After reviewing six studies on interventions for antipsychotic-related sexual dysfunction, researchers have declined making clinical recommendations, according to a paper published last fall in the Journal of Sexual Medicine.
“Existing evidence remains inconclusive,” the authors wrote.
An estimated 48% to 75% of patients taking antipsychotic drugs experience sexual side effects, they reported. Such side effects can interfere with quality of life and compliance with medication protocols.
Some patients in this situation may benefit from changing antipsychotic drugs, reducing the dose, adding a medication (such as a phosphodiesterase type 5 inhibitor), or taking a temporary break (a “drug holiday”). However, there has been little research to guide clinicians.
To learn more, the researchers examined six studies on patients with sexual dysfunction thought to be related to antipsychotic medication. They considered studies that used validated assessment tools [e.g., the Arizona Sexual Experience Scale (ASEX) or the International Index of Erectile Function (IIEF).]
Studies with outcome measures focused on prolactin levels were excluded, as prolactin has been deemed an unreliable marker for sexual dysfunction.
Each study investigated a different intervention, including adjunctive tadalafil, sildenafil, and lodenafil (all phosphodiesterase type 5 inhibitors), as well as adjunctive selegiline, and adjunctive aripiprazole. The sixth study focused on switching to quetiapine, another antipsychotic medication.
Only two of the studies – one involving sildenafil in male patients and one involving aripiprazole in female patients – showed positive results, but those studies had small samples and, along with the other studies, were considered to have low-quality evidence.
Small sample sizes and short follow-up periods were noted problems with the studies, the authors pointed out.
In the six reviewed studies, sample sizes ranged from 10 to 50 individuals, yet experts had previously recommended 150 participants. The authors explained that recruiting participants who have antipsychotic-related sexual dysfunction can be challenging. Research examining the barriers to participation could be helpful for the future, they added.
They also recommended that future studies have longer follow-up periods. In the reviewed papers, follow-up times ranged from 2 weeks to 16 weeks, which may not be enough for evaluating side effects or changes in sexual function and psychotic symptoms.
“This systematic review highlights the lack of high-quality evidence and the limited extent of available evidence for the treatment of antipsychotic-related sexual dysfunction,” the authors concluded.
Resources
The Journal of Sexual Medicine
Allen, Kirsty, MSc, et al.
“Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review”
(Full-text. Published online: October 1, 2019)
https://www.jsm.jsexmed.org/article/S1743-6095(19)31391-8/fulltext