Dovepress Rosa damascena oil for male SSRl-induced sexual dysfunction might have emerged because of other latent but unassessed 9.Kanfer FH,Reinecker H,Schmelzer D.[Self-management therapy: a textbook for clinical practicel.Selbstmanagement-Therapie:Ein psychological or physiological variables,which might have Lehrbuch fuir die klinische Praxis.5th ed.New York:Springer; biased two or more dimensions in the same direction.Fifth 2012. we relied on patients'self-ratings;this might be considered 10.Mota-Pereira J,Silverio J,Carvalho S,Ribeiro JC,Fonte D,Ramos J. Moderate exercise improves depression parameters in treatment- a limitation with regard to symptoms of depression,although resistant patients with major depressive disorder./Psychiatr Res.2011: the assessment of sexual function does commonly rely on 45(8):1005-1011. 11.Cooney GM,Dwan K,Greig CA,et al.Exercise for depression. self-ratings.However,future research should also include Cochrane Database Syst Rev.2013:9:CD004366. experts'ratings of symptoms of depression and global clinical 12.Mura G.Moro MF.Patten SB.Carta MG.Exercise as an add-on strategy impression.Sixth,other depression-related symptoms,such for the treatment of major depressive disorder:a systematic review. CNS Spectr.2014:19(6):496-508. as cognitive performance and psychosocial interaction,along 13.Stanton R,Happell B,Haymann M,Reaburn P.Exercise interventions with traits such as social attractiveness,"should be assessed. for the treatment of affective disorders-research to practice.Front Psychiatry.2014:5:46. Seventh,future studies might employ a more fine-grained and 14.Haghighi M,Salehi I,Erfani P,et al.Additional ECT increases BDNF- broader data collection approach with respect to patients'self- levels in patients suffering from major depressive disorders compared ratings and experts'ratings to allow detection of more subtle to patients treated with citalopram only.J Psychiatr Res.2013:47: 908-915. psychological changes.Last,given the strong associations 15.Kellner CH,Greenberg RM,Murrough JW,Bryson EO,Briggs MC. between depressive symptoms and sleep,future studies on Pasculli RM.ECT in treatment-resistant depression.Am /Psychiatry 2012:16912):1238-1244. this topic might also assess sleep patterns. 16.Ludka FK.Zomkowski AD.Cunha MP,et al.Acute atorvastatin treatment exerts antidepressant-like effect in mice via the L-argi- Conclusion nine-nitric oxide-cyclic guanosine monophosphate pathway and increases BDNF levels.Eur Neuropsychopharmacol.2013:23(5): Evidence from this double-blind,randomized,and placebo- 400-412. controlled clinical trial shows that the administration of 17.Hasler G.Pathophysiology of depression:do we have any solid evidence of interest to clinicians?World Psychiatry.2010:9(3): R.damascena oil improved sexual dysfunction in male 155-161. patients suffering from both MDD and SSRI-I SD. 18.Bauer M,Pfennig A,Severus E,Whybrow PC,Angst J,Moller HJ; World Federation of Societies of Biological Psychiatry,Task Force on Unipolar Depressive Disorders.World Federation of Societies of Acknowledgments Biological Psychiatry (WFSBP)guidelines for biological treatment The present work is the doctoral thesis of Mehdi Shirzadifar. of unipolar depressive disorders,part 1:update 2013 on the acute and continuation treatment of unipolar depressive disorders.World./Biol We thank Gioia Schultheiss for text editing and Nick Emler Psychiatry.2013:145):334-385. (University of Surrey,UK)for proofreading the manuscript. 19.Hashimoto K.Emerging role of glutamate in the pathophysiology of major depressive disorder.Brain Res Rev.2009:61(2):105-123. 20.Castren E.Is mood chemistry?Nature Reviews Neuroscience.2005: Disclosure 6(3):241-246. The authors declare no conflicts of interest in this work 21.Cassano P,Fava M.Depression and public health-an overview. JPsychosom Res.2002:53(4):849-857. 22.Reichenpfader U,Gartlehner G,Morgan LC,et al.Sexual dysfunction References associated with second-generation antidepressants in patients with major 1.Josefsson T,Lindwall M.Archer T.Physical exercise intervention in depressive disorder:results from a systematic review with network depressive disorders:meta-analysis and systematic review.Scand./Med meta-analysis.Drug Saf.2014;37(1):19-31. Sci Sports.2014:242):259-272. 23.Graf H,Walter M,Metzger CD,Abler B.Antidepressant-related sexual 2.Murray CJ,Lopez AD.Global mortality,disability,and the contribu- dysfunction-perspectives from neuroimaging.Pharmacol Biochem tion of risk factors:global burden of disease study.Lancet.1997: Behav.2014:121:138-145. 349(90631436-1442. 24.Clark MS,Jansen K,Bresnahan M.Clinical inquiry:How do antide- 3.Johannes CB,Clayton AH,Odom DM,et al.Distressing sexual prob- pressants affect sexual function?JFam Pract.2013:62(11):660-661 lems in United States women revisited:prevalence after accounting for 25.Clayton AH,El Haddad S,Iluonakhamhe JP,Ponce Martinez C. depression.JClin Psychiarry.2009:70(12):1698-1706. Schuck AE.Sexual dysfunction associated with major depressive 4.Bonierbale M,Lancon C,Tignol J.The ELIXIR study:evaluation of disorder and antidepressant treatment.Expert Opin Drug Saf.2014; sexual dysfunction in 4557 depressed patients in France.Curr Medl Res 13(10:1361-1374. Opin.2003:192):114-124. 26. Rosen RC,Lane RM,Menza M.Effects of SSRIs on sexual function: 5.Angst J.Sexual problems in healthy and depressed persons.Int Clin a critical review.J Clin Psychopharmacol.1999:19(1):67-85 Psychopharmacol.1998:13(Suppl 6):S1-S4. 27.Serretti A,Chiesa A.Treatment-emergent sexual dysfunction related to 6.Kennedy SH,Rizvi S.Sexual dysfunction,depression,and the impact antidepressants:a meta-analysis.Clin Psychopharmacol.2009:29(3): of antidepressants.J Clin Psychopharmacol.2009:29(2):157-164. 259-266. 7.Clayton AH.El Haddad S,Iluonakhamhe JP,Ponce Martinez C. 28. Garlehner G,Hansen R,Thieda P,et al.Comparative Effectiveness of Schuck AE.Sexual dysfunction associated with major depres- Second-Generation Antidepressants in the Pharmacologic Treatment sive disorder and antidepressant treatment.Expert Opin Drug Saf. of Adult Depression:Comparative Effectiveness Review Number 7. 2014:13(10):1361-1374. Rockville:Agency for Healthcare Research and Quality.2007. 8.Grawe K.[Neuropsychotherapy].Neuropsychotherapie.Gottingen: Available at:www.effectivehealthcare.ahrq.gov/ehc/products/7/59/ Hogrefe:2004. Antidepressants_Final_Report.pdf.Accessed:March 5,2012. Neuropsychiatric Disease and Treatment 2015:II submit your 633 DovepressNeuropsychiatric Disease and Treatment 2015:11 submit your manuscript | www.dovepress.com Dovepress Dovepress 633 Rosa damascena oil for male SSRI-induced sexual dysfunction might have emerged because of other latent but unassessed psychological or physiological variables, which might have biased two or more dimensions in the same direction. Fifth, we relied on patients’ self-ratings; this might be considered a limitation with regard to symptoms of depression, although the assessment of sexual function does commonly rely on self-ratings. However, future research should also include experts’ ratings of symptoms of depression and global clinical impression. Sixth, other depression-related symptoms, such as cognitive performance and psychosocial interaction, along with traits such as social attractiveness,41 should be assessed. Seventh, future studies might employ a more fine-grained and broader data collection approach with respect to patients’ self￾ratings and experts’ ratings to allow detection of more subtle psychological changes. Last, given the strong associations between depressive symptoms and sleep, future studies on this topic might also assess sleep patterns. Conclusion Evidence from this double-blind, randomized, and placebo￾controlled clinical trial shows that the administration of R. damascena oil improved sexual dysfunction in male patients suffering from both MDD and SSRI-I SD. Acknowledgments The present work is the doctoral thesis of Mehdi Shirzadifar. We thank Gioia Schultheiss for text editing and Nick Emler (University of Surrey, UK) for proofreading the manuscript. Disclosure The authors declare no conflicts of interest in this work. References 1. Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: meta-analysis and systematic review. Scand J Med Sci Sports. 2014;24(2):259–272. 2. Murray CJ, Lopez AD. Global mortality, disability, and the contribu￾tion of risk factors: global burden of disease study. Lancet. 1997; 349(9063):1436–1442. 3. Johannes CB, Clayton AH, Odom DM, et al. Distressing sexual prob￾lems in United States women revisited: prevalence after accounting for depression. J Clin Psychiatry. 2009;70(12):1698–1706. 4. Bonierbale M, Lançon C, Tignol J. The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France. Curr Medl Res Opin. 2003;19(2):114–124. 5. Angst J. Sexual problems in healthy and depressed persons. Int Clin Psychopharmacol. 1998;13(Suppl 6):S1–S4. 6. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. 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Exercise as an add-on strategy for the treatment of major depressive disorder: a systematic review. CNS Spectr. 2014;19(6):496–508. 13. Stanton R, Happell B, Haymann M, Reaburn P. Exercise interventions for the treatment of affective disorders – research to practice. Front Psychiatry. 2014;5:46. 14. Haghighi M, Salehi I, Erfani P, et al. Additional ECT increases BDNF￾levels in patients suffering from major depressive disorders compared to patients treated with citalopram only. J Psychiatr Res. 2013;47: 908–915. 15. Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli RM. ECT in treatment-resistant depression. Am J Psychiatry. 2012;169(12):1238–1244. 16. Ludka FK, Zomkowski AD, Cunha MP, et al. Acute atorvastatin treatment exerts antidepressant-like effect in mice via the L-argi￾nine-nitric oxide-cyclic guanosine monophosphate pathway and increases BDNF levels. Eur Neuropsychopharmacol. 2013;23(5): 400–412. 17. Hasler G. 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Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf. 2014;37(1):19–31. 23. Graf H, Walter M, Metzger CD, Abler B. Antidepressant-related sexual dysfunction – perspectives from neuroimaging. Pharmacol Biochem Behav. 2014;121:138–145. 24. Clark MS, Jansen K, Bresnahan M. Clinical inquiry: How do antide￾pressants affect sexual function? J Fam Pract. 2013;62(11):660–661. 25. Clayton AH, El Haddad S, Iluonakhamhe JP, Ponce Martinez C, Schuck AE. Sexual dysfunction associated with major depressive disorder and antidepressant treatment. Expert Opin Drug Saf. 2014; 13(10):1361–1374. 26. Rosen RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19(1):67–85. 27. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3): 259–266. 28. Garlehner G, Hansen R, Thieda P, et al. Comparative Effectiveness of Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: Comparative Effectiveness Review Number 7. Rockville: Agency for Healthcare Research and Quality. 2007. Available at: www.effectivehealthcare.ahrq.gov/ehc/products/7/59/ Antidepressants_Final_Report.pdf. Accessed: March 5, 2012