Department of Neuroscience, Psychiatric Unit, University of Parma, Parma, Italy.
Società Italiana di Psicoanalisi della Relazione SIPRe, Milano, Italy.
J Sex Med. 2021 Aug;18(8):1354-1363. doi: 10.1016/j.jsxm.2021.05.016. Epub 2021 Jul 8.
Sexual dysfunction may be a side effect of treatment with antipsychotics, antidepressants, and other psychotropic drugs.
To review the evidence concerning male sexual dysfunctions in patients taking psychotropic drugs to provide specific information to nonpsychiatric physicians for the management of these dysfunctions.
A systematic search of Medline and Embase databases was performed up to October 15, 2020. We included randomized controlled trials comparing the effects of psychotropic drugs versus placebo or versus another drug of the same class, for at least 5 weeks.
We considered studies whose male population could be evaluated separately from the female population and with a separate analysis of the different phases of the male sex cycle.
We included 41 studies in the final review. There was a significant association between sexual dysfunction and antidepressant drug therapy, compared to placebo (decreased libido OR 1.89, 95% CI:1.40 to 2.56, 22 series, 11 trials, 7706 participants; erectile dysfunction OR = 2.28, 95% CI: 1.31 to 3.97; 11 trials, 3008 participants; ejaculatory dysfunction OR = 7.31, 95% CI: 4.38 to 12.20,19 trials, 3973 participants). When the effects of selective serotonin reuptake inhibitors (SSRIs) were evaluated separately from those of serotonin/norepinephrine reuptake inhibitors (SNRIs), the use of SNRIs but not that of SSRIs was characterized by significantly higher odds of erectile dysfunction compared to placebo. Only limited data were found regarding the effects of antipsychotics on the phases of the male sexual cycle, as it was shown that aripiprazole and risperidone showed lower and higher odds for erectile or ejaculatory dysfunction, respectively, compared to other atypical antipsychotics.
Treatment of male sexual dysfunction in patients taking psychotropics requires a basic knowledge of the different drugs that affect sexual function with different mechanisms.
STRENGTHS & LIMITATIONS: The effects of psychotropic drugs on erectile function and ejaculation were evaluated separately. The great variability of the mechanisms of action makes it difficult to make comparisons between the effects of the different classes of psychotropic drugs.
Administration of antipsychotics affects male sexual function with different mechanisms, although the increase in prolactin values associated with the administration of first-generation antipsychotics and some atypical, such as risperidone, seems to play a primary role in determining male sexual dysfunction. Most antidepressants cause decreased libido, ejaculatory and erectile dysfunction, however the administration of SNRIs appears to be possibly associated with a specific risk of erectile dysfunction. Trinchieri M, Trinchieri M, Perletti G, et al. Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review. J Sex Med 2021;18:1354-1363.
性功能障碍可能是抗精神病药、抗抑郁药和其他精神药物治疗的副作用。
综述精神药物治疗患者男性性功能障碍的证据，为非精神科医生管理这些性功能障碍提供具体信息。
对 Medline 和 Embase 数据库进行了系统检索，检索时间截至 2020 年 10 月 15 日。我们纳入了比较精神药物与安慰剂或同一类药物疗效的随机对照试验，至少持续 5 周。
我们考虑了可以将男性人群与女性人群分开评估且对男性性周期的不同阶段进行单独分析的研究。
我们最终综述纳入了 41 项研究。与安慰剂相比，抗抑郁药治疗与性功能障碍显著相关（性欲降低 OR 1.89，95%CI：1.40 至 2.56，22 项研究，11 项试验，7706 名参与者；勃起功能障碍 OR=2.28，95%CI：1.31 至 3.97；11 项试验，3008 名参与者；射精功能障碍 OR=7.31，95%CI：4.38 至 12.20，19 项试验，3973 名参与者）。当单独评估选择性 5-羟色胺再摄取抑制剂（SSRIs）与 5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）的作用时，与安慰剂相比，SNRIs 的使用而非 SSRIs 的使用与勃起功能障碍的可能性显著更高相关。关于抗精神病药对男性性周期各阶段的影响，仅发现了有限的数据，因为研究表明，与其他非典型抗精神病药相比，阿立哌唑和利培酮分别显示出较低和较高的勃起或射精功能障碍的可能性。
治疗服用精神药物的男性性功能障碍需要对不同药物有基本的了解，这些药物通过不同的机制影响性功能。
分别评估了精神药物对勃起功能和射精的影响。作用机制的巨大差异使得难以比较不同类别的精神药物的作用。
抗精神病药通过不同的机制影响男性性功能，尽管与第一代抗精神病药和某些非典型药物（如利培酮）相关的催乳素值升高似乎在决定男性性功能障碍方面起着主要作用。大多数抗抑郁药会导致性欲降低、射精和勃起功能障碍，但是 SNRIs 的使用似乎与勃起功能障碍的特定风险相关。
