Transcript Sexual Dysfunction Induced By Psychotropic Medication

Sexual Dysfunction
Induced By Psychotropic
Medication
Susanne Lampitt
Clinical Nurse Educator
October, 2008
Clinicians tend to………...
• Have difficulty broaching the subject
• Focus on Extrapyramidal &
Anticholinergic side effects
• Ignore or minimize effects that
impact on sexuality & sexual function
• Why?
Male and Female prevalence rates of sexual
dysfunctional/problems
33%
35%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
0%
3%
10%
27%
Effects of antidepressants
on sexual function
• Treatment - emergent sexual dysfunction reported with all
• 40% of those taking antidepressants will develop some
form of sexual dysfunction
(Rothschild, 2000)
• Decreased Sexual desire/ excitement
• Diminished or delayed orgasm
• Loss of sensation in nipples, penis & vagina
• Decreased nocturnal erections
• Erection & delayed ejaculation
• Painful ejaculation
• Galactorrhoea
• Hard to separate effects of the depression from medication
Effects of First Generation
(Typical) Neuroleptics
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Difficulty in achieving or maintaining erection
Ejaculatory difficulties
Priapism (isolated incidents)
Desire & arousal problems
Poor lubrication
Diminished orgasm
Irregular menstruation/ amenorrhea or
menorrhagia
• Gynaecomastia, Galactorrhoea & breast
discomfort in both men and women
Effect of Second Generation
(Atypical) Neuroleptics
• Significantly lower incidence of EPS and
sexual side-effects
(Higgins et al, 2005)
• Risperidone associated with Galactorrhoea
• Olanzapine & Clozapine cause fewer
sexual side-effects (negligible effect on
prolactin levels)
Effect of Anticholinergic
Drugs
• Can diminish some side effects
• Can cause erectile dysfunction
• Failure of vaginal lubrication
The Clinicians Role
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Informed Consent for treatment
Education
Support
Monitoring
Need to be more proactive and feel
comfortable introducing the subject
• Written information should supplement
discussion
• Use of standardized side effect
assessment tools
Side Effect Assessment
Scales
• Simpson-Angus Scale (Simpson and Angus, 1970)
• The Abnormal Involuntary Movement Scale (Guy, 1976)
• The Udvalg for Kliniske Undersogelse Scale (Lingjaerde
et al, 1987)
• Side Effect Scale/Checklist for Antipsychotic Medication
(Bennett et al, 1995)
• Liverpool University Neuroleptic Side Effect Rating Scale
(Day et al, 1995)
• The Extrapyramidal Symptom Rating Scale (ESRS)
(Chouinard and Margolese, 2005
Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX)
The following questions refer to the possible appearance of sexual dysfunction after
initiating treatment with psychotropic agents.
A. Have you observed any type of change in your sexual activity (excitation, erection,
ejaculation, or orgasm) since you began taking the drug treatment?
YES
NO
B. Has the patient spontaneously reported this alteration or was it necessary to expressly
question him or her to discover the sexual dysfunction?
YES It was spontaneously reported.
NO It was not spontaneously reported.
1. Have you observed any decrease in your desire for sexual activity or in your interest in
sex?
0. No problem
1. Mild decrease. Somewhat less interest.
2. Moderate decrease. Much less interest.
3. Severe decrease. Almost none or no interest.
Treatments
• Assess that there is no other physical
pathology
• Spontaneous remission may occur
• Dose reduction
• Change medication
• ‘Antidote’ medication eg. Viagra
KEY POINTS
• Psychotropic medication can cause
significant side effects that impact on
sexuality and sexual function.
• Nurses have a key role to play in
educating and monitoring these sideeffects.
• Clients may be reluctant to report these
side-effects due to their sensitive nature.
• Nurses need to be proactive in informing
clients and asking about the impact of
drugs on sexual function.
Drug/
Medication
Increased
Sex Drive
Decreased
Sex Drive
Decreased
Arousal
Retrograde
Ejaculation
Inhibited
Ejaculation
Alcohol
Small amts
Large amts
Yes
Yes
Amphetamines
Yes
Possible
Yes
Painful
Ejaculation
Orgasm
Problems
Yes
Antihypertensives
Yes
Yes
Yes
Antipsychotics
(atypical)
Antipsychotics
(conventional)
Anxiolytics (very
few side effects)
Beta Blockers
Yes
Yes
Yes
Yes
Yes
Yes
Possible
Yes
Yes
Yes
Yes
Yes
Yes
Possible
Cocaine
Yes
Possible
Diuretics
Yes
yes
Hallucinogens
(unpredictable
side effects)
Heroin
Possible
Possible
Yes
Yes
Lithium
Yes
Yes
MAO inhibitors
May
May
Large amts
Chronic use
Yes
Yes
Yes
Yes
Yes
Marijuana
Mood stabilizers
Small amts
SSRIs
Steroids
Yes
Yes
Tricylic
antidepressants
Yes
Yes
Yes
Possible
Yes
possible
Yes
References:
Agnes Higgins. Impact of psychotropic medication on sexuality:
Literature review – Psychotropic Medication. British Journal of
Nursing, 2007, Volume 16, No9
Fontaine, K. L. (2009). Gender identity and sexual disorders. In C. R.
Kneisl & E. Trigoboff (Eds.), /Contemporary psychiatric-mental health
nursing/ (2nd ed., pp. 521-548). New Jersey: Pearson Prentice Hall.