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, sexual arousal or overall sexual satisfaction.


OBJECTIVE
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.


METHODS
We searched the Cochrane Schizophrenia Group's Register (June 2006), the Cochrane Library (Issue 2, 2005), MEDLINE (1966-8/2005), PsycLIT (1974-8/2005), EMBASE (1980-8/2005) and references of all identified studies for further trials. We contacted relevant pharmaceutical companies and authors of trials.


METHODS
We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.


METHODS
Working independently, we extracted data. For dichotomous data we calculated random effects odds ratios (OR) with 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data we calculated weighted mean differences on the basis of a random effects model. We analysed crossover trials under consideration of correlation of paired measures.


RESULTS
Currently this review includes two pioneering crossover studies (total n=42 men, duration 2-3 weeks). They reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n=32, WMD 3.20 CI 1.83 to 4.57), a greater mean duration of erections (n=32, WMD 1.18 CI 0.52 to 1.84) and frequency of satisfactory intercourse (n=32, WMD 2.84 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, WMD change on Aizenberg's sexual functioning scale -0.40 CI -3.95 to 3.15).


CONCLUSIONS
We are not confident that crossover studies are appropriate for this participant group. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Further well designed, conducted and reported trials are urgently needed.
Berner
M M
MM
Abt. Psychiatrie und Psychotherapie, Klinikum der Albert-Ludwigs-Universitaet, Hauptstrasse 5, Freiburg im Breisgau, Germany, D-79104. michael_berner@psyallg.ukl.uni-freiburg.de
Hagen
M
M
Kriston
L
L
D014150:Antipsychotic Agents / Q000009:adverse effects*; D018592:Cross-Over Studies; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D010879:Piperazines / Q000627:therapeutic use; D011687:Purines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012642:Selegiline / Q000627:therapeutic use; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000188:drug therapy*; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D014150:Antipsychotic Agents; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D012642:Selegiline; D000068677:Sildenafil Citrate