Letter to Editor Tramadol and Sexual Dysfunction Sir,

Sanitation 1 Medical Academic Center, Bangkok, Thailand, Visiting Professor, Faculty of Medicine, University of Nis, Serbia

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Khan and Rasaily reported on the use of tramadol for treatment of premature ejaculation (PE) and concluded that “the sex life of patients improved and they reported greater satisfaction with the sporadic treatment”. [1] Indeed, there are several reports confirming the usefulness of tramadol for management of PE. Yang et al., performed a meta-analysis and reported that “tramadol may be effective in PE treatment, especially when patients have failed therapies, like selective serotonin reuptake inhibitors”.[2] However, there are many considerations on the use of tramadol. First, the long-term use can result in drug addiction.[2] In addition, despite its advantage for management of PE, tramadol can induce the sexual dysfunction as a side effect.[3] This should be kept in mind. Finally, tramadol can also cause other side effects. Before usage, it is required to carefully investigate the risk and benefit for each patient.

Address for correspondence: Dr. Hai Err Sanitation 1 Medical Academic Center, Bangkok, Thailand. E-mail: [email protected]

REFERENCES 1.

Khan AH, Rasaily D. Tramadol use in premature ejaculation: Daily versus sporadic treatment. Indian J Psychol Med 2013;35:256-9. 2. Yang L, Qian S, Liu H, Liu L, Pu C, Han P, et al. Role of tramadol in premature ejaculation: A systematic review and meta-analysis. Urol Int 2013;91:197-205. 3. Giuliano F, Droupy S. Sexual side effects of pharmacological treatments. Prog Urol 2013;23:804-10. Access this article online Quick Response Code Website: www.ijpm.info

DOI: 10.4103/0253-7176.150859

Hai Err, Viroj Wiwanitkit

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Is Dhat Syndrome Indeed a Culturally Determined Form of Depression? Sir, Dhat syndrome, originally described as a culture bound syndrome of the Indian subcontinent[1] is a controversial diagnosis in many ways. Increasingly, its nosological status has been questioned with some describing it as a culturally determined form of depression[2] or an idiom of distress.[3] The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 has already withdrawn the separate status given to dhat syndrome in its earlier editions terming it as ‘not a true syndrome’.[3] But is there really evidence to suggest that dhat syndrome is a culturally determined form of depression? A PubMed search reveals 40 papers published on dhat syndrome. By going through back references, contacting prominent Indian Journal of Psychological Medicine | Jan - Mar 2015 | Vol 37 | Issue 1

authors and tracing articles not available on the internet, we were able to obtain an additional 25 articles making a total of 65. Of these, only two papers have argued exclusively that dhat syndrome is a culturally determined form of depression.[2,4] Two more papers, while arguing that it is not a true syndrome, have not committed that it is a depressive illness.[5,6] Some other papers have only made brief references that it is not a true syndrome without discussing it in detail.[7] We will be critically examining the arguments provided for calling dhat syndrome a culturally determined form of depression. In an original study, Mumford[2] observed that men reporting dhat symptom had higher Hospital Anxiety 107

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