Management of sexual problems due to antipsychotic drug therapy

Drugs commonly used to treat schizophrenia often cause sexual problems.This may affect erection, lubrication, orgasm, desire or libido, ejaculation, sexual arousal or overall sexual satisfaction. This may have serious negative consequences such as putting people off taking their medication or stopping taking drugs at an early stage. Sexual problems may limit a person’s quality of life, worsen self-esteem and cause relationship problems.Strategies to manage these sexual problems are taking additional drugs (Viagra TM), short drug holidays when people temporarily stop antipsychotic medication, reduction of dose and switching to another antipsychotic drug. This review includes four pioneering studies with a total of 138 participants lasting between two weeks to four months, meaning all were small and quite short. Two of the studies compared the effects of drugs to treat sexual problems and two compared the effect of switching to a different antipsychotic drug (while remaining on a current antipsychotic). There is some evidence that sildenafil ((ViagraTM, RevatioTM)) may be a good treatment for men who have problems getting and maintaining an erection. It also seems to increase frequency and satisfaction of sexual intercourse. Switching to olanzapine may improve sexual functioning in men and women.

However, before confident claims can be made, much more research on strategies to deal with sexual problems should be undertaken. Sildenafil may be a useful option in the treatment of sexual problems in men with schizophrenia, but this conclusion is based only on one small, short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was small. Further well designed trials and research, which investigate the effects of dose reduction, drug holidays, taking drugs such as Viagra TM, and switching antipsychotic medication, are much needed.

This plain language summary (PLS) was written by a consumer contributor, Ben Gray from RETHINK: Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness, Email: ben.gray@rethink.org.

Authors' conclusions: 

We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.

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Background: 

Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients’ compliance.

Objectives: 

To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy.

Search strategy: 

An updated search was performed in the Cochrane Schizophrenia Group’s Trials Register (3 May 2012) and the references of all identified studies for further trials.

Selection criteria: 

We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.

Data collection and analysis: 

We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random-effects model. We analysed cross-over trials under consideration of correlation of paired measures.

Main results: 

Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross-over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale -0.40 95% CI -3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD -2.02 95% CI -5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD -0.80 95% CI -1.55 to -0.05).

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