Introduction: Sexual dysfunction (SD) is a common adverse effect associated with the treatment of psychotropic drugs, particularly antidepressants (AD) and antipsychotics (APs). Clinicians increasingly recognize the importance of acknowledging and managing SD to ensure long-term adherence to medication. This adverse effect poses a significant challenge, as it can severely impact the quality of life and treatment compliance among patients. Materials and Methods: Patients must meet a diagnosis in ICD-10 that falls under psychotic spectrum disorders (cases generally include only first episode psychosis), depression, and anxiety. Remission of the disease is indicated by a decrease in scores on appropriate scales about that disease. Patients diagnosed with first-episode psychosis, depression, or anxiety are started on antipsychotics and antidepressants, respectively. Patients who achieve remission in 6-8 weeks of treatment are considered for the study. Selection will be through a random sampling method. Patients meeting the inclusion and exclusion criteria will be chosen for the study. The nature of the study will be explained to the patients. After obtaining informed consent, patients will be interviewed, and details will be collected per the
socio-demographic proforma. Results: From the table, the vast majority of patients fall into the age group between 21-30 years (38.7%), followed by the 31-40 years age group (32.7%). Female patients (53.6%) constitute a higher proportion than male patients (46.4%). Most of the population is employed (73.2%) compared to the unemployed group (15.5%). Most of the patient group lies in class 3 socioeconomic class (lower middle class- 58.9%). The subset of patients belonging to the group ‘not applicable’ are males, excluding most female patients who have regular menstrual cycles (39.9%). Conclusion: The study notes a decline in sexual functioning after the use of antipsychotics and antidepressants, which mainly depends on the baseline sexual functioning, dose of the drug, and type of the drug. The decline in sexual functioning (drug-induced) is often less than 50% in sexual functioning domains. Individuals with higher baseline scores in sexual functioning domains experience less or no dysfunction with minimal effective doses. Patients with higher baseline sexual functioning report a decline in sexual satisfaction than before, but their scores do not correlate with sexual dysfunction. With maximum doses of an individual drug, sexual dysfunction becomes obvious
Sexual dysfunction (SD) as a consequence of treatment with psychotropic drugs, especially antipsychotics (APs), is a common adverse effect. Acknowledging it, as well as managing it clinically, has become a goal of utmost importance for clinicians, as it often jeopardizes long-term adherence1.
Ever since the first reports of chlorpromazine and thioridazine causing orgasmic and erectile dysfunction were published, knowledge of treatment-emergent sexual dysfunction (TESD) and its underlying mechanisms of action has dramatically increased. Human sexuality is affected by a variety of neurogenic, psychogenic, vascular, and hormonal factors, and the action of antipsychotics may unbalance some of these mechanisms2. For example, dopamine facilitates sexual function through the mesolimbic system so that strict anti-dopaminergic antipsychotics can obstruct this process. However, partial dopaminergic agonists such as aripiprazole and cariprazine may not. On the other hand, serotonin inhibits sexual desire, likely through postsynaptic 5HT2 receptors, which are often targeted by atypical antipsychotics and can disrupt a complex balance between stimulation and blockade that affects sexual arousal, orgasm, and ejaculation retardation. Noradrenaline increases the ability for arousal through its influence on central receptors and inhibits erection by binding with peripheral α1 receptors3. α1-adrenergic receptors contribute to the emptying of cavernous bodies, so their stimulation can cause erectile dysfunction, and their blockade can cause priapism. Their counter-regulatory mechanisms involve the activation of cholinergic fibers, so anticholinergic drugs, such as some APs at specific doses, would cause erectile dysfunction4.
SD may cause diverse clinical alterations, such as low libido, difficulties in ejaculation, difficulties reaching orgasm, erection, and vaginal lubrication problems, as well as menstrual alterations or gynecomastia. These alterations are mostly reversible with treatment discontinuation, except for priapism, which can require surgical intervention in some cases.
Most psychiatrists frequently underestimate the presence of sexual dysfunction, even when adjusting for different SD prevalence across populations. It is not always considered a priority from a clinical perspective and is often almost completely disregarded. However, when patients are asked directly about SD, they rank it as a relevant problem. In a study by Finn, where the costs of drug side effects and symptoms among psychotic patients were measured, they regarded the presence of SD (inhibited/painful ejaculation and impotence) as the most critical drug side effect (over common ones like weight gain, oversedation, or hypotension), and just as crucial as suffering from persecutory delusions and other positive symptoms5.
Patients diagnosed with first-episode psychosis and depression or anxiety are started on antipsychotics and antidepressants,
respectively. Patients who attain remission in 6-8 weeks of treatment are considered for the study. Selection will be done by a random sampling method. Patients meeting the inclusion and exclusion criteria will be chosen for the study. The nature of the study will be explained to the patients. After obtaining informed consent, patients will be interviewed, and details will be collected per the sociodemographic proforma. Sexual functioning of patients, both before and after drug use, is collected through appropriate scales - Changes in Sexual Functioning Questionnaire (CSFQ) (male and female versions of the scale available). After this, the relationship between sociodemographic variables, illness-related variables, and sexual functioning is studied. The results are statistically analyzed, and a conclusion is arrived at. Statistical Analysis: IBM SPSS version 21 was used. Descriptive statistics like frequency and percentage were used. Inferential statistics like the chi-square test were used for association. SCALES Changes in Sexual Functioning Questionnaire (CSFQ) – male and female Hamilton Rating Scale for Depression (HAM-D) Hamilton Rating Scale for Anxiety (HAM-A) Brief Psychiatric Rating Scale (BPRS)
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