Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T15:46:27.377Z Has data issue: false hasContentIssue false
  • English
  • Français

Sexual Dysfunction and Psychotropic Medications

Published online by Cambridge University Press:  07 November 2014

Glen L. Stimmel  and
Mary A. Gutierrez
Glen L. Stimmel*
Affiliation:
Dr. Stimmel is professor of clinical pharmacy, psychiatry, and behavioral sciences at the, University of Southern California Schools of Pharmacy and Medicine in Los Angeles, California
Mary A. Gutierrez
Affiliation:
Dr. Gutierrez is associate professor of clinical pharmacy at the, University of Southern California School of Pharmacy in Los Angeles, California
*
Glen L. Stimmel PharmD, USC School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90089-9121; Tel: 323-442-1463; Fax:, 323-442-1681; E-mail:, [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Psychotropic drugs are often associated with sexual dysfunction. The frequency of antidepressant-associated sexual dysfunction is greatly underestimated in clinical trials that rely on patient self-report of these adverse events. Direct inquiry reveals that delayed orgasm/ejaculation occurs in ≥50% and anorgasmia in at least one third of patients given selective serotonin reuptake inhibitors. Antidepressant-induced sexual dysfunction can be successfully managed. A different antidepressant without significant sexual effects, such as bupropion or mirtazapine, can often be substituted. Other strategies involve drug holidays or adjunctive therapy with drugs such as sildenafil. Dopamine antagonist antipsychotic drugs are most commonly associated with decreased libido. The newer atypical antipsychotics, with less effect on dopamine, are less commonly associated with sexual dysfunction. Sexual dysfunction is commonly reported with seizure disorders, and many anticonvulsant drugs affect levels of sex hormones. Because sexual dysfunction can be related to many factors, care must be taken to establish the patient's baseline sexual functioning before the initiation of psychotropic drug therapy and to rule out other etiologies before drugs are implicated as causative.

Type
Research Article
Information
CNS Spectrums , Volume 11 , Issue S9 , 2006 , pp. 24 - 30
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Schiavi, RC, Segraves, RT. The biology of sexual function. Psychiatr Clin North Am. 1995;18:7–23.CrossRefGoogle ScholarPubMed
2.Stahl, SM. The psychopharmacology of sex. Part 1: Neurotransmitters and the 3 phases of the human sexual response. J Clin Psychiatry. 2001;62:80–81.CrossRefGoogle ScholarPubMed
3.Stahl, SM. The psychopharmacology of sex. Part 2: Effects of drugs and disease on the 3 phases of the human sexual response. J Clin Psychiatry. 2001;62:147–148.CrossRefGoogle ScholarPubMed
4.Seagraves, RT. The effects of minor tranquilizers, mood stabilizers, and antipsychotics on sexual function. Primary Psychiatry. 1997;4:46–48.Google Scholar
5.Gitlin, M. Sexual dysfunction with psychotropic drugs. Expert Opin Pharmacother. 2003;4:2259–2269.CrossRefGoogle ScholarPubMed
6.Labbate, LA, Grimes, J, Hines, A, Oleshansky, GA, Arana, W. Sexual dysfunction induced by serotonin reuptake antidepressants. J Sex Marital Therapy. 1998;24:3–12.CrossRefGoogle ScholarPubMed
7.Gitlin, MJ. Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994;55:406–413.Google ScholarPubMed
8.Rothschild, AJ. Sexual side effects of antidepressants. J Clin Psychiatry. 2000;61 (suppl 11):28–36.Google ScholarPubMed
9.Montejo-Gonzalez, AL, Liorca, G, Izquierdo, JA, et al.SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23:176–194.CrossRefGoogle Scholar
10.Michels, KB. Problems assessing nonserious adverse drug reactions: antidepressant drug therapy and sexual dysfunction. Pharmacotherapy. 1999;19:424–429.CrossRefGoogle ScholarPubMed
11.Gregorian, RS, Golden, KA, Bahce, A, Goodman, C, Kwong, WJ, Zhan, ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577–1589.CrossRefGoogle ScholarPubMed
12.Harrison, WM, Rabkin, JG, Ehrhardt, AA, et al.Effects of antidepressant medication on sexual function: a controlled study. J Clin Psychopharmacol. 1986;6:144–149.CrossRefGoogle ScholarPubMed
13.Crenshaw, TL, Goldberg, JP. Sexual Pharmacology: Drugs That Affect Sexual Function. New York: W.W. Norton & Company; 1996.Google Scholar
14.Margolese, HC, Assalian, P. Sexual side effects of antidepressants: a review. J Sex Marital Ther. 1996;22:209–217.CrossRefGoogle ScholarPubMed
15.Monteiro, WO, Noshirvani, HF, Marks, IM, Lelliott, PT. Anorgasmia from clomipramine in obsessive-compulsive disorder: a controlled trial. Br J Psychiatry. 1987;151:107–112.CrossRefGoogle ScholarPubMed
16.Seagraves, RT. Antidepressant-induced sexual dysfunction. J Clin Psychiatry. 1998;59 (suppl 4):48–54.Google Scholar
17.Rosen, RC, Lane, RM, Menza, M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19:67–85.CrossRefGoogle ScholarPubMed
18.Montejo, AL, Llorca, G, Izquierdo, JA, Rico-Villademoros, F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry. 2001;62(suppl 3):10–21.Google ScholarPubMed
19.Keltner, NL, McAfee, KM, Taylor, CL. Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspect Psychiatr Care. 2002;38:111–116.CrossRefGoogle ScholarPubMed
20.Stahl, SM. Selecting an antidepressant by using mechanism of action to enhance efficacy and avoid side effects. J Clin Psychiatry. 1998;59 (suppl 18):23–29.Google ScholarPubMed
21.Gutierrez, MA, Stimmel, GL. Management of and counseling for psychotropic drug-induced sexual dysfunction. Pharmacotherapy. 1999;19:823–831.CrossRefGoogle ScholarPubMed
22.Zajecka, J. Strategies for the treatment of antidepressant-induced sexual dysfunction. J Clin Psychiatry. 2001;62 (suppl 3):35–43.Google Scholar
23.Boyarsky, BK, Hirschfeld, RM. The management of medication-induced sexual dysfunction. Essent Psychopharmacol. 2000;3:151–170.Google Scholar
24.Rothschild, AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 1995;152:1514–1516.Google ScholarPubMed
25.Fava, M, Rankin, M. Sexual functioning and SSRIs. J Clin Psychiatry. 2002;63(suppl 5):13–16.Google ScholarPubMed
26.Feder, R. Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry. 1991;52:163–164.Google ScholarPubMed
27.Hollander, E, McCarley, A. Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry. 1992;53:207–209.Google ScholarPubMed
28.Eloubeidi, MA, Gaede, JT, Swaim, MW. Reversible nefazodone-induced liver failure. Dig Dis Sci. 2000;45(5):1036–1038.CrossRefGoogle ScholarPubMed
29.Cohen, AJ, Bartlik, B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998;24:139–143.CrossRefGoogle ScholarPubMed
30.Balon, R. Intermittent amantadine for fluoxetine-induced anorgasmia. J Sex Marital Ther. 1996;22:290–292.CrossRefGoogle ScholarPubMed
31.Norden, MJ. Buspirone treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors. Depression. 1994;2:109–112.CrossRefGoogle Scholar
32.DeBattista, C, Solvason, B, Poirier, J, et al.A placebo-controlled, randomized, double-blind study of adjunctive bupropion sustained-release in the treatment of SSRI-induced sexual dysfunction. J Clin Psychiatry. 2005;66:844–848.CrossRefGoogle ScholarPubMed
33.Clayton, AH, Warnock, JK, Kornstein, SG, Pinkerton, R, Sheldon-Keller, A, McGarvey, EL. A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 2004;65:62–67.CrossRefGoogle ScholarPubMed
34.Farah, A. Relief of SSRI-induced sexual dysfunction with mirtazapine treatment. J Clin Psychiatry. 1999;60:260–261.CrossRefGoogle ScholarPubMed
35.Nurnberg, HG, Gelenberg, AJ, Hargreave, TB, Harrison, WM, Siegel, RL, Smith, MD. Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Am J Psychiatry. 2001;158:1926–1928.CrossRefGoogle ScholarPubMed
36.Nurnberg, HG, Hensley, P, Gelenberg, AJ, Fava, M, Lauriello, J, Paine, S. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA. 2003;289:56–64.CrossRefGoogle ScholarPubMed
37.Walker, PW, Cole, JO, Gardner, EA, et al.Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion. J Clin Psychiatry. 1993;54:459–465.Google ScholarPubMed
38.Stimmel, GL, Dopheide, JA, Stahl, SM. Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects. Pharmacotherapy. 1997;17:10–21.CrossRefGoogle ScholarPubMed
39.Morrell, MJ, Flynn, KL, Done, S, Flaster, E, Kalayjian, L, Pack, AM. Sexual dysfunction, sex steroid hormone abnormalities, and depression in women with epilepsy treated with antiepileptic drugs. Epilepsy Behav. 2005;6:360–365.CrossRefGoogle ScholarPubMed
40.Penovich, PE. The effects of epilepsy and its treatment on sexual and reproductive function. Epilepsia. 2000;41 (suppl 2):S53–S61.CrossRefGoogle ScholarPubMed
41.Herzog, AG, Drislane, FW, Schomer, DL, et al.Differential effects of antiepileptic drugs on sexual function and reproductive hormones in men with epilepsy. Epilepsia. 2004;45:764–768.CrossRefGoogle ScholarPubMed
42.Herzog, AG, Fowler, KM. Sexual hormones and epilepsy: threat and opportunities. Curr Opin Neurol. 2005;18:167–172.CrossRefGoogle ScholarPubMed
43.Labbate, LA, Rubey, RN. Gabapentin-induced ejaculatory failure and anorgasmia. Am J Psychiatry. 1999;156:972.CrossRefGoogle ScholarPubMed
44.Grant, AC, Oh, H. Gabapentin-induced anorgasmia in women [letter]. Am J Psychiatry. 2002;159:1247.CrossRefGoogle ScholarPubMed
45.Newman, LC, Broner, SW, Lay, CL. Reversible anorgasmia with topiramate therapy for migraine. Neurology. 2005;65:1333–1334.CrossRefGoogle ScholarPubMed
46.Holtkamp, M, Weissinger, F, Meierkord, H. Erectile dysfunction with topiramate. Epilepsia. 2005;46:166–167.CrossRefGoogle ScholarPubMed
47.Hitiris, N, Barrett, JA, Brodie, MJ. Erectile dysfunction associated with pregabalin add-on treatment in patients with partial seizures: five case reports. Epilepsy Behav. 2006;8:418–421.CrossRefGoogle ScholarPubMed
48.Gil-Nagel, A, Lopez-Munoz, F, Serratosa, JM, Moncada, I, Garcia-Garcia, P, Alamo, C. Effect of lamotrigine on sexual function in patients with epilepsy. Seizure. 2006;15:142–149.CrossRefGoogle ScholarPubMed
49.Ghadirian, AM, Annable, L, Belanger, MC. Lithium, benzodiazepines, and sexual function in bipolar patients. Am J Psychiatry. 1992;149:801–805.Google ScholarPubMed
50.Melkersson, K. Differences in prolactin elevation and related symptoms of atypical antipsychotics in schizophrenic patients. J Clin Psychiatry. 2005;66:761–767.CrossRefGoogle ScholarPubMed
51.Haddad, PM, Wieck, A. Antipsychotic-induced hyperprolactinemia: mechanisms, clinical features, and management. Drugs. 2004;64:2291–2314.CrossRefGoogle ScholarPubMed
52.Smith, SM, O'Keane, V, Murray, R. Sexual dysfunction in patients taking conventional antipsychotic medication. Br J Psychiatry. 2002;181:49–55.CrossRefGoogle ScholarPubMed
53.Bobes, J, Garca-Portilla, MP, Rejas, J, et al.Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study. J Sex Marital Ther. 2003;29:125–147.CrossRefGoogle ScholarPubMed
54.Shiwach, RS, Carmody, TJ. Prolactogenic effects of risperidone in male patients–a preliminary study. Acta Psychiatr Scand. 1998;98:81–83.CrossRefGoogle ScholarPubMed
55.Byerly, MJ, Lescouflair, E, Weber, MT, et al.An open-label trial of quetiapine for antipsychotic-induced sexual dysfunction. J Sex Marital Ther. 2004;30:325–332.CrossRefGoogle ScholarPubMed
56.Cavallaro, R, Cocchi, F, Angelone, SM, Lattuada, E, Smeraldi, E. Cabergoline treatment of risperidone-induced hyperprolactinemia: a pilot study. J Clin Psychiatry. 2004;65:187–190.CrossRefGoogle ScholarPubMed
57.Gopalakrishnan, R, Jacob, KS, Kuruvilla, A, Basantharaj, B, John, JK. Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible dose, two-way crossover trial. Am J Psychiatry. 2006;163:494–499.CrossRefGoogle ScholarPubMed