Antipsychotics and sexual dysfunction: epidemiology, mechanisms and management

摘要

Objective: Growing attention has recently been given to the sexual dysfunction (SD) burden related to antipsychotics. The aims of the present work are 1) to review current evidence about SD related to antipsychotics, 2) to explain the need that it is purposely investigated and 3) to summarize available information about the biological underpinnings as well as the main management strategies of antipsychotic-related SD. Method: Medline, ISI web of science, the Cochrane collaboration database and references of retrieved articles were searched for original studies and review articles focusing on the epidemiology, measurement instruments, biological underpinnings and management strategies of antipsychotic-related SD. Results: Available evidence suggests that SD has a higher likelihood of occurring in both treated and untreated schizophrenia patients as compared with comparable healthy controls. Clinicians should rely upon specific scales designed to investigate SD, or at least ask directly about SD because otherwise patients tend to scarcely report this side effect. Antipsychotic drugs most commonly associated with SD are olanzapine, risperidone, haloperidol, clozapine, and thioridazine. On the other hand, ziprasidone, perphenazine, quetiapine and aripiprazole are associated with relatively low rates of SD. Biological studies showed that the incidence of sexual dysfunction could be directly related to the ability of an antipsychotic to increase prolactin levels and to bind to cholinergic, -adrenergic, histaminergic and dopaminergic receptors. Main strategies for the management of antipsychotic-induced SD include dose reduction of current antipsychotic, switching to prolactin-sparing antipsychotics such as quetiapine or using dopamine partial agonists such as aripiprazole. Conclusions: SD is a relevant issue that should be carefully considered when an antipsychotic is given. Clinicians should purposely investigate this side effect both before and after the prescription of a given antipsychotic and should be aware of strategies to manage antipsychotic-related SD.