Extended-release naltrexone (Vivitrol) augmentation for compulsive sexual behavior disorder: a case report

Area of Science:

• Psychiatry
• Pharmacology
• Neuroscience

Background:

• Compulsive sexual behavior disorder (CSBD) is an impulse control disorder with limited pharmacological treatments.
• Naltrexone, an opioid receptor antagonist, has shown potential for CSBD, but its extended-release injectable form lacks evaluation for this use.
• Current treatments often provide inadequate symptomatic benefit for CSBD.

Purpose of the Study:

• To evaluate the efficacy of extended-release naltrexone as an augmentation strategy for a patient with severe compulsive sexual behavior disorder.
• To assess the impact of extended-release naltrexone on compulsive sexual behaviors unresponsive to standard treatments.

Main Methods:

• A case presentation of a 54-year-old male with escalating CSBD symptoms despite desvenlafaxine and psychotherapy.
• Initiation of monthly intramuscular extended-release naltrexone (380 mg) as augmentation therapy.
• Symptom severity assessed using the Compulsive Sexual Behavior Inventory-13 (CSBI-13) and Hypersexual Behavior Inventory-19 (HBI-19) over three months.
• Monitoring of hepatic function and adverse events.

Main Results:

• Significant reduction in CSBD symptoms observed within one month of naltrexone initiation.
• CSBI-13 scores reduced by 61.5% at one month and 46.2% by three months.
• HBI-19 scores decreased by 46.2% at one month and 48.4% by three months.
• No adverse events or hepatic function abnormalities were reported.

Conclusions:

• Extended-release naltrexone may be an effective augmentation strategy for CSBD refractory to antidepressant pharmacotherapy and psychotherapy.
• This case suggests a potential role for injectable naltrexone in managing compulsive sexual behaviors.
• Further controlled trials are necessary to confirm the efficacy and safety of extended-release naltrexone for CSBD.