Clinical case reports, clinical series, and a small number of controlled studies provide evidence that many commonly prescribed psychiatric drugs may have untoward effects on sexual function. Both heterocyclic antidepressants and monoamine oxidase inhibitors appear to be associated with ejaculatory impairment. Erectile dysfunction and retarded ejaculation have been associated with neuroleptics. Several benzodiazepines have been reported to interfere with ejaculation. This information has clear significance for the prescribing physician.
Get full access to this article
View all access options for this article.
References
1.
SegravesR. T.MadsenR.CarterS. C., and DavisT. M., Erectile Dysfunction Associated with Pharmacological Agents, in Diagnosis and Treatment of Erectile Disturbances, SegravesR. T. and SchoenbergH. W. (eds.), Plenum, New York, 1985.
2.
SegravesR. T., Pharmacological Agents Causing Sexual Dysfunction, Journal of Sex and Marital Therapy, 3, pp. 157–176, 1977.
3.
SegravesR. T., Male Sexual Dysfunction and Psychoactive Drug Use, Postgraduate Medicine, pp. 227–233, 1982.
4.
CarterC. S. and DavisJ. M., Effects of Drugs on Sexual Arousal and Performance, in Clinical Management of Sexual Disorders, MeyerJ. (ed.), Williams and Wilkins, Baltimore, 1975.
5.
MillL. C., Drug-Induced Impotence, American Family Physician, 12, pp. 104–105, 1975.
6.
StoryN. L., Sexual Dysfunction Resulting from Drug Side Effects, Journal of Sex Research, 10, pp. 132–149, 1974.
7.
De LeoD. and MagniG., Sexual Side Effects of Antidepressant Drugs, Psychosomatics, 24, pp. 1076–1082, 1983.
8.
ShenW. W.SataL. S., and HofstatterL., Thioridazine and Understanding Sexual Phases in Both Sexes, Psychiatry Journal University Ottawa, 9, 187–190, 1984.
9.
PetrieW. M., Sexual Effects of Antidepressants and Psychomotor Stimulant Drugs, Modern Problems of Pharmaco Psychiatry, 15, pp. 77–90, 1980.
10.
HorowitzJ. D. and GlobleA. J., Drugs and Impaired Male Sexual Functions, Drugs, 18, pp. 206–217, 1979.
11.
MitchellJ. G. and PopkinM. K., Antipsychotic Drug Therapy and Sexual Dysfunction in Men, American Journal of Psychiatry, 139, pp. 633–637, 1982.
12.
MunjackD. J., Sex and Drugs, Clinical Toxicology, 15, pp. 75–89, 1979.
13.
BiuffumJ., Pharmacosexology Update: Prescription Drugs and Sexual Function, Journal of Psychoactive Drugs, 18, pp. 97–106, 1989.
14.
RabkinJ.QuitkinF.HarrisonW.TricamoE., and McGrathP., Adverse Reactions to Monoamine Oxidase Inhibitors. Part I, A Comparative Study, Journal of Clinical Psychopharmacology, 4, pp. 170–278, 1984.
15.
RabkinJ.QuitkinF.McGrathP.HarrisonW., and TricamoE., Adverse Reactions to Monoamine Oxidase Inhibitors. Part II. Treatment Correlates and Clinical Management, Journal of Clinical Psychopharmacology, 5, pp. 2–9, 1985.
16.
WyattR. J.FramD. H., and BuchbinderR., Treatment of Intractable Narcolepsy with a Monoamine Oxidase Inhibition, New England Journal of Medicine, 285, pp. 987–991, 1971.
17.
FriedmanS.KantorJ., and SobelS., A Follow-Up Study on the Chemotherapy of Neurodermatitis with a Monoamine Oxidase Inhibitor, Journal of Nervous and Mental Diseases, 166, pp. 349–357, 1978.
18.
HollanderM. H. and BanT. A., Ejaculatio Retarda due to Phenelzine, Psychiatry Journal University Ottawa, 4, pp. 233–234, 1980.
19.
RappM. S., Two Cases of Ejaculatory Impairment Related to Phenelzine, American Journal of Psychiatry, 136, pp. 1200–1201, 1979.
20.
GlassR. M., Ejaculatory Impairment from Both Phenelzine and Imipramine with Tinnitus from Phenelzine, Journal of Clinical Psychopharmacology, l, pp. 152–154, 1981.
21.
MossH. B., More Cases of Anorgasmia after MAOI Treatment, American Journal of Psychiatry, 140, p. 266, 1983.
22.
BartonJ. L., Orgasmic Inhibition by Phenelzine, American Journal of Psychiatry, 136, pp. 1616–1617, 1979.
23.
PohlR., Anorgasmia Caused by MAOIs, American Journal of Psychiatry, 140, p. 310, 1983.
24.
LeskoL. M.StotlandN. L., and SegravesR. T., Three Cases of Female Anorgasmia Associated with MAOIs, American Journal of Psychiatry, 139, pp. 1353–1354, 1982.
25.
FraserA. R., Sexual Dysfunction Following Antidepressant Drug Therapy, Journal of Clinical Psychopharmacology, pp. 62–63, 1984.
26.
NumberH. G. and LevineP. E., Spontaneous Remission of MAO-I Induced Anorgasmia, American Journal of Psychiatry, 144, 805–807, 1967.
27.
KohnR. M., Nocturnal Orthostatic Syncope in Pargyline Therapy, Journal of the American Medical Association, 187, p. 229, 1964.
28.
SimpsonG. M.BlairJ. H., and AmvsoD., Effects of Antidepressants on Genitourinary Function, Diseases of the Nervous System, 26, pp. 787–789, 1965.
29.
GrossM. D., Reversal by Bethanechol of Sexual Dysfunction Caused by Anticholinergic Antidepressants, American Journal of Psychiatry, 139, pp. 1193–1194, 1982.
30.
EverettH. C., The Use of Bethanechol Chloride with Tricyclic Antidepressants, American Journal of Psychiatry, 132, pp. 1202–1204, 1975.
31.
Couper-SmarttT. D. and RodhamR., A Technique for Surveying Side-Effects of Tricyclic Drugs with Reference to Reported Sexual Effects, Journal of International Medical Research, 1, pp. 473–476, 1973.
32.
GreenbergH. R., Erectile Impotence during the Course of Tofranil Therapy, American Journal of Psychiatry, 121, p. 1021, 1965.
33.
RuskinD. B. and GoldnerR. D., Treatment of Depression in Private Practice with Imipramine, Diseases of the Nervous System, 20, pp. 391–399, 1959.
34.
SovnerR., Anorgasmia Associated with Imipramine but Not Desipramine: A Case Report, Journal of Clinical Psychiatry, 44, pp. 345–346, 1983.
35.
SovnerR., Treatment of Tricyclic Antidepressant-Induced Orgasmic Inhibition with Cyproheptadine, Journal of Clinical Psychopharmacology, 4, p. 169, 1984.
36.
HekimianL. J.FriedhoftA. T., and DeeverE., A Comparison of the Onset of Action and Therapeutic Efficacy of Amoxapine and Amitriptyline, Journal of Clinical Psychiatry, 39, pp. 633–637, 1978.
37.
NiningerT. E., Inhibition of Ejaculation by Amitriptyline, American Journal of Psychiatry, 135, pp. 750–751, 1987.
38.
SegravesR. T., Reversal of Amitriptyline Anorgasmia by Bethanechol, American Journal of Psychiatry, 144, p. 1243, 1987.
39.
WoottenL. W. and BaileyR. I., Experiences with Clomipramine (Anafranil) in the Treatment of the Phobic Anxiety States in General Practice, Journal of International Medical Research, 3 (Suppl 1), pp. 1001–1007, 1975.
40.
YassaR., Sexual Disorders in the Course of Clomipramine Treatment: A Report of 3 Cases, Canadian Journal of Psychiatry, 27, pp. 148–149, 1982.
41.
AnanthJ.PechnoldT. C., and SteernN. V. D., Double-Blind Comparative Study of Chlomipramine in Obsessive Neurosis, Current Therapeutic Research, 25, pp. 703–709, 1979.
42.
EatonH., Clomipramine (Anafranil) in the treatment of Premature Ejaculation, Journal of Clinical Medical Research, 1, pp. 432–434, 1973.
43.
QuirkK. C. and EinarsonT. R., Sexual Dysfunction and Chlomipramine, Canadian Journal of Psychiatry, 27, pp. 228–231, 1983.
44.
BeaumontG., Sexual Side-Effect of Clomipramine (Anafranil), Journal of International Medical Research, 1, pp. 469–472, 1973.
45.
SchwarczG., Case Report of Inhibition of Ejaculation and Retrograde Ejaculation a Side-Effect of Amoxapine, American Journal of Psychiatry, 139, pp. 233–234, 1982.
46.
ShenW. W., Femal Orgasmic Inhibition by Amoxapine, American Journal of Psychiatry, 139, p. 1221, 1982.
47.
HarrisonW. M.RabkinJ. G.EhrhardtA. A.StewartJ. W.McGrathP. J.RossD., and QuitkinF. M., Effects of Antidepressant Medication of Sexual Function: A Controlled Study, Journal of Clinical Psychopharmacology, 6, pp. 144–149, 1986.
48.
HarrisonW. M.StewartJ.EhrhardtA. A.RabkinJ.McGrathP.LiewbowitzM., and QuitkinF. M., A Controlled Study of the Effects of Antidepressants on Sexual Function, Psychopharmacology Bulletin, 21, pp. 85–88, 1985.
49.
MonteiroW. O.NoshirvaniH. F.MarksI. M., and LelliottP. T., Anorgamia from Clomipramine in Obsessive-Compulsive Disorder: A Controlled Trial, British Journal of Psychiatry, 151, pp. 107–112, 1987.
50.
KowalskiA.StanleyR. O.DennersteinL.BurrowsG., and MacQuireK. P., The Sexual Side-Effects of Antidepressant Medication: A Double Blind Comparison of Two Antidepressants in a Non-psychiatric Population, British Journal of Psychiatry, 147, pp. 413–418, 1985.
51.
BlayS. L.FerrazM. P. T., and CalilH. M., Lithium-Induced Male Sexual Impairment: Two Case Reports, Journal of Clinical Psychiatry, 43, pp. 497–498, 1982.
52.
VinarovaE.UhlirO., and StikaL., Side-Effects of Lithium Administration, Activitas Nervosa Superior (Praha), 14, pp. 105–107, 1972.
53.
SteelT. E. and HowellE. F., Cyproheptadine for Imipramine-Induced Anorgasmia, Journal of Clinical Psychopharmacology, 6, pp. 326–327, 1986.
54.
GardnerE. A. and JohnstonJ. A., Bupripion—An Antidepressant without Sexual Pathophynological Action, Journal of Clinical Psychopharmacology, 5, pp. 24–29, 1985.
55.
HaiderI., Thioridazine and Sexual Dysfunction, International Journal of Neuropsychiatry, 2, pp. 255–257, 1962.
56.
WittonK., Sexual Dysfunction Secondary to Mellanil, Diseases of the Nervous System, 23, p. 1975, 1962.
57.
KotinJ.WilberD. E., and VerburgD., Thioridazine and Sexual Dysfunction, American Journal of Psychiatry, 133, pp. 82–85, 1976.
58.
FreyhanF. A., Loss of Ejaculation during Mellaril Treatment, American Journal of Psychiatry, 118, pp. 171–172, 1961.
59.
ShaderR. I., Sexual Dysfunction Associated with Thioridazine Hydrochloride, Journal of the American Medical Association, 188, pp. 1007–1009, 1964.
60.
CleinL., Thioridazine and Ejaculation, British Medical Journal, 2, pp. 548–549, 1962.
61.
DegenK., Sexual Dysfunction in Women Using Major Tranquilizers, Psychosomatics, 23, pp. 959–961, 1982.
62.
ShenW. W. and ParkS., Thioridazine-Induced Inhibition of Female Orgasm, Psychiatric Journal University Ottawa, 7, pp. 249–251, 1982.
63.
GreenbergH. R., Inhibition of Ejaculation by Chlorpromazine, Journal of Nervous and Mental Diseases, 152, pp. 364–366, 1971.
64.
BolelovckyZ., Chlorpromazine Inhibition of Ejaculation, Activitas Nervosa Superior (Praha). 7, p. 145, 1965.
65.
DitmanK. S., Inhibition of Ejaculation by Chloroprothixine, American Journal of Psychiatry, 120, pp. 1004–1005, 1964.
66.
ShaderR. I., Sexual Dysfunction Associated with Mesoridazine Besylate (Serentil), Psychopharmacologia, 27, pp. 193–194, 1972.
67.
BartholomewA. A., A Long-Acting Phenothiazine—A Possible Agent to Control Deviant Sexual Behavior, American Journal of Psychiatry, 124, pp. 77–83, 1968.
68.
DillonJ. B. and BatesT. J. N., Fluphenazine Enanthate in the Maintenance Treatment of Schizophrenia, British Medical Journal, 2, p. 1328, 1968.
69.
GhadirianA. M.ChouinardG., and AnnableL., Sexual Dysfunction and Plasma Prolactin Levels in Neuroleptic-Treated Schizophrenic Outpatients, Journal of Nervous and Mental Diseases, 170, pp. 463–467, 1982.
70.
CharalampousK. D.FreemesserG. F., and MalevJ., Loxapine Succinate: A Controlled Double-Blind Study in Schizophrenia, Current Therapy Research, 16, pp. 829–837, 1974.
71.
GoldsteinB.WeinerD., and BanasF., Clinical Evaluation of Thiothixine in Chronic Ambulatory Schizophrenic Patients, in The Thioxanthenes: Modern Problems in Pharmacopsychiatry, Volume 2, LehmannH. E.BannT. A. (eds.), Kargen, New York, 1969.
72.
BlairJ. H. and SimpsonG. M., Effects of Antipsychotic Drugs on Reproductive Function, Diseases of the Nervous System, 27, pp. 645–647, 1966.
73.
TennettG.BancroftJ., and CassJ., The Control of Deviant Sexual Behavior by Drugs: A Double-Blind Controlled Study of Benperidal, Chlorpromazine and Placebo, Archives of Sexual Behavior, 3, pp. 261–271, 1974.
74.
MagnusR. V.DeanB. C., and CurryS. H., Clorazepate: Double Blind Crossover Comparison of a Single Nightly Dose with Diazepam Twice Daily in Anxiety, Diseases of the Nervous System, 38, pp. 317–321, 1977.
75.
General Practitioners Research Group, A Single-Dose Anti-Anxiety Drug, Practitioner, 25, pp. 98–101, 1975.
76.
OthmerE. and OthmerS. C., Effect of Buspirone on Sexual Dysfunction in Patients with Generalized Anxiety Disorder, Journal of Clinical Psychiatry, 48, pp. 201–203, 1987.
77.
HughesJ. M., Failure to Ejaculate with Chlordiazepoxide, American Journal of Psychiatry, 121, pp. 610–611, 1964.
78.
SegravesR. T., Treatment of Premature Ejaculation with Lorazepam, American Journal of Psychiatry, 144, p. 1240, 1987.
79.
UhdeT. W.TancerM. E., and SheaC. A., Sexual Dysfunction Related to Alprazolam Treatment of Social Phobia, American Journal of Psychiatry, 145, pp. 531–532, 1989.
80.
SangalR., Inhibited Female Orgasm as a Side Effect of Alprazolam, American Journal of Psychiatry, 142, pp. 1223–1224, 1985.
81.
MunjackD. J. and CrockerB., Alprazolam-Induced Ejaculatory Inhibition, Journal of Clinical Psychopharmacology, 6, pp. 57–58, 1986.
82.
RileyA. J. and RileyE. J., The Effect of Single Dose Diazepam on Female Sexual Response Induced by Masturbation, Sexual and Marital Therapy, 1, pp. 49–53, 1986.
83.
KogeorgosJ. and de AlwisC., Priapism and Psychotropic Medication, British Journal of Psychiatry, 149, pp. 241–243, 1986.
84.
MerkinT. E., Priapism as a Sequela of Chlorpromazine Therapy, Journal of American College Emergency Physicians, 6, pp. 367–368, 1977.
85.
MeirazD. and FishelovitchJ., Priapism and Largactil Medication, Israel Journal of Medical Science, 5, pp. 1254–1256, 1969.
86.
Dawson-ButterworthK., Idiopathic Priapism Association with Schizophrenia, British Journal of Clinical Practice, 23, pp. 125–126, 1969.
87.
GriffithS. R. and ZilJ. S., Priapism in a Patient Receiving Antipsychotic Therapy, Psychosomatics, 25, pp. 629–311, 1984.
88.
AppellR. A.ShieldD. E., and McGuireE. J., Thioridazine-induced priapism, British Journal of Urology, 25, pp. 629–311, 1984.
89.
DormanB. W., and SchmidtJ. S., Association of Priapism in Phenothiazine Therapy, Journal of Urology, 116, pp. 51–53, 1976.
90.
VelekM.StanfordG. K., and MarcoL., Priapism Associated with Concurrent Use of Thioridazine and Metoclopramide, American Journal of Psychiatry, 144, pp. 827–828, 1987.
91.
FishbainD. A., Priapism Resulting from Fluphenazine Hydrochloride Treatment Reversed by Diphenhydramine, Annals of Emergency Medicine, 14, pp. 600–602, 1985.
92.
OsborneM. P., Penile Parkinsonism, Postgraduate Medical Journal, 50, pp. 523–524, 1974.
93.
MoreraA.EstradaA. G., and ValencianoR., Priapism and Neuroleptics: A Case Report, Acta Psychiatrica Scandinavica, 77, pp. 111–112, 1989.
94.
ScherM.KriegerJ. N., and JuergensS., Trazodone and Priapism, American Journal of Psychiatry, 140, pp. 1362–1363, 1983.
95.
WarnerM. D.PeabodyC. A.WhitefordH. A., and HollisterL. E., Trazodone and Priapism, Journal of Clinical Psychiatry, 48, pp. 244–245, 1987.
96.
BalonR.BerchovR., and HanH., Priapism Associated with Thiothixine, Chlorpromazine and Thioridazine, Journal of Clinical Psychiatry, 48, p. 216, 1987.
97.
GottliebJ. I., and LustbergT., Phenothiazine-induced Priapism: A Case Report, American Journal of Psychiatry; 134, pp. 1445–1446, 1977.