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Current Sexual Health Reports
Published in: Current Sexual Health Reports 3/2019

01-09-2019 | Antidepressant Drugs | Current Controversies (P Kleinplatz and C Moser, Section Editors)

Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment

Author: Richard Balon

Published in: Current Sexual Health Reports | Issue 3/2019

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Abstract

Purpose of Review

The goal of this review was to evaluate recent developments in sexual dysfunction associated with psychotropic medications and its management.

Recent Findings

Sexual dysfunction associated with psychotropic medications is a serious clinical problem which occurs mostly with antidepressants, especially serotonergic ones, and antipsychotics, especially those causing hyperprolactinemia. Sexual dysfunction(s) seems to be associated to a significantly lesser degree with some newer psychotropic medications, e.g., vilazodone, vortioxetine, and agomelatine among antidepressants, and aripiprazole and lurasidone among antipsychotics. There have been no significant new developments in management of sexual dysfunction(s) associated with psychotropic medications with the exception of using newer medications or switching to them. A new clinical phenomenon—post serotonin reuptake inhibitors sexual dysfunction—has emerged as a difficult management issue.

Summary

Sexual dysfunction associated with psychotropic medications continues to be an important issue requiring further research to provide solid evidence for regulatory agencies and for clinicians.
Literature
1.
Segraves RT, Balon R. Sexual pharmacology: fast facts. New York: WW Norton, Inc.; 2003.
2.
3.
Montejo A, Montejo L, Baldwin DS. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management. World Psychiatry. 2018;17:3–11.CrossRefPubMedPubMedCentral
4.
Croft HA, Pomara N, Gommoll C, Chen D, Nunez R, Mathews M. Efficacy and safety of vilazodone in major depressive disorder: a randomized, double-blind, placebo-controlled trial. I Clin Psychiatry. 2014;75(11):e1291–8.CrossRef
5.
Clayton AH, Gommoll C, Chen D, Nunez R, Mathews M. Sexual dysfunction during treatment of major depressive disorder with vilazodone, citalopram, or placebo: results from a phase IV clinical trial. Int Clin Psychopharmacol. 2015;30:216–23.CrossRefPubMedPubMedCentral
6.
• Clayton AH, McGarvey L, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability and validity. Psychopharmacol Bull. 1997;33:731–45 This article provides information on reliability and validity of the most established scale used for evaluating sexual dysfunction with psychotropic medication. PubMed
7.
• Keller A, McGarvey EL, Clayton AH. Reliability and construct validity of the Changes of Sexual Functioning Questionnaire Short-Form (CSFQ-14). J Sex Marit Ther. 2006;32:43–52 This article provides information on reliability and validity of the shorter version of CSFQ.CrossRef
8.
•• Jacobsen P, Mahableshwarkar MD, Chen Y, Chrones L, Clayton AH. Effect of vortioxetine vs. escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. 2015;12:2036–48 This study demonstrated lower frequency of sexual dysfunction associated with vortioxetine when compared to escitalopram.CrossRefPubMed
9.
• Clayton AH, Durgam S, Li D, Chen C, Chan L, Mathews M, et al. Effects of vilazodone on sexual functioning in healthy adults: results from a randomized, double-blind, placebo-controlled, and active-controlled study. Int Clin Psychopharmacol. 2017;32:27–35 This study demonstrated lesser nonsignificant impact of vilazodone on sexual function than paroxetine in healthy volunteers.CrossRefPubMed
10.
• Montejo AL, Deakin JFW, Gaillard R, Harmer C, Meyniel F, Jabourian A, et al. Better sexual acceptability of agomelatine (25 and 50 mg) compared to escitaloptam (20 mg) in healthy volunteers. A 9-week, placebo-controlled study using the PRSexDQ scale. J Psychopharmacol. 2015;29:1119–28 This study demonstrated significantly lower impact of agomelatine on sexual functioning when compared to escitalopram in healthy volunteers.
11.
Segraves RT, Balon R. Antidepressant-induced sexual dysfunction in men. Pharmacology, Biochemistry and Behavior. 2014;121:132–7.CrossRefPubMed
12.
Bijlsma EY, Chan JSW, Olivier B, Veening JG, Millan MJ, Waldinger MD, et al. Sexual side effects of serotonergic antidepressants: mediated by inhibition of serotonin on central dopamine release? Pharmacology, Biochemistry and Behavior. 2014;121:88–101.
13.
Baldwin DS, Manson C, Nowak M. Impact of antidepressants drugs on sexual function and satisfaction. CNS Drugs. 2015;29:905–13.CrossRefPubMed
14.
15.
• Lorenz TA, Meston CM. Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial. Depress Anxiety. 2014;31:188–95 This article suggests possible usefulness of exercise in approaching sexual dysfunction.CrossRefPubMedPubMedCentral
16.
Khamba B, Aucoin M, Lytle M, Verman M, Maldonado A, Iorio C, et al. Efficacy of acupuncture treatment of sexual dysfunction secondary to antidepressants. J Alter Complement Med. 2013;19:862–9.CrossRef
17.
Nurnberg HG, Hensley PL, 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.CrossRefPubMed
18.
•• Nurnberg HG, Hensley PL, Heiman JR, Croft HA, Debattista C, Paine S. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA. 2008;300:395–404 This study demonstrated possible use of sildenafil in sexual dysfunction associated with antidepressants in women. CrossRefPubMed
19.
Segraves RT, Lee J, Stevenson R, Walker DJ, Wang WC, Dickson RS. Tadalafil for treatment of erectile dysfunction in men on antidepressants. J Clin Psychopharmacol. 2007;27:62–6.CrossRefPubMed
20.
Modabbernia A, Sohrabi H, Nasehi AA, Raisi F, Saroukhani S, Jamshidi A, et al. Effect of saffron on fluoxetine-induced sexual impairment in men: randomized, double-blind, placebo-controlled trial. Psychopharmacol. 2012;223:381–8.
21.
Kashani L, Raisi F, Saroukhani S, Sohrabi H, Moddabernia A, Nasehi AA, et al. Saffron for treatment of fluoxetine-induced sexual dysfunction in women: randomized double-blind placebo-controlled study. Hum Psychopharmacol. 2013;28:54–60.CrossRefPubMed
22.
Dording CM, Fisher L, Papakostas G, Farabaugh A, Sonnawalla S, Fava M, et al. A double-blind, randomized, pilot dose-finding study of maca root (L.Meyenii) for the management of SSRI-induced sexual dysfunction. CNS Neurosci Ther. 2008;14:182–91.CrossRefPubMedPubMedCentral
23.
Farnia V, Shirzadifar M, Shakeri J, Rezaei M, Bajoghli J, Holsboer-Trachsler E, et al. Rosa damascene oil improves SSRI-induced sexual dysfunction in male patients suffering from major depressive disorders: results from a double-blind, randomized, and placebo-controlled clinical trial. Neuropsychiatr Dis Treat. 2015;11:625–35.PubMedPubMedCentral
24.
Dording C, Mischoulon D, Shyu I, Alpert J, Papakostas GI. SAMe and sexual functioning. Eur Psychiatry. 2012;27:451–4.CrossRefPubMed
25.
Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwijekwu C, Hawton K. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev. 2013;5:CD003382.
26.
Rubio-Abadal E, Del Cacho N, Saenz-Navarrete G, Arranz B, Cambra R-M, Cuadras D, et al. How hyperprolactinemia affects sexual function in patients under antipsychotic treatment. J Clin Psychopharmacol. 2016;36:422–8.CrossRefPubMed
27.
Fujioji J, Iwamoto K, Banno M, Kikuchi T, Aleksic B, Ozaki N. Effect of adjunctive aripiprazole on sexual dysfunction in schizophrenia: a preliminary open-label study. Pharmacopsychiatry. 2017;50:74–8.
28.
•• Potkin SG, Loze JY, Forray C, Baker RA, Sapin C, Peters-Strickland T, et al. Reduced sexual dysfunction with aripiprazole once-monthly versus paliperidone palmitate: results from QUALIFY. Int Clin Psychopharmacol. 2017;32:147–54 This study showed that aripiprazole once monthly is associated with less sexual dysfunction and less hyperprolactinemia than paliperidone palmitate.CrossRefPubMedPubMedCentral
29.
• McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000;26:25–40 Demonstration of reliability and validity of another frequently used tool to evaluate sexual dysfunction with psychotropic medications.CrossRefPubMed
30.
• Clayton AH, Tsai J, Mao Y, Pikalov A, Loebel A. Effect of lurasidone on sexual function in major depressive disorder patients with subthreshold hypomanic symptoms (mixed features): results from a placebo-controlled trial. J Clin Psychiatry. 2018;79(5):23–9 This study demonstrated low frequency of sexual dysfunction with a new antipsychotic lurasidone. CrossRef
31.
• Yoon HW, Lee JS, Park SJ, Lee SK, Choi WJ, Kim TY, et al. Comparing the effectiveness and safety of the addition of and switching to aripiprazole for resolving antipsychotic-induced hyperprolactinemia: a multicenter, open-label, prospective study. Clin Neuropharmacol. 2016;39:288–94 New approach to sexual dysfunction associated with antipsychotics.
32.
Terevnikov V, Stenberg J-H, Tiihonen J, Burkin M, Joffe G. Add-on mirtazapine improves organic functioning in patients with schizophrenia treated with first generation antipsychotics. Nord J Psychiatry. 2017;71:77–80.CrossRefPubMed
33.
Kronstein PD, Ishida E, Khin NA, Chang E, Hung HM, Temple RJ, et al. Summary of findings from the FDA regulatory science forum on measuring sexual dysfunction in depression trials. J Clin Psychiatry. 2015;76:1050–9.CrossRefPubMed
34.
Khin NA, Kronstein PD, Yang P, Ishida E, Hung HMJ, Mathis MV, et al. Regulatory and scientific issue in studies to evaluate sexual dysfunction in antidepressant drug trials. J Clin Psychiatry. 2015;76:1060–3.
35.
36.
•• Bala A, HMT N, Hellstrom WJG. Post-SSRI sexual dysfunction: a literature review. Sex Med Rev. 2018;6:29–34 This article reviews an emerging difficult to manage this clinical phenomenon.
37.
Waldinger MD, van Coevorden RS, Schweitzer DH, Georgiadis J. Penile anesthesia in post SSRI sexual dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) in channels. Eur J Pharmacol. 2015;753:263–8.CrossRefPubMed
38.
39.
Simonsen AL, Danborg PB, Gotzsche PC. Persistent sexual dysfunction after early exposure to SSRIs: systematic review of animal studies. Int J Risk Saf Med. 2016;28:1–12.CrossRefPubMed
40.
Leiblum S, Seehuus M, Brown C. Persistent genital arousal: disordered or normative aspect of female sexual response? J Sex Med. 2007;4:680–9.CrossRefPubMed
41.
de Magalhaes FJC, Kumar MT. Persistent genital arousal disorder following selective serotonin reuptake inhibitor cessation. J Clin Psychopharmacol. 2015;35:352–4.CrossRefPubMed
Metadata
Title
Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment
Author
Richard Balon
Publication date
01-09-2019
Publisher
Springer US
Published in
Current Sexual Health Reports / Issue 3/2019
Print ISSN: 1548-3584
Electronic ISSN: 1548-3592
DOI
https://doi.org/10.1007/s11930-019-00202-1

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