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In Reply: Dr Harinstein raises concerns that treatment with additional medication such as sildenafil can add to patient adverse effects and cost burdens and suggests further consideration of different management options. Although we agree that no single treatment is definitive, the large number of reports evaluating treatment modalities (including SRI agonists, antagonists, partial agonists, switching, or augmentation, or nonpharmacological approaches such as waiting, drug holiday, or dose reduction) include only a few randomized clinical trials. With the exception of phosphodiesterase type 5 inhibitors,¹ no clinically meaningful and significant data support those treatment modalities, leaving patients at risk for excess random pharmacology.²

Harinstein's concerns about added adverse effects also apply to other pharmacological and nonpharmacological treatment considerations, and these can be as bothersome as those of sildenafil. For example, stimulants can lead to agitation, disturbed sleep, and dependency; bupropion adverse effects include seizures and overactivation; mirtazapine may result in weight gain . . . [Full Text of this Article]

H. George Nurnberg, MD
gnurnberg@salud.unm.edu
Department of Psychiatry
University of New Mexico School of Medicine
Albuquerque

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