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In the eight randomized clinical trials, the dose of amitriptyline showed an inverse U-shape relationship with the frequency of any SD Figure 2A. Any outcomes that reported the negative impact of sexual function or SD under amitriptyline use were included. A prospective, double-blind, randomized, crossover, pilot phase II trial. SD was significantly correlated with insomnia linearly whereas somnolence and nausea dually. In fact, the presence of a psychiatric disorder may increase the frequency of drug-associated sexual adversity Chen et al. However, amitriptyline associates with a deterioration of sexual function in male patients whereas a trend of improvement was identified in female patients in the current study. In the eight randomized clinical trials, SD was mainly evaluated by the 17-item or 21-item Hamilton Depression Rating Scale HDRS in six studies and self-reporting in another two studies.

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