We known little about the normalization of psychobiological changes observed in depressive illness as the illness remits. One largely unexplored parameter in depressive illness is sexual function, in general, and nocturnal penile tumescence (NPT), in particular. We have shown that depressed men have significant reductions in NPT time with diminished or absent penile rigidity, findings strongly associated with a complaint of erectile dysfunction during the index depressive episode. Our data suggest that reduced NPT may represent one of the few nocturnal physiologic parameters of depression with waking behavioral correlates. Therefore, we now propose (Study I) to test the hypothesis that the diminished NPT of depression is reversible upon recovery from depression. Our pilot data suggest that this is so. To test this hypothesis definitively, 80 outpatients with RDC major depression will be treated with cognitive behavior therapy (CBT), to avoid the potentially confounding effect of antidepressant medication on both NPT measures and waking sexual function. Data from pre- and post-CBT assessment of sexual function, NPT, and dyadic adjustment will be compared. To develop preliminary information about tricyclic antidepressant effects on these same measures, CBT non-responders (an estimated 40% of the sample, or 32 men) will be treated with imipramine (IMI) and re-assessed behaviorally and polysomnographically while on therapeutic doses of IMI and again following withdrawal of IMI. Using repeated measures ANOVA we will: 1) test the reversibility hypothesis of Study I in CBT responders and 2) assess the stability of NPT abnormalities over time in CBT non-responders. Further, using multiple regression analyses, we will integrate waking and sleeping measures of sexual function to model the combination of physiological, psychological, and interpersonal variables that most efficiently predict recovery from waking erectile dysfunction in depressed men. In Study II (Sleep Tumescence in Late Life), we propose to collect normative NPT data from 45 healthy men aged 60-90, without complaints of coital failure. Using data from Studies I and II, we will test the null hypothesis that NPT activity/rigidity in midlife depressives does not differ from that seen in healthy elderly men, except in reversibility of impairment.

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Treatment Development and Assessment Research Review Committee (TDA)
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