<1> Unique Identifier 95014096 Authors Gitlin MJ. Institution Department of Psychiatry, UCLA School of Medicine 90024-6968. Title Psychotropic medications and their effects on sexual function: diagnosis, biology, and treatment approaches. [Review] Source Journal of Clinical Psychiatry. 55(9):406-13, 1994 Sep. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract BACKGROUND: The recognition and treatment of sexual side effects caused by psychotropic agents have become topics of increasing clinical concern. Gaps in our understanding of the biology of sex and in our knowledge of the effect of Axis I disorders on sexual functioning have made both recognition of sexual side effects and a coherent treatment approach to these side effects difficult. METHOD: The author reviews case reports, case series, and animal studies derived from a MEDLINE search for English language articles on the topics of the effects of psychiatric disorders on sexual functioning, the biology of sex, rates of sexual dysfunction associated with each medication class, and treatment approaches when these side effects occur. RESULTS: In evaluating sexual function in patients taking psychotropic medications, clinicians should first consider other potential causes of sexual dysfunction. In general, dopamine increases sexual behavior, serotonin inhibits it, while norepinephrine has conflicting effects. Sexual side effects have been described in association with all the major classes of psychotropic medications. Neuroleptics are often associated with sexual side effects. Priapism, seen with neuroleptics and trazodone, should be treated as a urological emergency. Anxiolytics cause mild, nonspecific sexual side effects as do the mood stabilizers. Among the antidepressants, the more powerful serotonergic medications--e.g., the serotonin selective reuptake inhibitors (SSRIs), clomipramine, and MAO inhibitors--may cause more sexual side effects than the tricyclics. Potential strategies to treat antidepressant-induced sexual side effects include lowering the dose, waiting, and switching to another agent. A number of specific antidotes, such as cyproheptadine and yohimbine, have been reported to reverse these side effects in a limited number of cases. CONCLUSION: Clinicians must be aware of and specifically ask about medication-induced sexual side effects. More effective treatments of these side effects must await much needed double-blind studies of various approaches, especially those to treat SSRI-induced sexual dysfunction. [References: 85] Registry Numbers 0 (Antidepressive Agents). 0 (Antipsychotic Agents). 0 (Monoamine Oxidase Inhibitors). 0 (Serotonin Uptake Inhibitors). 50-67-9 (Serotonin). 51-61-6 (Dopamine). <2> Unique Identifier 94196541 Authors Warot D. Institution Departement de Pharmacologie Clinique, Hopital Pitie-Salpetriere, Paris. Title [Value of autoquestionnaires in the evaluation of sex disorders related to drugs]. [French] Original Title Interet des autoquestionnaires dans l'evaluation des troubles sexuels lies aux medicaments. Source Therapie. 48(5):441-3, 1993 Sep-Oct. Local Messages TITLE NOT IN LIBRARY. REQUEST COPY VIA INTER-LIBRARY LOAN. Abstract Symptoms can be assessed by the subject or the patient himself. Drug-related sexual dysfunction may be of clinical relevance for medication compliance. Three kinds of self-rating scales are available: yes/no questionnaire, multiple choice questionnaire and visual analogue scales. Self-rating can be absolute (intensity score) or relative (improving or worsening score), over last rating or over baseline. Self-rating necessarily implies: comprehension of the vocabulary and the instructions by the subject; cooperation of the subject; and careful checking of the answers by the clinician. Main metrologic qualities are sensitivity, reliability and validity. To assess changes in sexual function, the "golden" sexual function questionnaire does not seem to exist. Separate questionnaires are provided for men and women with appropriate changes for specific items. The number of questions varies from 4 to 20 even more. Several aspects of the male and female sexuality must be studied. Two main questions can be raised: 1) is there any relation between responses obtained with self-reported questionnaire and responses to questioning by a clinician? is there any relation between self-reported sexual dysfunction and objective measures of sexual function like plethysmography? <3> Unique Identifier 93322342 Authors Balon R. Yeragani VK. Pohl R. Ramesh C. Institution Department of Psychiatry, Wayne State University School of Medicine, Detroit, Mich. Title Sexual dysfunction during antidepressant treatment. Source Journal of Clinical Psychiatry. 54(6):209-12, 1993 Jun. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract BACKGROUND: The reported incidence of sexual dysfunction associated with antidepressant medication varies from 1.9% to 92%. The majority of studies reporting incidences were not systematically conducted. METHOD: We interviewed 60 patients (22 men and 38 women, with anxiety and mood disorders) who were being treated with various antidepressants. We used a questionnaire focused on sexual side effects and other side effects. RESULTS: The incidence of sexual dysfunction during antidepressant use in our study is 43.3%. The sexual dysfunction was not limited to any particular diagnostic group nor to any particular antidepressant. There was no significant correlation between sexual dysfunction and anticholinergic side effects. The incidence of painful orgasm with antidepressants was 18% among males in our study. CONCLUSION: The relatively high incidence of sexual dysfunction associated with antidepressant treatment in this systematic study emphasizes the importance of a detailed inquiry about sexual side effects as this interferes with treatment compliance. Registry Numbers 0 (Antidepressive Agents). 303-49-1 (Clomipramine). 50-49-7 (Imipramine). 54910-89-3 (Fluoxetine). <4> Unique Identifier 93350718 Authors Donatucci CF. Lue TF. Institution Department of Urology, University of California School of Medicine, San Francisco 94143-07387. Title Erectile dysfunction in men under 40: etiology and treatment choice. Source International Journal of Impotence Research. 5(2):97-103, 1993 Jun. Abstract We undertook a retrospective review of 100 impotent men under age 40 to determine the underlying etiologic factors in the group and to evaluate the role of surgery in their care. Although patients ranged in age from 18 to 40 (mean--32.2 years), the number of patients increased steadily with advancing years. The majority of patients (72) had vasculogenic impotence (arteriogenic--15, venogenic--46, mixed--11), followed by psychogenic (13), neurogenic (12) and other causes (4). The differential diagnosis did not correlate with age. Contributing factors were present in 76%, trauma and substance abuse being most common. Essentially equal numbers of patients were treated surgically (40) and with intracavernous injection of vasoactive agents (39). Considerably fewer had a vacuum constriction device (5), oral medication (5), psychotherapy (4), other therapy (4), and none (3). The majority of patients referred to our tertiary urologic practice for treatment of vasculogenic impotence were sent by other urologists. Although the referral source did not appear to influence the choice of treatment, it probably has accounted for the preponderance of vasculogenic impotence in this series. Registry Numbers 0 (Vasoconstrictor Agents). <5> Unique Identifier 92254455 Authors Lundberg PO. Title [Sexual dysfunction--problem because of physical illness or medication]. [Swedish] Original Title Sexuella funktionshinder--problem pa grund av kroppslig sjukdom och lakemedel. Source Vardfacket. 15(16):XXII-XXIV, 1991 Sep 26. Local Messages TITLE NOT IN LIBRARY. REQUEST COPY VIA INTER-LIBRARY LOAN. <1> Unique Identifier 91065585 Authors Sullivan G. Lukoff D. Institution Rehabilitation Service, Brentwood Veterans Affairs, West Los Angeles, California. Title Sexual side effects of antipsychotic medication: evaluation and interventions. [Review] Source Hospital & Community Psychiatry. 41(11):1238-41, 1990 Nov. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract Sexual side effects of antipsychotic medications, which include disturbances of erection and ejaculation, changes in libido, and priapism in men and decreased libido, orgasmic dysfunction, and menstrual irregularities in women, are estimated to occur in 30 to 60 percent of persons taking the drugs. The authors review side effects associated with specific drugs and present guidelines for assessing whether sexual dysfunction is related to medication. Pharmacological interventions that may reduce antipsychotic-induced sexual dysfunction include gradually reducing the dose or changing the type of medication and administering other medications such as bethanechol, neostigmine, cyproheptadine, and bromocriptine that are known to improve sexual dysfunction. [References: 52] Registry Numbers 0 (Antipsychotic Agents). <2> Unique Identifier 89259142 Authors Susset JG. Tessier CD. Wincze J. Bansal S. Malhotra C. Schwacha MG. Institution Department of Urology, Providence Veterans Administration Medical Center, Rhode Island. Title Effect of yohimbine hydrochloride on erectile impotence: a double-blind study. Source Journal of Urology. 141(6):1360-3, 1989 Jun. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract A double-blind, partial crossover study on the therapeutic effect of yohimbine hydrochloride on erectile dysfunction was done in 82 sexually impotent patients. All patients underwent a multifactorial evaluation, including determination of penile brachial blood pressure index, cavernosography, sacral evoked response, testosterone and prolactin determination, Derogatis sexual dysfunction inventory and daytime arousal test. After 1 month of treatment with a maximum of 42.0 mg. oral yohimbine hydrochloride daily 14 per cent of the patients experienced restoration of full and sustained erections, 20 per cent reported a partial response to the therapy and 65 per cent reported no improvement. Three patients reported a positive placebo effect. Maximum effect takes 2 to 3 weeks to manifest itself. Yohimbine was active in some patients with arterial insufficiency and a unilateral sacral reflex arc lesion, and in 1 with low serum testosterone levels. The 34 per cent response is encouraging, particularly in a Veterans Administration population presenting with a high incidence of diabetes and vascular pathological conditions not found in regular office patients. Only few and benign side effects were recorded, which makes this medication worth an attempt, often as a first line of treatment even at a dose of 8 tablets. Registry Numbers 146-48-5 (Yohimbine). <3> Unique Identifier 89039269 Authors McWaine DE. Procci WR. Institution Department of Psychiatry, Harbor-UCLA Medical Center, Torrance. Title Drug-induced sexual dysfunction. [Review] Source Medical Toxicology & Adverse Drug Experience. 3(4):289-306, 1988 Jul-Aug. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract A large body of data, as well as clinical experience, link prescribed medications and substances of abuse with sexual dysfunction. This review surveys the relevant literature and summarises key points relating various classes of medications and their possible sexual side effects. Surprisingly, there were very few carefully designed, well organised, systematic studies of the effects of medication upon sexual performance. The preponderance of data is in the form of either case studies or collections of patient reports of side effects. As a result, there are great variations in the reported rates of sexual disturbances associated with the administration of a given medication. A further difficulty is the lack of precision in the use of terms which describe the various sexual disorders. A final problem is the almost total lack of data concerning both disordered and normal sexual functioning in females. [References: 121] <4> Unique Identifier 89150821 Authors Hawton K. Institution Warneford Hospital, Oxford. Title Erectile dysfunction and premature ejaculation. [Review] Source British Journal of Hospital Medicine. 40(6):428-36, 1988 Dec. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract In parallel with the increased recognition of organic causes of erectile dysfunction, several new physical methods of treatment have been developed for this problem. These include intracavernosal injections of vasodilators, penile prostheses, vascular surgery, vacuum condoms, and medication. However, psychological treatment approaches are still of considerable importance in the treatment of both erectile dysfunction and premature ejaculation. [References: 43] <5> Unique Identifier 89178815 Authors Miller NS. Gold MS. Institution New York Hospital/Cornell Medical Center, White Plains 10605. Title The human sexual response and alcohol and drugs. [Review] Source Journal of Substance Abuse Treatment. 5(3):171-7, 1988. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract The effects of alcohol and drugs on sexual function are important to consider in clinical histories and medication prescribing practices. Virtually all aspects of the human sexual response are affected by alcohol and drugs: 1. Desire (libido) is reduced. 2. Performance. Impotency as defined by lack of erection and ejaculation occurs. 3. Dissatisfaction ensues. These effects of alcohol and drugs can be understood and illustrated by examining the phases of excitement, plateau, orgasm, and resolution in the human sexual response. The important first step in the treatment of sexual dysfunction is to identify the alcohol/drug/medication use. The next is to recognize the profound effect it can have on the human sexual response. Furthermore, knowledge of the mechanism of action of the drugs and a basic conception of the physiology and psychology of sexual performance are necessary to predict the course of the sexual dysfunction. In many instances, the sexual dysfunction is reversible even after chronic alcohol/drug/medication use. [References: 31] Registry Numbers 64-17-5 (Alcohol, Ethyl). <6> Unique Identifier 87226445 Authors Morales A. Condra M. Owen JA. Surridge DH. Fenemore J. Harris C. Title Is yohimbine effective in the treatment of organic impotence? Results of a controlled trial. Source Journal of Urology. 137(6):1168-72, 1987 Jun. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract Yohimbine is an alpha-adrenoceptor blocker that has been used in the treatment of erectile dysfunction. Adequate trials of this substance in a clearly defined organically impotent population are not available. We conducted a randomized, controlled study with partial cross-over of yohimbine versus placebo in 100 organically impotent men. The first phase of the study showed a positive response in 42.6 per cent of the patients receiving yohimbine versus 27.6 per cent in the placebo group. Although favorable to the test medication these values did not reach statistical significance (p equals 0.42). A similar pattern was noted in the second phase of the study. The over-all response rate of 43.5 per cent was consistent with a previous noncontrolled trial but it was much lower than previous studies. The response rate of organically impotent patients to yohimbine is at best marginal. Owing to its ease of administration, safety and modest effect it still is used in those patients who do not accept more invasive methods. Adrenoceptors are involved in the erectile process, although other neurotransmitter systems also are putative modulators of penile erection, including cholinergic, dopaminergic and vasoactive intestinal polypeptide pathways. It is beyond reasonable expectation that a single agent be of value for all cases of organic impotence. However, yohimbine has shown modest effectiveness at the doses used in this trial (18 mg. per day). Higher doses or a different route of administration may produce different effects. Registry Numbers 146-48-5 (Yohimbine). <7> Unique Identifier 86224712 Authors Harrison WM. Rabkin JG. Ehrhardt AA. Stewart JW. McGrath PJ. Ross D. Quitkin FM. Title Effects of antidepressant medication on sexual function: a controlled study. Source Journal of Clinical Psychopharmacology. 6(3):144-9, 1986 Jun. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract There has been little systematic study of the types of sexual dysfunction produced by antidepressant medication or of the frequency with which this type of adverse effect occurs. The authors report results of a double-blind study in which the effects of imipramine, phenelzine, and placebo on specific aspects of sexual function were assessed in depressed outpatients before and after 6 weeks of treatment. Both active treatments were associated with a high incidence of adverse changes in sexual function and produced significantly more adverse effects on sexual function than placebo. Orgasm and ejaculation were impaired to a greater extent than erection. Adverse sexual function changes secondary to antidepressant medication occurred frequently in both men and women, although men reported a higher incidence. Antidepressant-related sexual dysfunction may be of clinical importance for medication compliance in view of current recommendations that antidepressants be administered for longer periods as maintenance therapy or for prophylaxis. Registry Numbers 0 (Antidepressive Agents). 50-49-7 (Imipramine). 51-71-8 (Phenelzine). <1> Unique Identifier 81044930 Authors Martin LM. Title Erectile impotence--it can be highly treatable. Source Geriatrics. 35(12):79-83, 1980 Dec. Local Messages LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE. Abstract In brief, the treatment of impotence is the treatment of the underlying cause whenever possible. When irreversible organic impotence is found, however, penile prosthesis should be considered. Both hydraulic inflatable and semirigid rod types are available. Morbidity with the procedure is relatively low in experienced hands and patient satisfaction has been reported as quite high. Pharmacogenic impotence may require a change or reduction of medication. Depression usually responds to some combination of antidepressants, psychotherapy, or electroconvulsive therapy, while modern short-term sex therapy has proved effective in reversing many of the anxiety-related cases. Deep-seated, anxiety-based impotence may require extensive psychotherapy, but many cases of recent-onset psychogenic impotence can be managed quite successfully with education, reassurance, and the optional short-term use of testosterone.