Sexual dysfunction is prevalent among psychiatric patients and may be related to both the psychopathology
and the pharmacotherapy. The negative symptoms of schizophrenia limit the capability
for interpersonal and sexual relationships. The first-generation antipsychotics cause further deterioration
in erectile and orgasmic function. Due to their weak antagonistic activity at D2 receptors, second-generation
antipsychotics are associated with fewer sexual side effects, and thus may provide an option for
schizophrenia patients with sexual dysfunction. Depression and anxiety are a cause for sexual dysfunction
that may be aggravated by antidepressants, especially selective serotonin reuptake inhibitors (SSRIs).
SSRI-induced sexual dysfunction may be overcome by lowering doses, switching to an antidepressant
with low propensity to cause sexual dysfunction (bupropion, mirtazapine, nefazodone, reboxetine), addition
of 5HT2 antagonists (mirtazapine, mianserin) or coadministration of 5-phosphodiesterase inhibitors.
Eating disorders and personality disorders, mainly borderline personality disorder, are also associated
with sexual dysfunction. Sexual dysfunction in these cases stems from impaired interpersonal relationships
and may respond to adequate psychosexual therapy. It is mandatory to identify the specific sexual
dysfunction and to treat the patients according to his/her individual psychopathology, current pharmacotherapy
and interpersonal relationships.
Copyright / Drug Dosage
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