HP-2-4 Antipsychotic-Induced Sexual Dysfunction Revisited

Abstract

Sexual dysfunction (SD) is a prevalent side effect in patients taking antipsychotics. It's a distressing side effect but, unfortunately, one of the most common affecting 45-80% of males and 30-80% of females being a cause for treatment nonadherence or discontinuation. SD due to antipsychotics may affect all phases of the sexual response cycle and include decreased sexual desire, erectile dysfunction, an orgasm, and delayed or retrograde ejaculation. SD attributable to antipsychotics is considered an underreported side effect all over the world. Our aim is to perform a non-systematic review of the literature regarding the current understanding of antipsychotic-induced SD and its management. A semi-structured review was conducted on Pubmed concerning the relationship between SD and antipsychotics. All antipsychotics drugs can cause sexual dysfunction. However, aripiprazole has been associated with lower rates of SD and seems to reduce the rates of SD in patients previously treated with other antipsychotics. The management of SD induced by antipsychotic drugs should include measurement of serum prolactin and modification of risk factors like hypertension, smoking, hyperglycemia and hypercholesterolemia. Waiting for spontaneous remission, reducing the dose of the antipsychotic or switching to aripiprazole are all viable strategies, if possible, to reduce SD. The evidence supporting the addition of symptomatic therapies is weak nevertheless dopaminergic drugs (amantadine, bromocriptine, cabergoline) or drugs with specific effects on sexual functioning (such as phosphodiesterase inhibitors or yohimbine) may be helpful in selected cases.