Drugs for Schizophrenia May Decrease Sexual Hormone Production in Both Man and Woman
Schizophrenia is a most interesting and vexing disease. Its prevalence is high (0.85 percent), its economic impact is severe, and the disease processes undermine a myriad of brain functions, causing distinctively human impairments. Patients have altered perception, false beliefs, disturbance of thought, and often remarkably reduced drive, inability to initiate action, and restriction in emotional experience and expression. Illness usually begins early in life and is long-lasting.
The cause, cure, and prevention of schizophrenia are not yet understood, but there have been substantial advances in comprehending and treating this illness. Recent developments involving new antipsychotic medications, empirically validated psychosocial treatment, the deinstitutionalization of patients, and increasing homelessness and substance abuse among schizophrenic populations require a reconception of the care and treatment of persons with this disease.
No matter how well a drug treats depression, the ability of the patient to tolerate its side effects strongly influences his or her compliance with therapy. Lack of compliance is probably the major barrier to success. According to one study, as many as 70% of elderly depressed patients did not adhere to antidepressant drug regimens. Side effects can be avoided or moderated if any regimen is started at low doses and built up over time. Although specific side effects are discussed under individual drugs, there are a few that are common to many of them:
Sexual dysfunction is a common side effect of nearly all the standard antidepressants and some of the newer drugs. These side effects can be particularly distressing for patients on maintenance treatment who otherwise feel well. Some of the newer antidepressants, such as mirtazapine, bupropion, or nefazodone, may be effective alternatives.
A common problem among men characterized by the consistent inability to sustain an erection sufficient for sexual intercourse or the inability to achieve ejaculation , or both. Impotence can vary. It can involve a total inability to achieve an erection or ejaculation, an inconsistent ability to do so, or a tendency to sustain only very brief erections.
Antischizophrenia /antipsychotic drug; chlorpromazine acts on alpha1/alpha2-receptors (antisympathomimetic properties, lowering of blood pressure, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction.
Sexual dysfunction is a relatively prevalent side effect of antidepressant medication. Nurnberg et al., (2003) conducted a prospective, double-blind, placebo-controlled study and found that sildenafil, a phosphodiesterase inhibitor, effectively improved erectile function in patients receiving a variety of serotonin-based anti-depressants, including citalopram, fluoxetine, paroxetine and sertraline. Taylor et al. (2005) conducted a meta-analysis examining a wide range of compounds meant to treat anti-depressant induced sexual dysfunction.
Selective Serotonin Reuptake Inhibitors (SSRI’s) have become notorious for causing "sexual dysfunction,” most commonly diagnosed as diminished sexual interest.It is well documented that SSRIs can cause various sexual dysfunctions such as anorgasmia (inability to reach orgasm), diminished libido (sex drive) and erectile dysfunction or difficult/premature ejaculation in men. Such side effects have been found present in between 41% and 83% of patients responding to physician inquiry. These side effects occasionally disappear spontaneously without discontinuing use of the drug, and in most cases resolve themselves after stopping taking the SSRI.
A study with sexual dysfunction for antipsychotic treatment:
Antipsychotic treatment is frequently associated with sexual dysfunction. The objective of the present study was to evaluate and compare sexual function and behavior in male schizophrenic patients who regularly take either classical neuroleptic drugs or the prototypical atypical antipsychotic agent, clozapine.
METHOD: Participants included 60 schizophrenic male patients (DSM-IV criteria); 30 maintained on treatment with classical antipsychotics and 30 on treatment with clozapine. The patients were evaluated with a detailed 18-item sexual function questionnaire.
RESULTS: Both groups reported sexual dysfunction, although scores were significantly higher, indicating better functioning, in the clozapine-treated group in the domains of orgasmic function (number of orgasms per month, p = .037; frequency of orgasm during sex, p = .046), enjoyment of sex (p = .013), and sexual satisfaction (p = .0004). Equivocal results were obtained for the desire parameters.
CONCLUSION: Maintenance therapy with the atypical neuroleptic clozapine may be associated with a lesser degree of sexual dysfunction than the classical antipsychotics in male outpatients with chronic schizophrenia.
Patients taking antipsychotic drugs for schizophrenia often produce little or no hormone in the sex glands, a condition known as hypogonadism, and commonly develop subsequent problems in sexual function, according to the findings published in the Journal of Clinical Psychiatry.
Dr. Oliver D. Howes and colleagues from the Institute of Psychiatry, London, examined rates of sexual dysfunction and hypogonadism in 103 patients with schizophrenia or schizoaffective disorder who had been on stable antipsychotic medication for at least 6 months.
These patients were compared with 62 normal untreated subjects recruited from primary care practices and with 57 subjects recruited from a sexual dysfunction clinic.
The participants were assessed using the Sexual Functioning Questionnaire (SFQ), in which higher scores indicate greater impairment.
Patients on antipsychotics had significantly greater average total SFQ scores -- 9.9 in women and 7.8 in men --- compared with normal subjects, who had scores of 4.1 and 4.09, respectively. The scores in the treated patients were similar to those in the patients who attended the sexual dysfunction clinic -- 7.2 in women and 9.9 in men).
Compared with normal subjects, the likelihood of patients having sexual dysfunction was increased by 15-fold in women and 9-fold in men.
Hypogonadism was common, with 79 percent of premenopausal women with low estrogen production and 92 percent with low progesterone levels. Twenty-eight percent of men had low testosterone production."
"The high rates of hypogonadism suggest that patients are at increased risk of cardiovascular disease and osteoporosis," Howes and colleagues say. "Clinicians are advised to inquire about sexual dysfunction and monitor...hormone levels in patients taking antipsychotics."