To describe and compare the reporting patterns and signal strengths of male sexual dysfunction associated with six commonly prescribed SSRIs in the FDA Adverse Event Reporting System. Adverse event data for six representative SSRIs, fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram, were retrieved from the FAERS database, spanning from the first quarter of 2004 to the first quarter of 2025. Disproportionality analysis was conducted using both the reporting odds ratio (ROR) and proportional reporting ratio (PRR) to identify potential signals of adverse drug events associated with these medications. We analyzed 6,631,746 adverse drug event reports associated with SSRIs and detected significant disproportionality signals indicative of male sexual dysfunction in patients with depression. Across all SSRIs, erectile dysfunction was the most commonly reported adverse event [fluoxetine (ROR: 4.97, 95%CI: 4.25-5.82), paroxetine (ROR: 3.99, 95%CI: 3.53-4.5), sertraline (ROR: 6.11, 95%CI: 5.53-6.75), fluvoxamine (ROR: 1.08, 95%CI: 0.35-3.36), citalopram (ROR: 7.7, 95%CI: 6.81-8.69), and escitalopram (ROR: 7.93, 95%CI: 6.99-8.99)], followed by sexual dysfunction [fluoxetine (ROR: 11.94, 95%CI: 10.01-14.23), paroxetine (ROR: 11.39, 95%CI: 10.05-12.91), sertraline (ROR: 13.34, 95%CI: 11.86-15.01), fluvoxamine (ROR: 9.64, 95%CI: 5.01-18.56), citalopram (ROR: 15.09, 95%CI: 12.98-17.54), and escitalopram (ROR: 16.42, 95%CI: 14.11-19.12)]. This FAERS analysis detected significant disproportionality signals for male sexual dysfunction across SSRIs. Signal variation reflects reporting differences, not comparative risk, due to database limitations. These findings highlight the need for clinical vigilance and further investigation.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression and anxiety, yet response rates remain suboptimal. Clinically accessible predictors of treatment outcome are therefore needed to guide decision-making in routine care. In this analysis, we examined data from a prospective hospital-based cohort of 92 outpatients with depression who initiated escitalopram monotherapy guided by therapeutic drug monitoring. The objective was to determine whether early levels of perceived stress predict subsequent treatment outcomes. Psychometric assessments included the clinician-rated Hamilton Depression (HAMD) and Anxiety (HAMA) Rating Scales and the self-rated Perceived Stress Scale (PSS), collected at baseline, week four, and week eight. Treatment outcomes were defined as absolute and relative changes in HAMD and HAMA scores at week eight, as well as response (≥50% HAMD reduction) and remission (HAMD <8). The week-4 PSS score predicted improvement in depression symptoms at week eight across all measures, independent of demographics, baseline PSS, and symptom severity at baseline or week four. Patients with low week-4 PSS scores (PSS<16) had markedly higher remission rates (22/27) compared to those with high scores (PSS>25), where remission was rare (1/21). The week-4 PSS score was also associated with improvement in anxiety symptoms, although less robust after adjustment for concurrent anxiety severity. Early perceived stress may represent a promising and accessible predictor of SSRI treatment outcomes. As an exploratory analysis, these findings should be considered hypothesis-generating and require replication before clinical implementation. The PSS is adaptable for digital platforms and may support future remote monitoring.

Social anxiety disorder (SAD) frequently co-occurs with major depressive disorder (MDD). We examined the prevalence and clinical correlates of SAD across three heterogeneous MDD cohorts. Secondary analyses were conducted in adult (CO-MED: n=482; GSRD: n=1398) and late-life (IRL-GREY: n=438) patients. SAD was assessed dimensionally (PDSQ) and categorically (MINI; SCID-1). Cohort-specific instruments were used to assess depressive severity (QIDS; MADRS), suicidality (CHRT; MADRS; SIS) and hypomanic symptoms (ASRM; YMRS). In late-life depression, neurocognitive tests were administered. Multivariate models were adjusted for depression and anxiety levels. SAD prevalence varied markedly by samples and diagnostic definitions (CO-MED: 46.7% with PDSQ≥6; 17.0% with PDSQ>12; GSRD: 3.0%; IRL-GREY: 8.7%). Across cohorts, SAD was associated with earlier MDD onset (CO-MED: p<0.001 d=-0.36; GSRD: p=0.014 d=-0.39; IRL-GREY: p=0.002 d=-0.54) and greater anxiety comorbidity (CO-MED: GAD: p<0.001 d=1.24; panic: p<0.001 d=1.29; GSRD: GAD: p<0.001; panic: p<0.001; IRL-GREY: agoraphobia: p<0.001). After controlling for depression and anxiety levels, SAD was linked to higher suicide risk in both adult cohorts (CO-MED: OR 1.04 (1.01-1.08); GSRD: OR 1.29 (1.04-1.64)) and to lower 6-week remission in CO-MED cohort (OR 0.51 (0.29-0.91)). In MDD, SAD has consistent associations with earlier illness onset and anxiety burden, modest associations with suicidality and antidepressant outcomes, and reduced impact in late life.

Depression and anxiety are common during pregnancy, but the prevalence of antidepressant use during pregnancy in Switzerland is not well documented. We explored antidepressant use before, during, and after pregnancy in Switzerland. We conducted a descriptive study using a Swiss health care insurance claims database (Helsana) between 2015 and 2021. We included pregnancies resulting in birth of women who were continuously insured during three 270-day periods: preconceptional, pregnancy, and postpartum. In these periods, we quantified the exposure prevalence to antidepressants overall and stratified by region and use of co-medication. Antidepressants of interest included selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors, Hyperici herba and others. Additionally, we assessed prevalence of antidepressant discontinuation during pregnancy. We included 34,584 pregnancies of whom 1386 (4.0%) were exposed (≥1 claim) to antidepressants preconceptionally, 788 (2.3%) during pregnancy, and 1273 (3.7%) postpartum. Of 1386 women with preconceptional use, 60% had no antidepressant claim during pregnancy. Antidepressant use decreased from 1.6% in trimester one to 1.1% in trimester three. The most frequently dispensed antidepressants during pregnancy were SSRIs (75.0%). Exposure to antidepressants was two-fold higher in the French-speaking region (2.6%) than in Central Switzerland (1.3%). About one-third of women continuing antidepressant treatment during pregnancy also used benzodiazepines (co-medication) at least once during this time. 4 of 100 women in Switzerland took antidepressants before pregnancy, but 60% discontinued treatment when they became pregnant. Since untreated depression in pregnancy may lead to severe long-term consequences for mother and child, this might be of concern.

Addressing social determinants of affective disorders is increasingly recognised as a major priority in mental health. This longitudinal study aimed to examine the effect of neighbourhood social fragmentation on psychological distress among mid-to-older aged (40-65yrs) community dwelling men and women over time. We analysed changes in psychological distress across four time points (2009-2016) using data from HABITAT, a population-representative longitudinal study of adults aged 40-65 in Brisbane, Australia. The analytic sample included 2902 men and 3950 women who completed the Kessler 6 scale. A novel longitudinal neighbourhood social fragmentation index was developed using Australian census data. Sex-specific mixed effects regression models were used to assess associations, adjusting for individual, household, and neighbourhood-level covariates. Men living in more socially fragmented neighbourhoods had higher mean scores of psychological distress (β=0.66, 95% CI: 0.28 to 1.04). The effect of neighbourhood social fragmentation on psychological distress among men was stable over time. A trend of higher distress scores for women occurred as the level of neighbourhood social fragmentation increased, however this was not found to be statistically significant (β=0.25, 95% CI: -0.11 to 0.60). In the context of ageing populations and rising mental health burden, neighbourhood social fragmentation may be a key factor in developing targeted mental health prevention strategies. Our findings suggest differences between men and women in the relationship between neighbourhood social fragmentation and psychological distress; these differences may reflect gendered social experiences. Promoting community cohesion in more socially fragmented areas may help to reduce psychological distress, particularly among men.