Management of Sexual Dysfunction Due to Antipsychotic Drug Therapy

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 138 patients with schizophrenia. The duration of trials varied from 2 weeks to 4 months, 2 were cross-over trials. Three studies included only outpatients and two trials men only. Two trials compared the effects of drugs against placebo and two compared the effect of switching to a different antipsychotic with maintaining current antipsychotic treatment.

• One trial (n=32) reported significantly more erections sufficient for penetration when receiving sildenafil compared with placebo (MD 3.20, 95% CI 1.83 to 4.57), a greater mean duration of erections (MD 1.18, 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (MD 2.84, 95% CI 1.61 to 4.07).
• The second trial (n=10) found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (MD change on Aizenberg's sexual functioning scale -0.40, 95% CI -3.95 to 3.15).
• The third trial (n=36) found no evidence of improving sexual functioning when switching from risperidone to quetiapine (MD -2.02, 95% CI -5.79 to 1.75).
• The fourth trial (n=54) reported significant improvement in sexual functioning when patients switched from risperidone or a typical antipsychotic to olanzapine (MD -0.80, 95% CI -1.55 to -0.05).

Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), imprecise results (one trial for each comparison, small studies with wide confidence intervals) and indirectness of evidence (short follow-up time).