Psychotropics and sexual dysfunction: the evidence and treatments

Sexual dysfunction is common in the general population and even more common in the mentally or medically ill. Because mentally ill patients often receive psychotropics, many of which affect sexual functioning, a patient's pre-existing sexual difficulties are often compounded, and these adverse effects may contribute to psychological difficulties or medication discontinuation. The effects of antidepressants, antipsychotics, mood stabilizers and anxiolytics on sexual functioning are critically reviewed. When possible, the types of sexual dysfunction (e.g. desire, arousal, or orgasm) induced by the drug is described. Treatments for drug-induced sexual function are described, but few controlled studies show benefit. Only sildenafil stands as a convincing treatment for drug-induced sexual dysfunction. The paper focuses on the placebo-controlled clinical trials that specifically evaluated sexual functioning in patients treated with psychotropics. Controlled studies are few for all the agents, though best for the antidepressants and antipsychotics. The exact magnitude and phase of sexual functioning affected remains to be elucidated for most psychotropic drugs. Although all phases of sexual functioning may be impaired by psychotropics, selective serotonin reuptake inhibitor antidepressants appear to primarily affect orgasm, while antipsychotics primarily affect desire. There is insufficient evidence to make conclusions about the anxiolytics or mood stabilizers.