Management of sexual dysfunction due to antipsychotic drug therapy

Abstract

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Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

“…While sometimes, fully restoring previous sexual function is not achievable, partially alleviating the experienced symptoms can satisfy the patient’s expectations without jeopardizing the antipsychotic effect of their treatment. When compared with SD caused by antidepressants, the literature on intervention in TESD caused by APS is scarce, and frequently inconsistent [ 2 , 147 ], although some viable options emerge. Some possible strategies for treating TESD are the following: (1) waiting for spontaneous remission; (2) dose reduction; (3) switching to another APS; and (4) the addition of an antidote (coadjuvant drug).…”

“…No studies have been performed with APS regarding this strategy [ 2 , 156 ]. In fact, randomized controlled trials are currently needed to provide evidence for this or any other dose reduction strategies [ 147 , 157 ].…”

“…A small open label trial points to olanzapine as an option [ 147 ], as it had been previously suggested by one case report [ 129 ] and an observational study [ 155 ].…”

“…Case reports and prospective studies suggest that switching to quetiapine might improve SD in a way that is tolerated by the patient [ 162 , 163 ], with one randomized trial confirming these positive results [ 84 ] at a mean dose below 500 mg/day. However, another randomized trial did not show a significant difference in SD improvement [ 63 , 147 ]. Nonetheless, it is still recommended as an option by some authors [ 1 , 150 , 157 ].…”

“…After the first successful case report with sildenafil, suggesting it as an option [ 176 ], two small observational studies followed with moderate to good results [ 177 , 178 ]. Despite a small sample ( n = 32) and short duration (2 weeks), a randomized placebo-controlled trial confirmed the potential of sildenafil as coadjuvant treatment in TESD [ 179 ], as ratified by a Cochrane review [ 147 ]. As with aripiprazole, the specific dose probably needs to be individualized for each patient, with some experiencing improvement at 25 mg/day and others at 100 mg/day.…”

Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

“…While sometimes, fully restoring previous sexual function is not achievable, partially alleviating the experienced symptoms can satisfy the patient’s expectations without jeopardizing the antipsychotic effect of their treatment. When compared with SD caused by antidepressants, the literature on intervention in TESD caused by APS is scarce, and frequently inconsistent [ 2 , 147 ], although some viable options emerge. Some possible strategies for treating TESD are the following: (1) waiting for spontaneous remission; (2) dose reduction; (3) switching to another APS; and (4) the addition of an antidote (coadjuvant drug).…”

“…No studies have been performed with APS regarding this strategy [ 2 , 156 ]. In fact, randomized controlled trials are currently needed to provide evidence for this or any other dose reduction strategies [ 147 , 157 ].…”

“…A small open label trial points to olanzapine as an option [ 147 ], as it had been previously suggested by one case report [ 129 ] and an observational study [ 155 ].…”

“…Case reports and prospective studies suggest that switching to quetiapine might improve SD in a way that is tolerated by the patient [ 162 , 163 ], with one randomized trial confirming these positive results [ 84 ] at a mean dose below 500 mg/day. However, another randomized trial did not show a significant difference in SD improvement [ 63 , 147 ]. Nonetheless, it is still recommended as an option by some authors [ 1 , 150 , 157 ].…”

“…After the first successful case report with sildenafil, suggesting it as an option [ 176 ], two small observational studies followed with moderate to good results [ 177 , 178 ]. Despite a small sample ( n = 32) and short duration (2 weeks), a randomized placebo-controlled trial confirmed the potential of sildenafil as coadjuvant treatment in TESD [ 179 ], as ratified by a Cochrane review [ 147 ]. As with aripiprazole, the specific dose probably needs to be individualized for each patient, with some experiencing improvement at 25 mg/day and others at 100 mg/day.…”

Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

“…While sometimes, fully restoring previous sexual function is not achievable, partially alleviating the experienced symptoms can satisfy the patient’s expectations without jeopardizing the antipsychotic effect of their treatment. When compared with SD caused by antidepressants, the literature on intervention in TESD caused by APS is scarce, and frequently inconsistent [ 2 , 147 ], although some viable options emerge. Some possible strategies for treating TESD are the following: (1) waiting for spontaneous remission; (2) dose reduction; (3) switching to another APS; and (4) the addition of an antidote (coadjuvant drug).…”

“…No studies have been performed with APS regarding this strategy [ 2 , 156 ]. In fact, randomized controlled trials are currently needed to provide evidence for this or any other dose reduction strategies [ 147 , 157 ].…”

“…A small open label trial points to olanzapine as an option [ 147 ], as it had been previously suggested by one case report [ 129 ] and an observational study [ 155 ].…”

“…Case reports and prospective studies suggest that switching to quetiapine might improve SD in a way that is tolerated by the patient [ 162 , 163 ], with one randomized trial confirming these positive results [ 84 ] at a mean dose below 500 mg/day. However, another randomized trial did not show a significant difference in SD improvement [ 63 , 147 ]. Nonetheless, it is still recommended as an option by some authors [ 1 , 150 , 157 ].…”

“…After the first successful case report with sildenafil, suggesting it as an option [ 176 ], two small observational studies followed with moderate to good results [ 177 , 178 ]. Despite a small sample ( n = 32) and short duration (2 weeks), a randomized placebo-controlled trial confirmed the potential of sildenafil as coadjuvant treatment in TESD [ 179 ], as ratified by a Cochrane review [ 147 ]. As with aripiprazole, the specific dose probably needs to be individualized for each patient, with some experiencing improvement at 25 mg/day and others at 100 mg/day.…”

Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

“…While sometimes, fully restoring previous sexual function is not achievable, partially alleviating the experienced symptoms can satisfy the patient’s expectations without jeopardizing the antipsychotic effect of their treatment. When compared with SD caused by antidepressants, the literature on intervention in TESD caused by APS is scarce, and frequently inconsistent [ 2 , 147 ], although some viable options emerge. Some possible strategies for treating TESD are the following: (1) waiting for spontaneous remission; (2) dose reduction; (3) switching to another APS; and (4) the addition of an antidote (coadjuvant drug).…”

“…No studies have been performed with APS regarding this strategy [ 2 , 156 ]. In fact, randomized controlled trials are currently needed to provide evidence for this or any other dose reduction strategies [ 147 , 157 ].…”

“…A small open label trial points to olanzapine as an option [ 147 ], as it had been previously suggested by one case report [ 129 ] and an observational study [ 155 ].…”

“…Case reports and prospective studies suggest that switching to quetiapine might improve SD in a way that is tolerated by the patient [ 162 , 163 ], with one randomized trial confirming these positive results [ 84 ] at a mean dose below 500 mg/day. However, another randomized trial did not show a significant difference in SD improvement [ 63 , 147 ]. Nonetheless, it is still recommended as an option by some authors [ 1 , 150 , 157 ].…”

“…After the first successful case report with sildenafil, suggesting it as an option [ 176 ], two small observational studies followed with moderate to good results [ 177 , 178 ]. Despite a small sample ( n = 32) and short duration (2 weeks), a randomized placebo-controlled trial confirmed the potential of sildenafil as coadjuvant treatment in TESD [ 179 ], as ratified by a Cochrane review [ 147 ]. As with aripiprazole, the specific dose probably needs to be individualized for each patient, with some experiencing improvement at 25 mg/day and others at 100 mg/day.…”