Psychotropic Use and Sexual Dysfunction: Is There a Practical Solution?

Abstract

The psychotropic medications that we commonly use in our day-to-day life clinical practice are comparable to the players of a football team. If benzodiazepine, whether it is lorazepam, clonazepam, or clobazam is our goalkeeper, then in a 4-3-3 formation we have four strong defenders in the form of fluoxetine, sertraline, paroxetine, and escitalopram. If Lithium is our central defensive midfielder, then the two wingers of our team are valproate and carbamazepine. With quetiapine as our central attacking midfielder, the two lethal strikers at our disposal are risperidone and olanzapine. Thus, we have a good team of 11 players. And we are ready for our game against psychiatric disorders. But, like injury being commonplace for players in a football field, also we have to deal with adverse effects in our practice; sexual dysfunction is one of them. From a category-based classification of psychotropic medications, we are moving towards a mechanism-based one. Talking about mechanisms, prolactin raising ‘antipsychotic’ is responsible for sexual dysfunction associated with psychotropic use. ‘Antidepressant’ with higher serotonergic property can also cause sexual dysfunction. There are practical solutions to the problem. Prolactin sparing antipsychotic has less potential to cause sexual dysfunction. Among antidepressants, mirtazapine and bupropion are useful agents. At times, treatment with molecules like sildenafil is necessary. When we combine with this pharmacological approach that of psychosocial intervention, we arrive at a synergic reaction. The ultimate goal is to tailor make our treatment, or in other words ‘personalised medicine in psychiatry’.