Aspirin for treatment of lithium‐associated sexual dysfunction in men: randomized double‐blind placebo‐controlled study

Saroukhani, Sepideh; Emami-Parsa, Morteza; Modabbernia, Amirhossein; Ashrafi, Mandana; Farokhnia, Mehdi; Hajiaghaee, Reza; Akhondzadeh, Shahin

doi:10.1111/bdi.12108

Cited by 48 publications

(71 citation statements)

References 33 publications

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“…In the only controlled trial, aspirin 240 mg daily was more effective than placebo in reducing overall sexual dysfunction and in improving erectile dysfunction (Saroukhani et al 2013). Phosphodiesterase 5 inhibitors, which have been demonstrated as effective in treating SSRI-induced sexual dysfunction in both men and women (Nurnberg et al 2008, 2003), should be considered for those with lithium-associated sexual difficulties, especially if diminished arousal plays an important role.…”

Section: Resultsmentioning

confidence: 99%

Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

371

301

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Despite its virtually universal acceptance as the gold standard in treating bipolar disorder, prescription rates for lithium have been decreasing recently. Although this observation is multifactorial, one obvious potential contributor is the side effect and toxicity burden associated with lithium. Additionally, side effect concerns assuredly play some role in lithium nonadherence. This paper summarizes the knowledge base on side effects and toxicity and suggests optimal management of these problems. Thirst and excessive urination, nausea and diarrhea and tremor are rather common side effects that are typically no more than annoying even though they are rather prevalent. A simple set of management strategies that involve the timing of the lithium dose, minimizing lithium levels within the therapeutic range and, in some situations, the prescription of side effect antidotes will minimize the side effect burden for patients. In contrast, weight gain and cognitive impairment from lithium tend to be more distressing to patients, more difficult to manage and more likely to be associated with lithium nonadherence. Lithium has adverse effects on the kidneys, thyroid gland and parathyroid glands, necessitating monitoring of these organ functions through periodic blood tests. In most cases, lithium-associated renal effects are relatively mild. A small but measurable percentage of lithium-treated patients will show progressive renal impairment. Infrequently, lithium will need to be discontinued because of the progressive renal insufficiency. Lithium-induced hypothyroidism is relatively common but easily diagnosed and treated. Hyperparathyroidism from lithium is a relatively more recently recognized phenomenon.

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Section: Resultsmentioning

confidence: 99%

Lithium side effects and toxicity: prevalence and management strategies

Gitlin

2016

Int J Bipolar Disord

371

301

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“…There are insufficient data to make a recommendation regarding the use of aspirin (adjunctive) (level 3 negative),296 celecoxib (adjunctive) (level 3 negative),297 gabapentin (monotherapy) (level 3 negative),298 leviteracitam (adjunctive) (level 3 negative),299 lisdexamfetamine (adjunctive) (level 3 negative),300 memantine (adjunctive) (level 3),301 pioglitazone (adjunctive) (level 3),302, 303 riluzole (level 4 negative),304 and risperidone (adjunctive) (level 3) 305. Although adjunctive therapy with pregnenolone separated from placebo at week 6, the change in depressive symptoms was not significantly different from week 8 to week 12 between the two groups (level 2) 306…”

Section: Acute Management Of Bipolar Depressionmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Using the lowest effective dose of the drug, switching to alternatives, or some add-on strategies may be useful 148 . A small randomized placebo-controlled trial suggests that adjunctive aspirin (240 mg/day) may improve erectile dysfunction in patients undergoing lithium treatment 149 . There is currently no information on the potential utility of PDE-5 inhibitors such as sildenafil, but it seems reasonable to consider them based on clinical experience in other patients.…”

Section: Management Of Treatment-induced Sexual Dysfunction In Bipolamentioning

confidence: 99%

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

2018

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Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.

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Aspirin for treatment of lithium‐associated sexual dysfunction in men: randomized double‐blind placebo‐controlled study

Abstract: Aspirin effectively improves lithium-related sexual dysfunction in men with stable BAD.

Cited by 48 publications

References 33 publications

Lithium side effects and toxicity: prevalence and management strategies

Lithium side effects and toxicity: prevalence and management strategies

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

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