{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T07:46:32Z","timestamp":1769845592811,"version":"3.49.0"},"reference-count":90,"publisher":"Akademiai Kiado Zrt.","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Physiol Hung"],"published-print":{"date-parts":[[2019,3,19]]},"abstract":"<jats:sec sec-type=\"introduction\">\n          <jats:title>Introduction<\/jats:title>\n          <jats:p>Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is associated with incidence of adverse events, such as constipation, diarrhea, dry mouth, headache, insomnia, and sexual dysfunction (SDys). Escitalopram (ESC), an effective and safe selective serotonin reuptake inhibitor with good tolerability, was used in this study. In this study, we investigated the prospective effect of Pycnogenol (PYC), an antioxidant, anti-inflammatory, and vasodilator agent, on ESC-induced SDys.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"methods\">\n          <jats:title>Methods<\/jats:title>\n          <jats:p>This was a randomized, parallel, open-label study. Seventy-two outpatients of both genders with depression were randomized into two groups as follows: 37 patients from the ESC\u2009+\u2009PYC group took 50\u00a0mg of PYC per day for 4 months in ESC co-treatment, and 35 subjects from the ESC group took ESC only. Five patients dropped out and were excluded from the analysis. The participants were examined every month (visits 1\u20134).<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"results\">\n          <jats:title>Results<\/jats:title>\n          <jats:p>ESC use led to improvement of depressive symptoms and severity scored by standardized psychiatric tests. PYC co-treatment resulted in attenuation of SDys beginning at 1 month of treatment and continuing for two consecutive months. Furthermore, an increase in heart rate in the PYC group was registered.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec sec-type=\"conclusions\">\n          <jats:title>Conclusions<\/jats:title>\n          <jats:p>We propose that PYC-mediated SDys attenuation is based on its ability to improve endothelial functions by its antioxidant, anti-inflammatory, vasodilatory, and anticoagulant action. We assume that the action of PYC on heart rate is in accordance with the aforementioned vasodilatory action of PYC and consequent baroreflex-mediated heart rate response. PYC co-treatment reduced ESC-induced SDys and elevated heart rate.<\/jats:p>\n        <\/jats:sec>","DOI":"10.1556\/2060.106.2019.02","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T14:20:37Z","timestamp":1553005237000},"page":"59-69","source":"Crossref","is-referenced-by-count":11,"title":["Pycnogenol supplementation as an adjunct treatment for antidepressant-induced sexual dysfunction"],"prefix":"10.1556","volume":"106","author":[{"given":"A","family":"Smetanka","sequence":"first","affiliation":[{"name":"1 Outpatient Psychiatric Clinic, Bojnice, Slovakia"},{"name":"2 Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Stara","sequence":"additional","affiliation":[{"name":"3 Biomedical Center Martin, Division of Neurosciences, Jessenius Faculty of Medicine in Martin, Department of Physiology JFM CU, Comenius University in Bratislava (JFM CU), Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Farsky","sequence":"additional","affiliation":[{"name":"4 Department of Nursing, Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Tonhajzerova","sequence":"additional","affiliation":[{"name":"5 Department of Physiology, Jessenius Faculty of Medicine in Martin, Biomedical Center Martin JFM CU, Comenius University in Bratislava (JFM CU), Martin, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Ondrejka","sequence":"additional","affiliation":[{"name":"6 Clinic of Psychiatry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Bratislava, Slovakia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"ref281","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1192\/bjp.134.4.382","article-title":"A new depression scale designed to be sensitive to change","volume":"134","author":"Montgomery","year":"1979","journal-title":"Br. 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Disord."},{"key":"ref841","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ijcard.2006.04.062","article-title":"L-Arginine, the substrate for NO synthesis: an alternative treatment for premature atherosclerosis?","volume":"116","author":"Siasos","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref791","doi-asserted-by":"crossref","first-page":"270","DOI":"10.4161\/oxim.2.5.9498","article-title":"Plant polyphenols as dietary antioxidants in human health and disease","volume":"2","author":"Pandey","year":"2009","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref571","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1093\/eurheartj\/ehr482","article-title":"Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, randomized, placebo-controlled, cross-over study","volume":"33","author":"Enseleit","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref381","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1002\/mnfr.201000644","article-title":"Adverse effects of concentrated green tea extracts","volume":"55","author":"Sch\u00f6nthal","year":"2011","journal-title":"Mol. Nutr. Food Res."},{"key":"ref81","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/j.1743-6109.2009.01248.x","article-title":"Selective serotonin reuptake inhibitor-induced sexual dysfunction","volume":"6","author":"Corona","year":"2009","journal-title":"J. Sex. Med."},{"key":"ref221","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/0706743716659417","article-title":"Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder","volume":"61","author":"Kennedy","year":"2016","journal-title":"Can. J. 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Pharmacother."},{"key":"ref191","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/S0271-5317(01)00342-6","article-title":"A randomized, double-blind, placebo-controlled, prospective, 16 week crossover study to determine the role of Pycnogenol in modifying blood pressure in mildly hypertensive patients","volume":"21","author":"Hosseini","year":"2001","journal-title":"Nutr. Res."},{"key":"ref701","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/j.1464-410X.2010.09213.x","article-title":"Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study","volume":"106","author":"Ledda","year":"2010","journal-title":"BJU Int."},{"key":"ref341","doi-asserted-by":"crossref","first-page":"270","DOI":"10.4161\/oxim.2.5.9498","article-title":"Plant polyphenols as dietary antioxidants in human health and disease","volume":"2","author":"Pandey","year":"2009","journal-title":"Oxid. 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Med."},{"key":"ref601","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1472-6904-6-4","article-title":"Single and multiple dose pharmacokinetics of maritime pine bark extract (Pycnogenol) after oral administration to healthy volunteers","volume":"6","author":"Grimm","year":"2006","journal-title":"BMC Clin. Pharmacol."},{"key":"ref691","first-page":"29","article-title":"Prelox\u00ae for improvement of erectile function: a review","volume":"11","author":"Lamm","year":"2003","journal-title":"Eur. Bull. Drug Res."},{"key":"ref21","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.curtheres.2005.04.006","article-title":"Antidepressant-related adverse effects impacting treatment compliance: results of a patient survey","volume":"66","author":"Ashton","year":"2005","journal-title":"Curr. Ther. Res."},{"key":"ref01","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/ptr.3462","article-title":"Clinical assessment of a supplement of Pycnogenol\u00ae and L-arginine in Japanese patients with mild to moderate erectile dysfunction","volume":"26","author":"Aoki","year":"2012","journal-title":"Phytother. Res."},{"key":"ref231","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4081\/aiua.2015.3.190","article-title":"Improvement of seminal quality and sexual function of men with oligoasthenoteratozoospermia syndrome following supplementation with L-arginine and Pycnogenol\u00ae","volume":"87","author":"Kobori","year":"2015","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref711","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1192\/bjp.bp.114.156786","article-title":"Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors","volume":"207","author":"Lewer","year":"2015","journal-title":"Br. J. Psychiatry"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.phymed.2010.04.009","article-title":"Improvement of signs and symptoms of chronic venous insufficiency and microangiopathy with Pycnogenol\u00ae: a prospective, controlled study","volume":"17","author":"Cesarone","year":"2010","journal-title":"Phytomedicine"},{"key":"ref551","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1001\/archinternmed.2010.310","article-title":"No beneficial effects of pine bark extract on cardiovascular disease risk factors","volume":"170","author":"Drieling","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref421","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/sj.ijir.3901597","article-title":"Improvement of erectile function with Prelox: a randomized, double-blind, placebo-controlled, crossover trial","volume":"20","author":"Stanislavov","year":"2008","journal-title":"Int. J. Impot. Res."},{"key":"ref591","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-9255-3-1","article-title":"Inhibition of NF-\u03baB activation and MMP-9 secretion by plasma of human volunteers after ingestion of maritime pine bark extract (Pycnogenol)","volume":"3","author":"Grimm","year":"2006","journal-title":"J. Inflamm. (Lond.)"},{"key":"ref741","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1079\/BJN20061809","article-title":"Absorption, excretion and metabolite profiling of methyl-, glucuronyl-, glucosyl- and sulpho-conjugates of quercetin in human plasma and urine after ingestion of onions","volume":"96","author":"Mullen","year":"2006","journal-title":"Br. J. Nutr."},{"key":"ref891","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jtcme.2016.05.008","article-title":"Effects of a supplement combining Pycnogenol\u00ae and L-arginine aspartate on lower urinary dysfunction compared with saw palmetto extract","volume":"7","author":"Yagi","year":"2017","journal-title":"J. Tradit. Complement. Med."},{"key":"ref401","first-page":"39","article-title":"The effect of Pycnogenol on the erythrocyte membrane fluidity","volume":"23","author":"Sivonov\u00e1","year":"2004","journal-title":"Gen. Physiol. Biophys."},{"key":"ref391","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ijcard.2006.04.062","article-title":"L-Arginine, the substrate for NO synthesis: an alternative treatment for premature atherosclerosis?","volume":"116","author":"Siasos","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref241","first-page":"29","article-title":"Prelox\u00ae for improvement of erectile function: a review","volume":"11","author":"Lamm","year":"2003","journal-title":"Eur. Bull. Drug Res."},{"key":"ref881","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.fct.2013.06.053","article-title":"Assessment of the cytotoxic, genotoxic, and antigenotoxic potential of Pycnogenol\u00ae in in vitro mammalian cells","volume":"61","author":"Taner","year":"2013","journal-title":"Food Chem. Toxicol."},{"key":"ref411","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/00926230390155104","article-title":"Treatment of erectile dysfunction with pycnogenol and L-arginine","volume":"29","author":"Stanislavov","year":"2003","journal-title":"J. Sex. Marital. Ther."},{"key":"ref111","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/S0271-5317(03)00126-X","article-title":"Lipid metabolism and erectile function improvement by pycnogenol\u00ae, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction \u2013 a pilot study","volume":"23","author":"D\u0306ura\u010dkov\u00e1","year":"2003","journal-title":"Nutr. Res."},{"key":"ref541","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.fitote.2010.06.011","article-title":"Pycnogenol: a blend of procyanidins with multifaceted therapeutic applications?","volume":"81","author":"D\u2019Andrea","year":"2010","journal-title":"Fitoterapia"},{"key":"ref451","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1002\/ptr.3462","article-title":"Clinical assessment of a supplement of Pycnogenol\u00ae and L-arginine in Japanese patients with mild to moderate erectile dysfunction","volume":"26","author":"Aoki","year":"2012","journal-title":"Phytother. 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