Management of sexual dysfunction due to antipsychotic drug therapy

Background Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients’ compliance. Objectives To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy. Search methods An updated search was performed in the Cochrane Schizophrenia Group’s Trials Register (3 May 2012) and the references of all identified studies for further trials. Selection criteria We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction. Data collection and analysis We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random‐effects model. We analysed cross‐over trials under consideration of correlation of paired measures. Main results Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross‐over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic‐induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale ‐0.40 95% CI ‐3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD ‐2.02 95% CI ‐5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD ‐0.80 95% CI ‐1.55 to ‐0.05). Authors' conclusions We are not confident that cross‐over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological