[Psychotropic is another word for drugs used to treat psychiatric disorders. It is used interchangeably with psychopharmacologic drugs. The acronym PISD, which will be used often in this article, refers to psychotropicinduced sexual dysfunction.]
It's bad enough you or a loved one is struggling with a mental disorder. Now, the same drugs used to treat your disorder are putting a crimp in your sex life. Not that anybody's talking about it. As one researcher writes, "Treatment-emergent sexual problems have been described as 'the unspoken side-effect of antipsychotics.'"
Many doctors fail to warn their patients about the potential for sexual dysfunction when prescribing psychotropic drugs, often leaving the patient to chalk it up to yet another symptom of their disorder. One writer notes, "Counseling patients about the possibility of sexual dysfunction due to an antidepressant is often uncomfortable and avoided by too many clinicians." Communication, however, is a two-way street and it is incumbent upon the person taking these medications to speak to their doctor about adverse sexual side effects. When left unreported to doctors, it can play a part in patient non-adherence.
It's hard to know when some cases of sexual dysfunction may be the result of the disorder and not the drug. As one pair of researchers writes, "Depression is characterized by loss of interest, reduction in energy, lowered self-esteem and inability to experience pleasure; irritability and social withdrawal may impair the ability to form and maintain intimate relationships. It would be surprising if this constellation of symptoms did not produce difficulties in sexual relationships." Obviously, experimenting with the suspect medication may clarify the problem.
Recently, Public Citizen published a list of all prescription drugs that can cause sexual dysfunction-ranging from meds for GI problems to beta-blockers for cardiac conditions. Of the 131 drugs cited, 31 of them were psychotropic medications.
The classes of medications that may cause PISD are:
Unfortunately, there are, as yet, no head-to-head clinical trials comparing rates of sexual dysfunction among the different classes of medications.
One study showed that 30% to 60% of people taking antipsychotic (dopamine-blocking) psychotropic drugs experienced adverse sexual side effects. When patients were asked directly by their doctor (not via a survey or questionnaire) if they were experiencing any sexual dysfunction from their drugs, 96% said yes.
In order to understand this, we may all need a post-graduate degree in biochemistry. Generally speaking, sexual response relies on a complex interplay between the body's hormones (such as prolactin) and the brain's neurotransmitters (such as serotonin, dopamine, and acetylcholine). While less is known about the role of hormones, the effect of neurotransmitters in sexual function is "well established." Many antipsychotic drugs are dopamine-blockers, meaning they inhibit the circulation of dopamine throughout the brain. The problem is that dopamine-blocking drugs-characteristic of most antipsychotic drugs-increase the body's prolactin levels, which can wreck havoc on sexual functioning.
Normal sexual response is comprised of four phases:
Psychotropic drugs can interfere at any stage of this scenario. Researchers advise doctors to specify which form of sexual dysfunction may occur, "as these have different causes and require different treatment approaches." For instance, women may describe a loss of libido; men may feel just as desirous as before, but less able to get an erection.
In men, PISD may cause:
In women, PISD may cause:
Many doctors adopt a "wait-and-see" approach after prescribing a medication with an adverse sexual profile. Sometimes negative side effects will decrease or go away altogether after the initial period. But more often than not, patients experience some degree of sexual dysfunction.
Unfortunately, there is no single strategy that will work for everyone. Just as you and your doctor probably spent some time hammering out a successful drug regimen for your mental disorder, finding the solution that may work for your PISD may be an equally time-consuming experience.
Some strategies doctors employ include to combat PISD are:
Here the person who takes the PISD is taken off the medication for a specified amount of time (usually relatively brief). The downside here is the risk in developing discontinuation symptoms.
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