Pharmacotherapy of paraphilias with long-acting agonists of luteinizing hormone-releasing hormone: a systematic review.
BACKGROUND
In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) are commonly used but can have serious side effects. Selective serotonin reuptake inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that luteinizing hormone-releasing hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients.


METHODS
MEDLINE was searched for clinical trials, case-control studies, case reports, and other clinically and theoretically important literature published between 1980 and November 2002 on the treatment of paraphilia with LHRH agonists. Keywords included LHRH agonists, GnRH- agonists, antiandrogens, paraphilia, pedophilia, and sex offenders.


RESULTS
We found 4 case reports, 1 case- control study, 7 open uncontrolled studies, and 1 study comparing patients receiving CPA with those receiving LHRH agonist treatment in forensic hospitals. In total, the studies reported on a sample of 118 treated patients with different forms of paraphilias (sadism, pedophilia, exhibitionism, voyeurism). Nearly all of the studies used self-reports to measure the effects of medication. Duration of follow-up was between 6 months and 7 years and revealed that there were no relapses if patients remained under treatment. Patients previously treated with other agents like CPA, MPA, or SSRIs reported better effects when taking LHRH agonists.


CONCLUSIONS
Although there is a need for further research, LHRH agonists offer a treatment option for patients with severe paraphilia. We propose a differentiated pharmacologic treatment regarding side effects, symptomatology, and severity.
Briken
Peer
P
Institute of Sex Research and Forensic Psychiatry, Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany. briken@uke.uni-hamburg.de
Hill
Andreas
A
Berner
Wolfgang
W
D000465:Algorithms; D000726:Androgen Antagonists / Q000627:therapeutic use; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D017373:Cyproterone Acetate / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D005084:Exhibitionism / Q000188:drug therapy; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D017063:Outcome Assessment, Health Care; D010262:Paraphilic Disorders / Q000188:drug therapy* / Q000523:psychology; D010378:Pedophilia / Q000188:drug therapy; D011902:Rape / Q000523:psychology; D012742:Sex Offenses / Q000523:psychology; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000627:therapeutic use
D000726:Androgen Antagonists; D003692:Delayed-Action Preparations; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D017373:Cyproterone Acetate; D016729:Leuprolide