Skip to main content
SpringerLink
Log in

Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment

  • Current Controversies (P Kleinplatz and C Moser, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Segraves RT, Balon R. Sexual pharmacology: fast facts. New York: WW Norton, Inc.; 2003.

    Google Scholar 

  2. Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006;163:1504–9.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  14. Lorenz T, Rullo J, Faubion S. Antidepressant-induced female sexual dysfunction. Mayo Clinic Proceedings. 2016;91:1280–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Dording C, Mischoulon D, Shyu I, Alpert J, Papakostas GI. SAMe and sexual functioning. Eur Psychiatry. 2012;27:451–4.

    Article  CAS  PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Reisman Y. Sexual consequences of post-SSRI syndrome. Sex med Rev. 2017;5:429–33.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  38. Calabro RS, De Luca R, Manuli A, Portaro S, Naro A, Quattrini F. Rowards improving post-SSRI dysfunction by using nutriceuticals: lessons from a case study. J Sex marital Ther 2019 Jan. 14:1–4. https://doi.org/10.1080/0092623X2018.1556755.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  41. de Magalhaes FJC, Kumar MT. Persistent genital arousal disorder following selective serotonin reuptake inhibitor cessation. J Clin Psychopharmacol. 2015;35:352–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University School of Medicine, Tolan Park Building 3rd Floor, 3901 Chrysler Service Dr., Detroit, MI, 48201, USA

    Richard Balon

Authors
  1. Richard Balon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Balon.

Ethics declarations

Conflict of Interest

The author declares that he has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Current Controversies

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balon, R. Update on Sexual Dysfunction Associated with Psychotropic Medications and Its Treatment. Curr Sex Health Rep 11, 125–131 (2019). https://doi.org/10.1007/s11930-019-00202-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-019-00202-1

Keywords

Search

Navigation