Sexual Dysfunction Related to Psychotropic Drugs: A Critical Review Part II: Antipsychotics

Abstract

▼Sexual dysfunction is a potential side eff ect of antipsychotic drugs: this article presents a critical review of the current literature. Although many studies have been published on the subject, only some used a validated sexual function rating scale and most lacked either a baseline or placebo control or both. In addition, many of the studies on sexual dysfunction associated with antipsychotic medication are limited by other methodological fl aws. However, there is consistent evidence to suggest that a large number of antipsychotic drugs adversely aff ect one or more of the 3 phases of sexual response (desire, arousal and orgasm). Among the antipsychotics, the so called "prolactin-raising" are probably most associated with sexual dysfunction, even if further studies to confi rm this are needed: the reviewed literature shows no consistent evidence that any one antipsychotic drug has a signifi cantly superior side eff ect profi le over another and current information on this topic is often based on methodologically weak research. Clinicians must be aware of drug-induced sexual dysfunction, since its presence can have important consequences for clinical management and compliance.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Psychotropic Use and Sexual Dysfunction: Is There a Practical Solution?

“…Still, the second generation seems better than the first generation as far as the sexual side effect is concerned [6]. Diminished libido is more commonly observed with dopamine antagonist antipsychotics and sexual dysfunction is less with newer atypical antipsychotics with low dopamine effect [9].…”

“…Diminished libido is more commonly observed with dopamine antagonist antipsychotics and sexual dysfunction is less with newer atypical antipsychotics with low dopamine effect [9]. Desire, arousal, and/or orgasm alone or in combination are adversely affected by antipsychotic drugs, more so by the 'prolactin-raising' ones [6].…”

“…Binding to dopaminergic, cholinergic, histaminergic and α-adrenergic receptors may directly affect sexual function by inhibiting motivation and reward, increasing sedation and reducing peripheral vasodilation [6].…”

“…This elevated prolactin influences gonadotropin releasing hormone (GnRH) in the hypothalamus, thereby affecting follicle stimulating hormone (FSH) and luteinising hormone (LH) in the anterior pituitary, and ultimately reducing oestrogen in women and testosterone in men [6].…”

Use of neuro-psychiatry medicines in patients with sexual dysfunction: a retrospective study

“…6,8,9 Few Indian studies have examined the sexual dysfunction associated with antipsychotics and antidepressants. 10,11 However, systematic large scale data of neuropsychiatry comorbidities and medicines used for their treatment in Indian patients presenting with sexual dysfunction are limited.…”