AN52(2)46-60 - ACTIVITAS NERVOSA SUPERIOR Activitas Nervosa...

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Activitas Nervosa Superior 2010; 52 :2,46-60 46 S EXUAL D ISORDERS C AUSED BY A NTIDEPRESSANTS : C ONSIDERATIONS IN THE C ONTEXT OF B RAIN H EMISPHERE F UNCTIONS Vadim S. Rotenberg* Tel-Aviv University, Bat-Yam, Israel Received February 10, 2010; accepted February 24, 2010 Abstract All phases of normal sexual activity are under the control of the right hemisphere coupled with limbic structures, and depression is characterized by the functional insufficiency of this system. At the same time, those modern antidepressants that cause sexual disorders are activating the left hemisphere and determine its domination on the expense of the right one and disturb free and spontaneous emotional interrelationships, sexual behavior and pleasure. Those antidepressants that do not cause sexual dysfunction are not activating predominantly the left hemisphere structures and activate the lim- bic brain zones responsible for reward, reinforcement and emotional excitement. Key words: Antidepressants; Brain Hemispheres; Sexual Dysfunction The aim of this theoretical review is to reconsider the mechanisms of sexual disorders caused by the most common antidepressants by taking into consideration the interrelationships between the left and the right he- misphere and their role in different phases of sexual activity. I will start with this topic and afterward turn to the antidepressants that cause and do not cause sexual disorders. BRAIN MECHANISMS OF SEXUAL ACTIVITY There are four consecutive phases of normal sexual ac- tivity: sexual excitation (arousal), plateau, orgasm and resolution. Each phase is characterized by the specific combination of activation and deactivation of brain structures. Some of these patterns are similar and some are different in men and women. Orgasm is a peak of sexual experience. According to Georgiadis et al. (2009) in both genders orgasm is cha- racterized by the functional activation of anterior lobe of the cerebellar vermis and deep cerebellar nuclei as well as pontine tegmentum, and deactivation of the left dorsolateral, ventromedial anterior orbitofrontal cortex and temporal lobe. In comparison to clitorial stimula- tion in women when orgasm has to be avoided, orgasm is characterized by the relative decrease of cortical blood flow (rCBF) in the left lateral orbitofrontal cor- tex, inferior temporal gyrus and anterior temporal pole (Georgiadis et al., 2006). In comparison to the rest state, orgasm is characterized by decreased rCBF in ventro – and posterolateral parts of the left temporal lobe, left amygdala and right anterior temporal pole, and by in- creased blood flow in central sulcus (a primary somato- sensory cortex), in primary motor cortex, in deep cere- bellar nuclei and in adjacent anterior lobe of vermis. In comparison to sexual stimulation of erotic zones, or- gasm is characterized by an increase of rCBF in the left deep cerebellar nuclei and by decrease of blood flow in the left lateral orbito-frontal cortex, left ventrolateral
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This note was uploaded on 03/08/2011 for the course CLINICAL P 2010 taught by Professor Actnervsuper during the Spring '11 term at The Chicago School of Prof. Psychology.

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AN52(2)46-60 - ACTIVITAS NERVOSA SUPERIOR Activitas Nervosa...

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