX or on any measure of sexual functioning at the end of the trial . CONCLUSION A fixed dose of 150 mg/day of bupropion SR taken in the morning does not appear to be effective in the treatment of SSRI-induced sexual dysfunction . Additional trials will be required to define what role , if any , bupropion might have in the treatment of SSRI-induced sexual side effects Rationale Saffron ( Crocus sativus L. ) has shown aphrodisiac effects in some animal and human studies . Objectives To assess the efficacy and tolerability of saffron in fluoxetine-related sexual dysfunction . Methods This was a 4-week r and omized double-blind placebo-controlled study . Thirty-six married male patients with major depressive disorder whose depressive symptoms had been stabilized on fluoxetine and had subjective complaints of sexual impairment entered the study . The patients were r and omly assigned to saffron ( 15 mg twice per day ) or placebo for 4 weeks . International Index of Erectile Function scale was used to assess sexual function at baseline and weeks 2 and 4 . Results Thirty patients finished the study . Baseline characteristics as well as baseline and final depressive symptoms scores were similar between the two groups . Effect of time × treatment interaction on the total score was significant [ Greenhouse – Geisser-corrected , F ( 1.444 , 40.434 ) = 6.154 , P = 0.009 ] . By week 4 , saffron result ed in significantly greater improvement in erectile function ( P < 0.001 ) and intercourse satisfaction domains ( P = 0.001 ) , and total scores ( P < 0.001 ) than the placebo group . Effect of saffron did not differ significantly from that of  placebo in orgasmic function ( P = 0.095 ) , overall satisfaction ( P = 0.334 ) , and sexual desire ( P = 0.517 ) domains scores . Nine patients ( 60 % ) in the saffron group and one patient ( 7 % ) in the placebo group achieved normal erectile function ( score > 25 on erectile function domain ) at the end of the study ( P value of Fisher ’s exact test = 0.005 ) . Frequency of side effects were similar between the two groups . Conclusions Saffron is a tolerable and efficacious treatment for fluoxetine-related erectile dysfunction Erectile dysfunction ( ED ) and depression are highly prevalent and frequently comorbid . Sildenafil effectively treats ED in men with depression and in men taking antidepressants . We evaluated the efficacy of sildenafil in men with depression in remission and ED . Patients with a history of ED when major depressive disorder ( MDD ) was diagnosed , which persisted after MDD was treated to remission , were r and omized to 12 weeks of treatment with sildenafil ( 50 mg , flexible ) or placebo .  Efficacy was assessed using intercourse success rates , a global efficacy question ( Has treatment improved your erections ? ) , the International Index of Erectile Function ( IIEF ) and Life Satisfaction Checklist ( LSC ) . By week 12 , intercourse success rates were significantly higher among sildenafil- ( 74 % ) compared to placebo-treated patients ( 29 % ; P=0.0001 ) . About 83 % and 34 % of sildenafil- and placebo-treated patients , respectively , reported improved erections ( odds ratio=9.4 , P=0.0001 ) . IIEF scores in the sildenafil group ( n=83 ) were significantly improved compared to those in the placebo group ( n=85 ; P < 0.0001 ) . LSC sexual life item improved significantly among sildenafil- versus placebo-treated patients . The most frequently reported adverse events were transient and mild-to-moderate .  Sildenafil is an effective and well-tolerated treatment for ED in patients with a history of ED at the time of MDD diagnosis , and which persisted after the MDD was treated to remission BACKGROUND The efficacy , tolerability , and effects on sexual function and satisfaction of nefazodone and sertraline were compared in a multicenter , r and omized , double-blind , parallel-group study in out patients with major depression . METHOD One hundred sixty patients , 18 years of age or older , who met DSM-III-R criteria for single or recurrent nonpsychotic major depressive episodes were r and omly assigned to 6 weeks of treatment with either nefazodone ( 100 - 600 mg/day ) or sertraline ( 50 - 200 mg/day ) . Symptoms were assessed before and during treatment using the 17-item Hamilton Rating Scale for Depression ( HAM-D-17 ) , Clinical Global Impressions ( CGI ) Improvement scale , the CGI Severity of Illness scale , and a sexual function question naire . RESULTS Of 143 patients evaluable for efficacy , 72 received sertraline and 71 received nefazodone . The mean modal daily dose at endpoint was 148 mg for sertraline and 456 mg for nefazodone . Analysis of efficacy measures ( HAM-D-17 and CGI ) showed consistent and comparable improvement in symptoms of depression for both treatment groups . Sertraline had negative effects on sexual function and satisfaction in both men and women , and nefazodone had no adverse effect on sexual well-being . Safety assessment s based on adverse events , vital sign measurements , electrocardiographs , physical examinations , and clinical laboratory tests revealed no serious adverse events or organ toxicity associated with nefazodone or sertraline administration . CONCLUSION Nefazodone and sertraline are well tolerated , and there was no statistically significant difference in their antidepressant activity .  Sertraline treatment has negative effects on sexual function and performance in both sexes , while nefazodone has none . These findings may have clinical implication s when choosing antidepressant therapy CONTEXT Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in premature medication treatment discontinuation and for which no treatment has demonstrated efficacy in women . OBJECTIVE To evaluate the efficacy of sildenafil for sexual dysfunction associated with selective and nonselective serotonin reuptake inhibitors ( SRIs ) in women . DESIGN , SETTING , AND PARTICIPANTS An 8-week prospect i ve , parallel-group , r and omized , double-blind , placebo-controlled clinical trial conducted between September 1 , 2003 , and January 1 , 2007 , at 7 US research centers that included 98 previously sexually functioning , premenopausal women ( mean [ SD ] age 37.1 [ 6 ] years ) whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction . INTERVENTION Forty-nine patients were r and omly assigned to take sildenafil or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity . MAIN OUTCOME MEASURES The primary outcome measure was the mean difference in change from baseline to study end ( ie , lower ordinal score ) on the Clinical Global Impression sexual function scale . Secondary measures included the Female Sexual Function Question naire , the Arizona Sexual Experience scale-female version , the University of New Mexico Sexual Function Inventory-female version , a sexual activity event log , and the Hamilton Depression Rating scale . Hormone levels were also assessed . RESULTS In an intention-to-treat analysis , women treated with sildenafil had a mean Clinical Global Impression-sexual function score of 1.9 ( 95 % confidence interval [ CI ] , 1.6 - 2.3 ) compared with those taking placebo ( 1.1 ; 95 % CI , 0.8 - 1.5 ) , with a mean end point difference of 0.8 ( 95 % CI , 0.6 - 1.0 ; P = .001 ) . Assigning baseline values carried forward to the 22 % of patients who prematurely discontinued result ed in a mean end point in the sexual function score of 1.5 ( 95 % CI , 1.1 - 1.9 ) among women taking sildenafil compared with 0.9 ( 95 % CI , 0.6 - 1.3 ) among women taking placebo with a mean end point difference of 0.6 ( 95 % CI , 0.3 - 0.8 ; P = .03 ) . Baseline endocrine levels were within normal limits and did not differ between groups . The mean ( SD ) Hamilton scores for depression remained consistent with remission in both groups ( 4.0 [ 3.6 ] ; P = .90 ) . Headache , flushing , and dyspepsia were reported frequently during treatment , but no patients withdrew because of serious adverse effects . CONCLUSION In this study population , sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00375297 To evaluate the possible influence of buspirone on sexual dysfunction in depressed patients treated with a selective serotonin reuptake inhibitor ( SSRI )  , we analyzed data from a placebo-controlled trial design ed to explore the efficacy of buspirone as add-on treatment for patients not responding to an SSRI alone . At baseline , all patients met the criteria for a major depressive episode according to DSM-IV and had received citalopram or paroxetine during a minimum of 4 weeks without responding to the treatment .  Buspirone ( flexible dosage , 20 - 60 mg/day ) or placebo was added to the SSRI for 4 weeks ; the mean daily dose of buspirone at endpoint was 48.5 mg ( SD = 1.0 ) . Sexual dysfunction was evaluated using a structured interview . Before starting medication with buspirone or placebo , 40 % ( 47 of 
    Output:
    
For women it remains uncertain whether sildenafil is more effective than placebo .
Data from three studies in men and women of bupropion 150 mg twice daily indicate a benefit over placebo on rating scale scores ( SMD 1.60 , 95 % CI 1.40 to 1.81 ) , but response rates in two studies of bupropion 150 mg once daily demonstrated no statistically significant difference in effect ( RR 0.62 , 95 % CI 0.09 to 4.41).Other augmentation strategies failed to demonstrate significant improvements in sexual dysfunction compared with placebo .
For men with antidepressant-induced erectile dysfunction , the addition of sildenafil or tadalafil appears to be an effective strategy .
For women with antidepressant-induced sexual dysfunction the addition of bupropion at higher doses appears to be the most promising approach studied so far