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The uncoupled endothelial NOS generates O, which reacts with NO to form ONOO, reducing NO bioavailability while activating pro-inflammatory pathways and exacerbating vascular endothelial damage, marked by diminished vasodilation, elevated vascular resistance, inflammatory activation and reduction of penile blood flow, ultimately impairing erectile function [62]

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Yet most would still agree that the delicate interplay of neurotransmitters in an individual patient suffering from depression is not always easy to interpret or treat