1 / 27

In The Name of Allah

In The Name of Allah. Sexual Dysfunction Related to Psychotropic Drugs. Dr Maryam Banihashemi Resident of psychiatry Roozbeh Hospital. It is not Easy to determine if a Drug Disrupts Sexual Function or Not:. * Many Diseases Affect Sexual Function

ron
Download Presentation

In The Name of Allah

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. In The Name of Allah

  2. Sexual Dysfunction Related to Psychotropic Drugs Dr Maryam Banihashemi Resident of psychiatry Roozbeh Hospital

  3. It is not Easy to determine if a Drug Disrupts Sexual Function or Not: *Many Diseases Affect Sexual Function *Sexual Problems may not be Reported due to Feeling Embarrassed Actual Rate of Sexual Dysfunction due to Drugs may be Higher than Reported

  4. The burden of sexual dysfunction is not only relevant to drugcompliance: sexual functioning impacts significantly on quality of life

  5. Psychopharmacological effect of neurotransmitters on the 3 stages(desire, arousal and orgasm) of the human sexual response

  6. Antidepressants Major depression is the most common mental disturbance . Sexual dysfunction is a potential side effect of antidepressant drugs . Antidepressants with strong serotonergic properties have the highest rate of sexual side effects . Other mechanisms

  7. Antidepressant-induced sexual dysfunction is mainly due to asexual inhibitory action Delayed ejaculation : The most common Delayed and/or absent orgasm Reduced and/or lack of sexualdesire Reduced and/or absent sexual arousal Enhanced sexual functioning : More rarely

  8. Percentage of sexual dysfunction

  9. TCAs : Clomipramine , amitriptyline and imipramine :higher rates of sexual dysfunction Desipramine and nortriptyline : lower rates of sexual dysfunction Clomipramine : Treatment of patients with premature ejaculation(With daily dosing of 12.5-50 mg )

  10. SSRIs : Sertraline and Paroxetine : Difference in sexual side effects between men and women Delayed ejaculation : Paroxetine , Citalopram & Sertraline Dapoxetine : Exclusive indication is the treatment of premature ejaculation

  11. Other antidepressants : Venlafaxine has not been shown to be effective in the treatment of premature ejaculation Bupropion : Improvement in psychosexual function Nefazodone and Trazodone are associated with a very low incidence of sexual dysfunction …

  12. Case : Female/35 yrs Depression from 9 mo. Ego Citalopram : 40mg/d Increased low desire ( 6 mo.) Delayed orgasm

  13. Treatment of Antidepressant-Induced SexualDysfunction

  14. 1. Wait for a spontaneous reduction of side effects over time2. Reduce dose of drug

  15. 3. Arrange a temporary drug reduction or a suspension of drug for 2 days in the week : “therapeutic vacation” or “drug holiday”This strategy does not apply to fluoxetine due to its longer half-life

  16. 4. Switch to a different antidepressant drug with fewer sexual side effects bupropion, mirtazapine, or nefazodone

  17. 5. Add a symptomatic therapy-Other antidepressants : Bupropion,Nefazodoneor Mirtazapine-Partial serotonergic agonists and also partial alphanoradrenergicantagonist : Buspirone-Serotonin antagonist : Cyproheptadine-Alpha-adrenergic antagonist : Yohimbine-Dopaminergic agonists : Amantadine , Bromocriptine-Psychostimulant dopamine agonists : Methylphenidate and dextroamphetamine-Cholinergic enhancers : Neostigmine, Bethanechol-Phosphodiesterase inhibitors : Sildenafil, Tadalafil-Herbal medicines : Ginkgo biloba , Ginseng

  18. Strategies to Treat Psychotropic-Induced Sexual Dysfunction

  19. Strategies to Treat Psychotropic-Induced Sexual Dysfunction

  20. GinkoBiloba Mechanism of Action of GinkoBiloba for Reversing Antidepressant-Induced Sexual Dysfunction *Enhanced Vascular Flow to the Genitals through Inhibition of Platelet-Activating Factor *A Direct Effect of the Extract on Prostaglandins, which Enhance Erectile Function *Serotonin and Norepinephrine Receptor-Induced Effects on the Brain Ginkgo Biloba was Found to be 84% Effective in Alleviating Antidepressant-Induced Sexual Dysfunction Women (n = 33) more Responsive than Men (n = 30) Relative Success Rates: 91% versus 76%.

  21. Pharmacological Treatment for Sexual Pain Disorders Includes Treatment of Underlying Cause : * Estrogen for Vaginal Atrophy or Antifungal for Vulvovaginal Candidiasis * TCA ,Other Antidepressants, anticonvulsants, and Topical Agents for Vulvar Vestibulitis

  22. Vulvodynia(burning pain during sex) Testosterone Cream, with use of biofeedback, and with Low Doses of some Antidepressants which also Treat Nerve Pain (eg. Venlefaxine). Surgery has not been Successful.

  23. Antipsychotics *The mechanismof action leading to sexual dysfunction is more complex *Hyperprolactinemia is caused by blockage of dopamine D2receptors in the hypothalamic infundibular system (which caninhibit sexual function) *There have also been reported cases of sexual dysfunctionwith normal prolactin levels : in these cases, thesexual dysfunction was probably associated with other physical(e. g., diabetes) or psychological (e. g., quality of partner relationship)factors

  24. Sexual dysfunction (SD) and antipsychotics

  25. Treatment of sexual dysfunction induced byantipsychotics 1. A thorough clinical evaluation, to excludecomorbid conditions (physical and psychiatric) or sexual dysfunction secondary to alcohol or illicit drug use or other prescribed medication. The assessment should include measurement of serum prolactin in patients presenting with side effects suggestive of hyperprolactinemia.

  26. 2.Modification of risk factors (where possible, avoid use of other drugs associated with sexual dysfunction, smoking cessation, abstinence from alcohol and illicit drugs, maintaining normal blood sugar levels in diabetic patients, treatment of hypertension and hypercholesterolemia).

  27. Thanks for your attention

More Related