Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health Practice

Abstract

Amitriptyline is an old drug but is still prevalently used as the first-line treatment for a variety of common diseases. Surprisingly, knowledge of sexual risks with amitriptyline comes from only one clinical trial and several case reports from three decades ago. In the current study, a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) related to amitriptyline and sexual dysfunction (SD) was performed. The frequency, gender-difference, types, disease-specificity and time course of SD, and the relationship between SD and nonsexual adversity were studied. A total of 14 publications, including 8 qualified randomized clinical trials, were eligible. The frequency of SD in overall, male and female patients was 5.7, 11.9 and 1.7%, respectively. SD was six-fold higher in men than women. The frequency of SD was 6.9% in depressive patients compared with 0.8% in non-depressive patients (p = .008), and gradually decreased at 8 weeks after treatment (p = .02). Amitriptyline impacted arousal and libido more than orgasm and ejaculation in male patients but mainly libido in female patients. SD was significantly correlated with insomnia linearly whereas somnolence and nausea dually. Therefore, amitriptyline-associated SD mainly occurs in depressive and male patients, disturbs each phase of the sexual response cycle in men but mainly libido in women, gradually decreases under long-term treatment, and can be predicted by the co-existence of insomnia, somnolence or nausea during treatment. Clinicians should caution and tailor the gender and disease vulnerability of amitriptyline in their practice.

A platform utilizing Drosophila ovulation for nonhormonal contraceptive screening

“…The similarity of the ovarian phenotype between chlorpromazine-treated and PR-knockout mice also leads us to propose that chlorpromazine might target PR-associated proteolysis and ECM remodeling in follicular granulosa cells during follicle rupture. Amitriptyline, an antidepressant drug for migraines, has not been well-studied in the reproductive process and is not linked to defective ovulation ( 60 ). In contrast, amitriptyline seems to improve ovary morphology and functions in rats with estradiol valerate–induced polycystic ovary by modulating ovarian adrenergic signaling ( 61 ).…”

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction

“…§ § § § § § § § § § § § §,123 (NEW) 13.4.1 Brachytherapy: Delivery of radioactive material sealed in needles, seeds, wires or catheters directly into the prostate gland for curative management of prostate cancer. 110,123 Usually beneficial [94][95][96] Psychotherapy and multidisciplinary pain management Usually beneficial [94][95][96] Nonsteroidal anti-inflammatory drugs (NSAID) No direct effect on SD Opioids Chronic use is associated with worsening of SD 106 Tricyclic antidepressants (TCA) Amitriptyline may have a negative impact on arousal and libido, especially on depressive patients 107 Anticonvulsants Pregabalin may cause ED, anorgasmia and loss of libido 92,93 Transurethral resection Retrograde ejaculation…”

Classics in Chemical Neuroscience: Amitriptyline

“…Sexual dysfunction is estimated to occur in 6 times more males than females who take amitriptyline. 84 Sexuality is a complex and integrated part of one's identity. As such, emotional and psychological processes are as important as physical stimulation.…”

“…Sexual dysfunction is estimated to occur in 6 times more males than females who take amitriptyline . Sexuality is a complex and integrated part of one’s identity.…”