General Comments

Unfortunately, few double-blind placebo-controlled trials exist to guide clinicians in understanding the sexual impact of medications. As a result, much of the information that follows is based on less refined information as, for example, case reports. Caution in interpretation is therefore advisable.

Unless otherwise referenced, information in this section has been taken from Segraves and Balon and Kaufman and Vermeulen.

In general, there is often great difficulty in differentiating the sexual consequences of a disorder from side effects of the medication used in treatment. When thinking about a sexual desire problem, attempting this separation requires care in determining that it did not exist before drug treatment began (i.e., making sure that it is, in fact, acquired rather than lifelong). Likewise, one would expect drug-related sexual problems to occur under all circumstances rather than some (i.e., to be generalized rather than situational), and that the desire problem would disappear if the drug is stopped but reappear if resumed. Last, one would want to determine that the diminished sexual desire would not be better explained by the onset of an illness or exposure to an environmental stress.

Antipsychotics

This group includes those which are "typical" (also called "neuroleptics" and "traditional," for example, phenothiazines, thioxanthenes, and butyrophenones), as well as "atypical" (e.g., risperidone, olanzapine, quetiapine, and clozapine). Men who are taking antipsychotic drugs generally complain of various sexual side effects including loss of sexual desire (although interference with ejaculation seems particularly common). One factor that seems especially noteworthy is that many of the typical antipsychotics, as well as risperidone in the atypical group, result in an elevation in PRL which, in turn, has significant sexual consequences including a lessening of sexual desire.

Antianxiety Agents

Alprazolam (Xanax) was reported to sometimes result in diminished sexual desire in both men and women. In that SSRIs are often used to treat anxiety, the information on "antidepressants" immediately below is of relevance.

Antidepressants

The incidence of sexual dysfunction generally with antidepressants is estimated at 30–50%. All types of antidepressants (TCAs, MAOIs, SSRIs) are linked to decreased sexual desire. Sexual dysfunctions generally are said to be less with bupropion, mirtazapine, moclobemide, and maybe reboxetine.

Mood Stabilizers

Lithium may result in diminished sexual desire in a minority of patients.