title: Management of sexual dysfunction due to antipsychotic drug therapy.
abstract: 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.
  
  
  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
  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.
  
  
  METHODS
  We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.
  
  
  METHODS
  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.
  
  
  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).
  
  
  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 carry-over. 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. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg im Breisgau, Germany. dr.m.berner@rhein-jura-klinik.de
authors.forename: Hannah M
authors.initials: HM
authors.lastname: Schmidt
authors.forename: Mathias
authors.initials: M
authors.lastname: Hagen
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.forename: Karla
authors.initials: K
authors.lastname: Soares-Weiser
authors.forename: Nicola
authors.initials: N
authors.lastname: Maayan
authors.forename: Michael M
authors.initials: MM
authors.lastname: Berner
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000627:therapeutic use; D018592:Cross-Over Studies; D057915:Drug Substitution; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D000077152:Olanzapine; 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
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D001569:Benzodiazepines; D012642:Selegiline; D000068677:Sildenafil Citrate; D000077152:Olanzapine