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Sexual Dysfunction and Psychotropic Medications

  • Glen L. Stimmel (a1) and Mary A. Gutierrez (a2)
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.

Copyright
Corresponding author
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:, stimmel@usc.edu.
References
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1.Schiavi, RC, Segraves, RT. The biology of sexual function. Psychiatr Clin North Am. 1995;18:723.
2.Stahl, SM. The psychopharmacology of sex. Part 1: Neurotransmitters and the 3 phases of the human sexual response. J Clin Psychiatry. 2001;62:8081.
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;62:147148.
4.Seagraves, RT. The effects of minor tranquilizers, mood stabilizers, and antipsychotics on sexual function. Primary Psychiatry. 1997;4:4648.
5.Gitlin, M. Sexual dysfunction with psychotropic drugs. Expert Opin Pharmacother. 2003;4:22592269.
6.Labbate, LA, Grimes, J, Hines, A, Oleshansky, GA, Arana, W. Sexual dysfunction induced by serotonin reuptake antidepressants. J Sex Marital Therapy. 1998;24:312.
7.Gitlin, MJ. Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994;55:406413.
8.Rothschild, AJ. Sexual side effects of antidepressants. J Clin Psychiatry. 2000;61 (suppl 11):2836.
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;23:176194.
10.Michels, KB. Problems assessing nonserious adverse drug reactions: antidepressant drug therapy and sexual dysfunction. Pharmacotherapy. 1999;19:424429.
11.Gregorian, RS, Golden, KA, Bahce, A, Goodman, C, Kwong, WJ, Zhan, ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:15771589.
12.Harrison, WM, Rabkin, JG, Ehrhardt, AA, et al.Effects of antidepressant medication on sexual function: a controlled study. J Clin Psychopharmacol. 1986;6:144149.
13.Crenshaw, TL, Goldberg, JP. Sexual Pharmacology: Drugs That Affect Sexual Function. New York: W.W. Norton & Company; 1996.
14.Margolese, HC, Assalian, P. Sexual side effects of antidepressants: a review. J Sex Marital Ther. 1996;22:209217.
15.Monteiro, WO, Noshirvani, HF, Marks, IM, Lelliott, PT. Anorgasmia from clomipramine in obsessive-compulsive disorder: a controlled trial. Br J Psychiatry. 1987;151:107112.
16.Seagraves, RT. Antidepressant-induced sexual dysfunction. J Clin Psychiatry. 1998;59 (suppl 4):4854.
17.Rosen, RC, Lane, RM, Menza, M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19:6785.
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):1021.
19.Keltner, NL, McAfee, KM, Taylor, CL. Mechanisms and treatments of SSRI-induced sexual dysfunction. Perspect Psychiatr Care. 2002;38:111116.
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):2329.
21.Gutierrez, MA, Stimmel, GL. Management of and counseling for psychotropic drug-induced sexual dysfunction. Pharmacotherapy. 1999;19:823831.
22.Zajecka, J. Strategies for the treatment of antidepressant-induced sexual dysfunction. J Clin Psychiatry. 2001;62 (suppl 3):3543.
23.Boyarsky, BK, Hirschfeld, RM. The management of medication-induced sexual dysfunction. Essent Psychopharmacol. 2000;3:151170.
24.Rothschild, AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 1995;152:15141516.
25.Fava, M, Rankin, M. Sexual functioning and SSRIs. J Clin Psychiatry. 2002;63(suppl 5):1316.
26.Feder, R. Reversal of antidepressant activity of fluoxetine by cyproheptadine in three patients. J Clin Psychiatry. 1991;52:163164.
27.Hollander, E, McCarley, A. Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry. 1992;53:207209.
28.Eloubeidi, MA, Gaede, JT, Swaim, MW. Reversible nefazodone-induced liver failure. Dig Dis Sci. 2000;45(5):10361038.
29.Cohen, AJ, Bartlik, B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998;24:139143.
30.Balon, R. Intermittent amantadine for fluoxetine-induced anorgasmia. J Sex Marital Ther. 1996;22:290292.
31.Norden, MJ. Buspirone treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors. Depression. 1994;2:109112.
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;66:844848.
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;65:6267.
34.Farah, A. Relief of SSRI-induced sexual dysfunction with mirtazapine treatment. J Clin Psychiatry. 1999;60:260261.
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;158:19261928.
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;289:5664.
37.Walker, PW, Cole, JO, Gardner, EA, et al.Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion. J Clin Psychiatry. 1993;54:459465.
38.Stimmel, GL, Dopheide, JA, Stahl, SM. Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects. Pharmacotherapy. 1997;17:1021.
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;6:360365.
40.Penovich, PE. The effects of epilepsy and its treatment on sexual and reproductive function. Epilepsia. 2000;41 (suppl 2):S53S61.
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;45:764768.
42.Herzog, AG, Fowler, KM. Sexual hormones and epilepsy: threat and opportunities. Curr Opin Neurol. 2005;18:167172.
43.Labbate, LA, Rubey, RN. Gabapentin-induced ejaculatory failure and anorgasmia. Am J Psychiatry. 1999;156:972.
44.Grant, AC, Oh, H. Gabapentin-induced anorgasmia in women [letter]. Am J Psychiatry. 2002;159:1247.
45.Newman, LC, Broner, SW, Lay, CL. Reversible anorgasmia with topiramate therapy for migraine. Neurology. 2005;65:13331334.
46.Holtkamp, M, Weissinger, F, Meierkord, H. Erectile dysfunction with topiramate. Epilepsia. 2005;46:166167.
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;8:418421.
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;15:142149.
49.Ghadirian, AM, Annable, L, Belanger, MC. Lithium, benzodiazepines, and sexual function in bipolar patients. Am J Psychiatry. 1992;149:801805.
50.Melkersson, K. Differences in prolactin elevation and related symptoms of atypical antipsychotics in schizophrenic patients. J Clin Psychiatry. 2005;66:761767.
51.Haddad, PM, Wieck, A. Antipsychotic-induced hyperprolactinemia: mechanisms, clinical features, and management. Drugs. 2004;64:22912314.
52.Smith, SM, O'Keane, V, Murray, R. Sexual dysfunction in patients taking conventional antipsychotic medication. Br J Psychiatry. 2002;181:4955.
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;29:125147.
54.Shiwach, RS, Carmody, TJ. Prolactogenic effects of risperidone in male patients–a preliminary study. Acta Psychiatr Scand. 1998;98:8183.
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;30:325332.
56.Cavallaro, R, Cocchi, F, Angelone, SM, Lattuada, E, Smeraldi, E. Cabergoline treatment of risperidone-induced hyperprolactinemia: a pilot study. J Clin Psychiatry. 2004;65:187190.
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;163:494499.
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