Sexual Dysfunction Associated with the Drug Treatment of Psychiatric Disorders: Incidence and Treatment

Adverse sexual effects of psychiatric medication can cause considerable distress to patients and so lead to noncompliance. Despite the clinical importance of psychotropic-induced sexual dysfunction, there is relatively little systematic research on its incidence and treatment. Investigation is complicated by the fact that sexual dysfunction may predate the onset of medication or may be secondary to the presenting illness. In addition, objective measures of sexual dysfunction have been difficult to construct. Few studies have attempted to combine phenomenological and physiological measures of sexual dysfunction. Nevertheless, studies suggest that sexual dysfunction is commonly seen in association with the major classes of psychotropic medication. Disturbances of erection and ejaculation are the most frequently reported sexual adverse effects of dopamine blocking antipsychotics. Antidepressant medications often lead to sexual dysfunction, with serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors commonly resulting in anorgasmia. On the other hand, certain serotonergic agents (e.g. 5-HT_1A agonists) may lead to improvement in sexual symptoms, pointing to the complexity of serotonergic mediation of sexual function. Treatment of sexual dysfunction induced by psychiatric drugs commonly involves attempting to titrate dosage, or switching from one medication to another. Certain psychotropics, such as amfebutamone (bupropion), may have few adverse sexual effects. Reversal of the dopaminergic effects of antipsychotics or the serotonergic effects of antidepressants are other strategies that may be useful. Finally, there is good evidence that adrenergic receptors mediate erection and ejaculation. As a result, there is increasing research on the efficacy of agents such as yohimbine, an α₂-noradrenergic antagonist, for the treatment of sexual adverse effects