The Use of Monoamine Pharmacological Agents in the Treatment of Sexual Dysfunction: Evidence in the Literature

Abstract

Introduction The monoamine neurotransmitters serotonin, dopamine, and norepinephrine play an important role in many medical and psychological conditions, including sexual responsiveness and behavior. Pharmacological agents that modulate monoamines may help alleviate sexual dysfunction. Aims To provide an overview of pharmacological agents that modulate monoamines and their use in the treatment of sexual dysfunction. Methods EMBASE and PubMed search for articles published between 1950 and 2010 using key words “sexual dysfunction,”“monoamines,”“monoaminergic receptors,” and “generic names for pharmacological agents.” Main Outcome Measures To assess the literature evaluating the efficacy of monoamine pharmacologic agents used in the treatment of sexual dysfunction. Results The literature primarily cites the use of monoaminergic agents to treat sexual side effects from serotonergic reuptake inhibitors (SSRIs), with bupropion, buspirone and ropinirole providing the most convincing evidence. Controlled trials have shown that bupropion improves overall sexual dysfunction, but not frequency of sexual activity in depressed and nondepressed patients. Nefazodone and apomorphine have been used to treat sexual dysfunction, but their use is limited by significant side effect and safety profiles. New research on pharmacologic agents with subtype selectivity at dopaminergic and serotonergic receptors and those that possess dual mechanisms of action are being investigated. Conclusions There has been tremendous progress over the past 50 years in understanding the role of monoamines in sexual function and the effect of pharmacologic agents which stimulate or antagonize monoaminergic receptors on sexual dysfunction. Nevertheless, large, double-blind, placebo-controlled studies evaluating the efficacy of currently available agents in populations without comorbid disorders are limited, preventing adequate interpretation of data. Continued research on sexual function and specific receptor subtypes will result in the development of more selective pharmacologic agents with the goal of increasing efficacy without the dose-limiting side effects of nonselective agents.

The Antidepressants Fluoxetine and Bupropion Differentially Affect Proceptive Behavior in the Naturally Cycling Female Rat

“…These side effects are present in 30% to 73% of users . In line with this, animal sexual behavior studies have shown that acute or chronic treatment with SSRIs inhibits sexual behavior in males and females . The inhibitory effects of fluoxetine (FLX) and other SSRIs on female sexual behavior may be veiled by their disruptive actions on the regularity of the estrous cycle .…”

Modulation of Dopaminergic Pathways to Treat Erectile Dysfunction

“…In one open trial where 13 patients reported sexual dysfunction after they began with antidepressant treatment, sexual function, measured by use of the Arizona Sexual Experience Scale and Clinical Global Impression of Improvement scales, showed a significant effect on both scales 3 weeks after initiation of treatment with ropinirole . The doses of ropinirole (3–4 mg/day) in the latter study were markedly lower than the doses (20–25 mg/day) described to cause hypersexuality and sexual urges in patients with Parkinson's disease . Therefore, the potential for treating ED of mixed origin by selective agonists for dopamine D 2 or D 3 receptors remains to be explored, although the effects on potentially severe side effects as behaviour and blood pressure should be taken into account.…”

EEG to Primary Rewards: Predictive Utility and Malleability by Brain Stimulation

“…Reward structures are clearly implicated in sexual anticipation through receipt [73]. Dopamine agonists increase sex behaviors [74] and enhance sexual response [75]. …”