Neural Correlates of Antidepressant-Related Sexual Dysfunction: A Placebo-Controlled fMRI Study on Healthy Males Under Subchronic Paroxetine and Bupropion

Abler, Birgit; Seeringer, Angela; Hartmann, Antonie; Grön, Georg; Metzger, Coraline D.; Walter, Martin; Stingl, Julia C.

doi:10.1038/npp.2011.66

Cited by 77 publications

(82 citation statements)

References 58 publications

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“…Consistent with our finding of increased sexual arousal after methylphenidate, the DA precursor levodopa enhanced the activation of the nucleus accumbens when subliminal sexual stimuli were shown, whereas the DA D 2 -receptor antagonist haloperidol decreased activations (Oei et al, 2012). Accordingly, the DA and NE transporter inhibitor and antidepressant bupropion, which has less side effects on sexual arousal and libido than serotonergic antidepressants, increased activation of brain regions related to sexual functioning (Abler et al, 2011). Moreover, flibanserin, which enhances NE and DA while reducing 5-HT (Borsini et al, 2002), increased sexual desire in women with hypoactive sexual desire (Katz et al, 2013).…”

Section: Discussionsupporting

confidence: 88%

Effects of methylphenidate and MDMA on appraisal of erotic stimuli and intimate relationships

Schmid

Hysek

Preller

et al. 2015

European Neuropsychopharmacology

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Methylphenidate mainly enhances dopamine neurotransmission whereas 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") mainly enhances serotonin neurotransmission. However, both drugs also induce a weaker increase of cerebral noradrenaline exerting sympathomimetic properties. Dopaminergic psychostimulants are reported to increase sexual drive, while serotonergic drugs typically impair sexual arousal and functions. Additionally, serotonin has also been shown to modulate cognitive perception of romantic relationships. Whether methylphenidate or MDMA alter sexual arousal or cognitive appraisal of intimate relationships is not known. Thus, we evaluated effects of methylphenidate (40mg) and MDMA (75mg) on subjective sexual arousal by viewing erotic pictures and on perception of romantic relationships of unknown couples in a double-blind, randomized, placebo-controlled, crossover study in 30 healthy adults. Methylphenidate, but not MDMA, increased ratings of sexual arousal for explicit sexual stimuli. The participants also sought to increase the presentation time of implicit sexual stimuli by button press after methylphenidate treatment compared with placebo. Plasma levels of testosterone, estrogen, and progesterone were not associated with sexual arousal ratings. Neither MDMA nor methylphenidate altered appraisal of romantic relationships of others. The findings indicate that pharmacological stimulation of dopaminergic but not of serotonergic neurotransmission enhances sexual drive. Whether sexual perception is altered in subjects misusing methylphenidate e.g., for cognitive enhancement or as treatment for attention deficit hyperactivity disorder is of high interest and warrants further investigation.

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Section: Discussionsupporting

confidence: 88%

Effects of methylphenidate and MDMA on appraisal of erotic stimuli and intimate relationships

Schmid

Hysek

Preller

et al. 2015

European Neuropsychopharmacology

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“…In a recent functional magnetic resonance imaging (fMRI) study in healthy subjects using primary rewards, we demonstrated decreased subcortical reward system activation under steady-state conditions of the SSRI paroxetine but not under the dopamine-norepinephrine reuptake inhibitor bupropion (Abler et al, 2011). No interaction effect of task and medication was observed in prefrontal brain areas.…”

Section: Introductionmentioning

confidence: 75%

“…Exclusion criteria were any psychiatric, neurological, and/or major medical diagnoses currently or in the past; any serious general medical condition; use of illegal drugs; excessive consumption of caffeine or alcohol; any regular systemic medication; and/or any other medication within the week before the study. Detailed sample characteristics and exclusion criteria were reported previously (Abler et al, 2011). Upon recruitment, subjects completed a German version (Reinecke et al, 2006) of the Massachusetts General Hospital Sexual Function Questionnaire (Labbate and Lare, 2001).…”

Section: Methodsmentioning

confidence: 99%

Modulation of Frontostriatal Interaction Aligns with Reduced Primary Reward Processing under Serotonergic Drugs

Abler¹,

Grön²,

Hartmann³

et al. 2012

J. Neurosci.

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Recently, functional interactions between anteroventral prefrontal cortex and nucleus accumbens (NAcc) have been shown to relate to behavior counteracting reward-desiring (Diekhof and Gruber, 2010). Downregulation of the reward system by serotonin has also been suggested as the mode of action accounting for unsatisfactory effects of serotonin reuptake inhibitors (SSRIs) such as insufficient alleviation or even increase of anhedonia, and loss of interest. However, understanding of the in vivo mechanisms of SSRI-related alteration of the human reward system is still incomplete. Using functional magnetic resonance imaging (fMRI) within a double-blind cross-over within-subjects study design and administering the SSRI paroxetine, the dopamine/norepinephrine reuptake inhibitor bupropione, and placebo for 7 d each, we investigated a group of 18 healthy male subjects. Under paroxetine, subjects showed significantly decreased activation of the bilateral NAcc during processing of primary rewards (erotic videos), but not under bupropion. Similar to the previous study, analysis of psychophysiological interactions revealed that this downregulation relied on negative interactions between left and right NAcc fMRI signals and the bilateral anteroventral prefrontal cortex that now were significantly enhanced under paroxetine and reduced under bupropion. Individual drug-dependent modulations of interacting brain regions were significantly associated with individual expressions of impulsivity as a personality trait. Our results corroborate and extend previous insights on interregional crosstalk from secondary to primary rewards and demonstrate parallels between active inhibitory control of and serotonergic effects on the dopaminergic reward system's activity.

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“…It is not uncommon for substance misusers to experience difficulties with sexual performance owing to the effects of for example, opiates, methamphetamine and certain SSRI's. [16][17][18][19][20] Further, Arndt 21 stated that paraphilic infantilism often co-occurs with fetishism, masochism and/ or transvestism. Case 2 had expressed his sexuality via paraphilic transvestism whilst reverting to paraphilic infantilism following stimulant drug abuse.…”

Section: Case 2 Reportedmentioning

confidence: 99%

The Use of Cognitive Behavioural Therapy on Two Case Reports of Paraphilic Infantilism, Substance Misuse and Childhood Abuse

Banbury

Lusher

Athanasiadou-Lewis

et al. 2017

MOJAMT

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Abbreviations: APA, american psychiatric association; AB, adult baby; SB, sissy babies'; DL, diaper lovers; CBT, cognitive behavioral therapy; SSRIS, selective serotonin re-uptake inhibitors; PTSD, posttraumatic stress disorder Introduction: An overview of paraphilic infantilismParaphilia refers to the intense and persistent sexual interest and arousal towards objects, situations or individuals which are atypical, equal to and/or greater than normophilic sexual interests.1 Paraphilic disorders in the DSM-5 include exhibitionism, fetishism, peadophilia, sexual masochism, sexual sadism, transvestic fetishism and voyeurism possess a formal diagnostic criteria (APA, 2015). However, paraphilic infantilism is classified as a sexual disorder under, 'other specified paraphilic disorder'. 1 It was during the 1960's that reference to clients' exclusive wearing of diapers as a means of attaining sexual arousal became documented. Tuchman & Lachman 2 reported a child sex offender, who had been molesting his 4 and 6 year old daughters. He would wear rubber pants over his diaper and enjoyed urinating and masturbating in them. Malitz 3 describes a 20 year old male who had broken into a house with the sole intention of wearing diapers and defecating in them and subsequently reaching orgasm. Dinello 4 provided a diagnostic understanding of a 17 year old male who wore diapers, had eaten baby food, drank from a baby bottle and masturbated whilst wearing a diaper.During the 1980's, Money 5 termed the paraphilic condition of impersonating a baby, autonepiophilia, diaperism or paraphilic infantilism. Money 6 distinguished between infantilism, autonepiophilia and paraphilic diaper-wearing, stating that the latter is a paraphilic fetish involving an erotic attraction to an article of clothing whilst the former is a non-fetishistic paraphilia aimed at regressive age identity role play. Paraphilic infantilism was described as an individual acting as an infant including associated behaviours of drinking from a baby bottle, being fed baby food, being breast fed, wearing baby cloths, wearing diapers and sleeping in a crib. This may have involved the assistance of a 'nanny', 'daddy' or 'mommy' to accommodate the infantilists requirements. 6,7 When role play involves regressing back to an infant state the individual is referred to as an adult baby (AB). The AB's like to dress up as a baby, get baby fed, have diaper changes and so forth.7 'Sissy babies' (SB) are adults who also play the infant role however, the role played is the opposite gender and may involve cross dressing SBs. Those who only engage in wearing diapers, as a sexual fetish, without the regressive fantasies are referred to as diaper lovers (DL). 7Those who experience both the sexual aspect of wearing diapers and the enjoyment of engaging in infantile play are referred to as adult baby/diaper lovers (AB/DL). 7Money 6 also referred to paraphilic juvenilism or age play. Age Play predominately involves adults who role play at being babies, children or younger adults. Money 6 examin...

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Neural Correlates of Antidepressant-Related Sexual Dysfunction: A Placebo-Controlled fMRI Study on Healthy Males Under Subchronic Paroxetine and Bupropion

Cited by 77 publications

References 58 publications

Effects of methylphenidate and MDMA on appraisal of erotic stimuli and intimate relationships

Effects of methylphenidate and MDMA on appraisal of erotic stimuli and intimate relationships

Modulation of Frontostriatal Interaction Aligns with Reduced Primary Reward Processing under Serotonergic Drugs

The Use of Cognitive Behavioural Therapy on Two Case Reports of Paraphilic Infantilism, Substance Misuse and Childhood Abuse

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