Abstract
The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal) and orgasm. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies sexual disorders into 4 categories: (i) primary; (ii) general medical condition-related; (iii) substance-induced; and (iv) ‘not otherwise specified’ sexual dysfunctions. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases.
Substance-induced sexual dysfunctions are caused by the use of either substances of abuse [alcohol (ethanol), amphetamines, cocaine, opioids or sedatives/-hypnotics/anxiolytics], or prescription medications which include psychotropic drugs.
Patients with psychiatric difficulties tend to experience more frequent sexual function disturbances. The literature provides more than anecdotal evidence that psychotropic drugs can induce sexual function disorders in the epidemiologically vulnerable population of psychiatric patients.
Sexual dysfunctions caused by psychotropic drugs can be divided into 2 groups: sexual inhibition (inhibited desire, inhibited arousal and inhibited orgasm) and increased sexual function disorders (increased sexual desire, priapism and premature ejaculation).
The diagnosis of psychotropic drug-induced sexual function disorders is easy if the psychiatrist is sensitive to the existence of these adverse effects. This mostly involves careful history taking, although several questionnaires have been developed for reliable and valid quantification of sexual functioning. Diagnosis is usually established if the sexual function disorders develop when the patient is receiving a psychotropic drug and then disappear when the offending drug is discontinued.
The management of psychotropic-drug induced sexual inhibition can be divided into 6 steps: inform the patient about the possibility of sexual inhibition occurring before prescribing a psychotropic agent; wait for remission or tolerance of sexual inhibition; reduce the dosage of the psychotropic drug; switch the medication to one less likely to cause sexual inhibition; if possible, adjust the concomitant nonpsychotropic drugs; and add various pharmacological agents to the existing psychotropic drug to treat the sexual inhibition.
Physicians should take sexual histories as a routine practice when prescribing psychotropic drugs. Through careful management and patience on the part of both the patient and the physician, psychotropic drug-induced sexual function disorders can be improved so that the patient’s compliance with medication and quality of life can be optimised.
Similar content being viewed by others
References
Masters WH, Johnson V. Human sexual response. Boston (MA): Little, Brown, and Co., 1966
Shen WW, Sata LS, Hofstatter L. Thioridazine and understanding sexual phases in both sexes. Psychiatry J Univ Ottawa 1984; 9: 187–9
Masters WH, Johnson V. Human sexual inadequacy. Boston (MA): Little, Brown, and Co., 1970
Kaplan HS. The classification of the female sexual dysfunctions. J Sex Marital Ther 1974; 1: 124–38
Kaplan HS. The new sex therapy: active treatment of sexual dysfunctions. New York (NY): Brunner/Mazel, 1974
Kaplan HS. Disorders of sexual desire and other new concepts and techniques in sex therapy. New York (NY): Brunner/Mazel, 1979
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington (DC): American Psychiatric Association, 1987
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association, 1994
Shen WW, Sata LS. Inhibited female orgasm resulting from psychotropic drugs: a clinical review. J Reprod Med 1983; 28: 497–9
Shen WW, Sata LS. Inhibited female orgasm resulting from psychotropic drugs: a five-year updated clinical review. J Reprod Med 1990; 35: 11–4
Hsu JH, Shen WW. Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients. Int J Psychiatry Med 1995; 25: 191–201
Shen WW, Hsu JH. Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients. Int J Psychiatry Med 1995; 25: 239–48
Davidson JRT. Sexual dysfunction and antidepressants. Depression 1995; 2: 233–40
Monteiro WO, Noshirvani HF, Marks IM, et al. Anorgasmia from clomipramine in obsessive-compulsive disorder: a controlled trial. Br J Psychiatry 1987; 151: 107–12
Harrison WM, Stewart J, Ehrhardt AA, et al. A controlled study of the effects of antidepressants on sexual function. Psychopharmacol Bull 1985; 21: 85–8
Harrison WM, Rabkin JG, Ehrhardt AA, et al. Effects of antidepressant medication on sexual function: a controlled study. J Clin Psychopharmacol 1986; 6: 144–9
Solyom L, Solyom C, Ledwidge B. The fluoxetine treatment of low-weight, chronic bulimia nervosa. J Clin Psychopharmacol 1990; 10: 421–5
Lingjaerde O, Ahlfors UG, Bech P, et al. The UKU side-effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatrica Scand 1987; 76 Suppl. 334: 1–99
Aizenberg D, Zemishlany Z, Dorman-Etrog P, et al. Sexual dysfunction in male schizophrenic patients. J Clin Psychiatry 1995; 56: 137–41
Ghadirian AM, Annable L, Blanger M-C. Lithium, benzodiazepines and sexual function in bipolar patients. Am J Psychiatry 1992; 149: 801–5
Kotin T, Wilbert DE, Verberg D, et al. Thioridazine and sexual dysfunction. Am J Psychiatry 1976; 133: 82–5
Kowalski A, Stanley RO, Dennerstein L, et al. The sexual side effects of antidepressant medication: a double-blind comparison of two antidepressants in a non-psychiatric population. Br J Psychiatry 1985; 147: 413–8
Ghadirian AM, Chouinard G, Annable L. Sexual dysfunction and plasma prolactin levels in neuroleptic treated schizophrenic outpatients. J Nerv Ment Dis 1982; 170: 463–7
Kline MD. Fluoxetine and anorgasmia [letter]. Am J Psychiatry 1989; 146: 804
Herman JB, Brotman AW, Pollack MH, et al. Fluoxetine-induced sexual dysfunction. J Clin Psychiatry 1990; 51: 25–7
Musher JS. Anorgasmia with the use of fluoxetine [letter]. Am J Psychiatry 1990; 147: 948
Zujecka J, Fawcett J, Schaff M, et al. The role of serotonin in sexual dysfunction: fluoxetine-associated orgasm dysfunction. J Clin Psychiatry 1991; 52: 66–8
Goldbloom DS, Kennedy SH. Adverse interaction of fluoxetine and cyproheptadine in two patients with bulimia nervosa. J Clin Psychiatry 1991; 52: 261–2
Piazza LA, Markowitz JC, Kocsis JH, et al. Sexual functioning in chronically depressed patients treated with SSRI antidepressants: a pilot study. Am J Psychiatry 1997; 154: 1757–9
Labbate LA, Grimes J, Hines A, et al. Sexual dysfunction induced by serotonin reuptake antidepressants. J Sex Marital Ther 1998; 24: 3–12
Dorevitch A, Davis H. Fluvoxamine-associated sexual dysfunction. Ann Pharmacother 1994; 28: 872–4
Németh A, Arató M, Treuer T, et al. Treatment of fluvoxamine-induced anorgasmia with a partial drug holiday [letter]. Am J Psychiatry 1996; 153: 1365
Mitchell JE, Popkin MK. Antidepressant drug therapy and sexual dysfunction in men: a review. J Clin Psychopharmacol 1983; 3: 76–9
Warnock JK, Burdren JC, Morris DW. Female hypoactive sexual desire disorder due to androgen deficiency: clinical and psychometric issues. Psychopharmacol Bull 1997; 33: 761–5
Barbeau A. L-dopa therapy in Parkinson’s disease: a critical review of nine years experience. J Can Med Assn 1969; 101: 791–800
Goodwin FK. Psychiatric side effects of levodopa in man. JAMA 1971; 218: 1915–20
Sata LS, Shen WW. Neuroleptics and sexual functioning. Integr Psychiatry 1986; 4: 103–5
Labbote LA, Pollack MH. Treatment of fluoxetine-induced sexual dysfunction with bupropion—a case report. Ann Clin Psychiatry 1994; 6: 13–5
Gardner EA, Johnston JA. Bupropion—an antidepressant without sexual psychophysiological action. J Clin Psychopharmacol 1985; 5: 24–9
Walker PW, Cole JO, Gardner EA, et al. Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion. J Clin Psychiatry 1993; 54: 459–65
Modell JG, Katholi CR, Modell JD, et al. Comparative sexual side effects of bupropion, fluoxetine, paroxetine and sertraline. Clin Pharmacol Ther 1997; 61: 476–87
Feiger A, Kiev A, Shrivastava RK, et al. Nefazodone versus sertraline in outpatients with major depression: focus on efficacy, tolerability, and effects on sexual function and satisfaction. J Clin Psychiatry 1996; 57 Suppl. 2: 53–62
Philipp M, Kohnen R, Benkert O. A comparison study of moclobemide and doxepin in major depression with special reference to effects on sexual dysfunction. Int Clin Psychopharmacol 1993; 7: 149–53
Lauerma H. A case of moclobemide-induced hyperorgasmia. Int Clin Psychopharmacol 1995; 10: 123–4
Shen WW, Park S. The use of monoamine oxidase inhibitors in the treatment of traumatic war neurosis: case report. Milit Med 1983; 148: 430–1
Nelson JH III, Winter CC. Priapism: evolution of management in 48 patients in a 22-year series. J Urol 1977; 117: 455–8
Warner MD, Peabody CA, Whiteford HA. Trazodone and priapism. J Clin Psychiatry 1987; 48: 244–5
Patel AG, Mukherji K, Lee A. Priapism associated with psychotropic drugs. Br J Hosp Med 1996; 55: 315–9
Thompson JW, Ware MR, Blashfield RK. Psychotropic drug medication and priapism: a comprehensive review. J Clin Psychiatry 1990; 51: 430–3
Mitchell JE, Popkin MK. Antipsychotic drug therapy and sexual dysfunction in men. Am J Psychiatry 1982; 139: 633–7
Lazarus A. Priapism and psychotropic drug therapy [letter]. J Clin Psychopharmacol 1986; 6: 60–1
Lindenmayer JP Risperidone: efficacy and side effects. J Clin Psychiatry Monogr 1994; 12: 53–60
Nicolson R, McCurley R. Risperidone-associated priapism [letter]. J Clin Psychopharmacol 1997; 17: 133–4
Segraves RT. Overview of sexual dysfunction complicating the treatment of depression. J Clin Psychiatry 1992; 53 Suppl. 10b: 4–10
Shen WW. Female orgasmic inhibition by amoxapine [letter]. Am J Psychiatry 1982; 139: 1220–1
Sovner R. Anorgasmia associated with imipramine but not desipramine: case report. J Clin Psychiatry 1983; 44: 345–6
Reich J. The sexual side effects of an SSRI treated by behavioral methods [letter]. J Ment Nerv Dis 1997; 185: 707
Benazzi F, Mazzoli M. Fluoxetine-induced sexual dysfunction: a dose-dependent effect? [letter]. Pharmacotherapy 1994; 27: 246
Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry 1995; 152: 1514–6
Shen WW. The metabolism of psychoactive drugs: a review of enzymatic biotransformation and inhibition. Biol Psychiatry 1997; 141: 814–26
Quirk KC, Einarson TR. Sexual dysfunction and clomipramine. Can J Psychiatry 1982; 27: 228–31
Schubert DSP. Reversal of doxepine-induced hypoactive sexual desire by substitution of nortriptyline. J Sex Edu Ther 1992; 18: 42–4
Shen WW. Pharmacotherapy of schizophrenia: the American current state. Keio J Med (Tokyo) 1994; 43: 192–200
Yager J. Bethanachol chloride can reverse erectile and ejaculatory dysfunction induced by tricyclic antidepressants and mazindol: case report. J Clin Psychiatry 1986; 47: 210–1
Riley AJ, Riley EJ. Cyproheptadine and antidepressant-induced anorgasmia [letter]. Br J Psychiatry 1986; 148: 217–8
Arnott S, Nutt D. Successful treatment of fluvoxamine-induced anorgasmia with cyproheptadine. Br J Psychiatry 1994; 164: 838–9
Lauerma H. Successful treatment of citalopram-induced anorgasmia by cyproheptadine. Acta Psychiatr Scand 1996; 93: 69–70
Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry 1992; 53: 119–22
Hollender E, McCarley A. Yohimbine treatment of sexual side effects induced by serotonin reuptake blocker. J Clin Psychiatry 1992; 53: 207–9
Shrivastava RK, Shrivastava S, Overweg N, et al. Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors [letter]. J Clin Psychopharmacol 1995; 15: 83–4
Norden MJ. Buspirone treatment of sexual dysfunction associated with selective serotonin re-uptake inhibitors. Depression 1994; 2: 109–12
Gitlin MJ. Treatment of sexual side-effects with dopaminergic agents [letter]. J Clin Psychiatry 1995; 56: 124
Reynolds RD. Sertraline-induced anorgasmia treated with intermittent nefazodone [letter]. J Clin Psychiatry 1997; 58: 89
Nelson EB, Keck PE Jr, McElroy SL. Resolution of fluoxetine-induced sexual dysfunction with the 5-HT3 antagonist granisetron [letter]. J Clin Psychiatry 1997; 58: 496–7
Boolell M, Gepsi-Attee S, Gingell JC, et al. Sildenafil: a novel effective oral therapy for male erectile disorder. Br J Urol 1996; 78: 257–61
NIH Consensus Development Panel on Impotence. Impotence. JAMA 1993; 270: 83–90
Power-Smith P. Beneficial sexual-effects from fluoxetine. Br J Psychiatry 1994; 164: 249–50
Ott BR. Leuprolide treatment of sexual aggression in a patient with dementia and the Kluver-Bucy syndrome. Clin Neuropharmacol 1995; 18: 443–7
Stewart JT, Shin KJ. Paroxetine treatment of sexual inhibition in dementia [letter]. Am J Psychiatry 1997; 154: 1474
Perilstein RD, Lipper S, Friedman LJ. Three cases of paraphilias responsive to fluoxetine treatment. J Clin Psychiatry 1991; 52: 169–70
Kafka MP. Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Ann Clin Psychiatry 1994; 6: 189–95
Cordoba OA, Chapel JL. Medroxyprogesterone acetate antiandrogen treatment of hypersexuality in a pedophiliac sex offender. Am J Psychiatry 1983; 140: 1036–9
Bartholomew AA. A long-acting phenothiazine as a possible agent to control deviant sexual behavior. Am J Psychiatry 1968; 124: 917–23
Tennent G, Bancroft J, Cass, J. The control of deviant sexual behavior by drugs: A double-blind controlled study of haloperidol, chlorpromazine, and placebo. Arch Sex Beh 1974; 3: 261–71
Derogatis LR. Etiologic factors in premature ejaculation. Med Aspects Human Sexuality 1980; 14: 1168–76
Bartova D, Bouchal M. Thioridazine treatment of ejaculation praecox. Activitas Nervosa Superior (Praha) 1965; 7: 244–5
Mellgren A. Treatment of ejaculation praecox with thioridazine. Psychosomatique 1987; 15: 454–60
Bennet D. Treatment of ejaculation praecox with monoamine oxidase inhibitors [letter]. Lancet 1961; 2: 1309
Goodman RE. An assessment of clomipramine (Anafranil) in the treatment of premature ejaculation. J Int Med Res 1980; 8 Suppl. 3: 53–9
Girgis SM, El-Haggar S, El-Hermouzy S. A double-blind trial of clomipramine in premature ejaculation. Andrologia 1982; 14: 364–8
Segraves RT, Segraves SK, Maguire E. Clomipramine versus placebo in the treatment of premature ejaculation: a pilot study. J Sex Marital Ther 1983; 19: 198–200
Klug B. Clomipramine in premature ejaculation. Med J Aust 1984; 141: 71
Assalian P. Clomipramine in the treatment of premature ejaculation. J Sex Res 1988; 24: 213–5
Althof SE, Levine SB, Corty EW, et al. A double blind crossover trial of clomipramine for rapid ejaculation in 15 couples. J Clin Psychiatry 1995; 56: 402–7
Segraves RT. Treatment of premature ejaculation with lorazepam [letter]. Am J Psychiatry 1987; 144: 1240
Stratta P, Mancini F, Cupillari M, et al. Fluoxetine in premature ejaculation [letter]. Human Psychopharmacol 1993; 8: 61–2
Forester P, King J. Fluoxetine for premature ejaculation [letter]. Am J Psychiatry 1994; 151: 1523
Kindler S, Dolbert OT, Cohen H, et al. The treatment of comorbid premature ejaculation and panic disorder with fluoxetine. Clin Neuropharmacol 1997; 20: 466–71
Waldinger MD, Hengeveld MW, Zwinderman AH. Paroxetine treatment of premature ejaculation: a double blind, randomized, placebo-controlled study. Am J Psychiatry 1994; 151: 1377–9
Wise TN. Sertraline as a treatment for premature ejaculation [letter]. J Clin Psychiatry 1994; 55: 417
Mendels J, Camera A, Sikes C. Sertraline treatment for premature ejaculation. J Clin Psychopharmacol 1995; 15: 341–6
Burnap DW, Golden JS. Sexual problems in medical practice. J Med Educ 1967; 42: 673–80
Greenblatt DJ, Shadec RI, Koch-Weser J. Psychotropic drug use in the Boston area. Arch Gen Psychiatry 1975; 32: 518–21
Singh H. A case of inhibition of ejaculation as a side effect of Mellaril. Am J Psychiatry 1961; 117: 1041–2
Shen WW, Park S. Thioridazine-induced inhibition of female orgasm. Psychiatr J Univ Ottawa 1982; 7: 249–251
Wyatt RJ, Fram DH, Buchbinder R, et al. Treatment of intractable narcolepsy with monoamine oxidase inhibitor. N Engl J Med 1971; 285: 987–91
Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull 1997; 33: 735–45
Ellison JM, DeLuca P. Fluoxetine induced genital anesthesia relieved by Ginkgo biloba extract [letter]. J Clin Psychiatry 1998; 59: 199–200
Shen WW, Urosovich, Clayton DO. Sildenafil in the treatment of female sexual dysfunction induced by selective serotonin reuptake inhibitors: a case report and a review of the literature. J Reprod Med. In press
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Clayton, D.O., Shen, W.W. Psychotropic Drug-Induced Sexual Function Disorders. Drug-Safety 19, 299–312 (1998). https://doi.org/10.2165/00002018-199819040-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002018-199819040-00005