Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors

Abstract

Objectives: The aim of this study was to assess the prevalence of patients with Erectile Dysfunction (ED) receiving psychotropic drugs, the impact of these drugs on hormonal profile, and the efficacy of PDE5-i in these patients. Materials and methods: We recruited 1872 patients referring for ED to our Andrology Unit. Assessment included serum testosterone, gonadotropins, TSH, prolactin, and PSA, and the IIEF-5 questionnaire for ED diagnosis. Inclusion criteria were age 21-75 years and IIEF-5 total score ≤ 21; exclusion criteria included hypogonadism, diabetes mellitus, previous prostatectomy, other medication intake, and ED diagnosis prior to psychotropic drug treatment. Efficacy was rated with the IIEF-5 (remission: total score ≥ 22). Results: The prevalence of ED patients treated with psychotropic drugs since ≥ 3 months was 9.5% (178/1872), subdivided according to the drugs used into: Group A, 16 patients treated with atypical antipsychotics (9.0%); Group B, 55 patients with benzodiazepines (30.9%); Group C, 33 patients with antidepressant drugs (18.5%); and Group D, 74 patients with multiple psychotropic drugs (41.6%). Patients in Group A were significantly younger than other groups (p < 0.05). The hormonal profile presented only higher prolactin level in patients treated with antipsychotics, alone or in combination (p < 0.05). Overall, 146 patients received PDE5-i. Remission rate, after three months of treatment, was significantly higher in Group B compared to C and D groups (p < 0.05). Conclusions: A substantial portion of patients receiving psychotropic drugs show ED. Sexual performance in these patients benefits from PDE5-i. Age, effects of psychiatric disorders, psychotropic drugs, and PDE5-i treatment modality accounted for variability of response in this sample.

Lithium and Erectile Dysfunction: An Overview

“…For instance, consistent with beneficial effects of indomethacin in preclinical studies on lithium-related erectile dysfunction in rats [ 32 ], a recent clinical trial found that aspirin may improve erectile function in patients with bipolar disorders taking lithium [ 104 ]. Treatment with PDE5 inhibitors could also be another option, as they have been found to be beneficial both in antipsychotic-induced erectile dysfunction [ 105 , 106 ] as well as in subjects treated with lithium combined with other psychotherapeutic agents [ 107 ].…”

“…PDE5 inhibitors (e.g., sildenafil) have been shown to be beneficial in the treatment of erectile dysfunction related to antipsychotics therapy [ 105 , 106 ]. More recent investigation has also demonstrated that patients treated with lithium combined with other psychotherapeutic agents had improvement in their erectile dysfunction after treatment with PDE5 inhibitors [ 107 ]. Clearly, more studies are needed to investigate several other approaches that could be beneficial in improving erectile and sexual function in patients receiving lithium.…”

Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment

“…Firstly, we found that a proportion of the participants in MMT used benzodiazepines (both self-administered and medically prescribed) during methadone treatment. This was the only admitted psychopharmacological treatment, and although its presence may interfere with the results [27] (benzodiazepines are psychotropic drugs with some adverse sexual effects) [28], it is not easy to find patients on methadone treatment in monotherapy. Secondly, another limitation of the study is bias due to its retrospective design (instead of prospective one); however, the relatively high mean duration of methadone treatment (6.34 ± 6.74 and 9.85 ± 7.78 years of treatment for men and women, respectively) avoids bias in the recalling symptoms of sexual dysfunction prior to initiating MMT, which would influence the result of this study.…”

Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study

“…Finally, some aspects of sexual functioning, such as subjective satisfaction and sexual pain, were not evaluated, since they are not included in the PRSexDQ-SALSEX Questionnaire, but could be taken into consideration in further studies [59]. Being a naturalistic study, patients could take benzodiazepines according to usual clinical practice and these could have some effect on sexual dysfunction [60,61]; however, the doses used were low and only lasted a short time (3–6 weeks).…”