性功能障碍可能是抗精神病药物治疗的副作用,抗抑郁药,和其他精神药物。
回顾有关服用精神药物的男性性功能障碍患者的证据,为非精神病医生提供治疗这些功能障碍的具体信息。
截至10月15日,对Medline和Embase数据库进行了系统搜索,2020年。我们纳入了随机对照试验,比较了精神药物与安慰剂或其他同类药物的效果。至少5周。
我们考虑了可以将男性人口与女性人口分开评估的研究,并对男性性周期的不同阶段进行了单独分析。
我们在最终审查中纳入了41项研究。性功能障碍和抗抑郁药物治疗之间存在显著关联,与安慰剂相比(性欲下降OR1.89,95%CI:1.40至2.56,22系列,11试验,7706名参与者;勃起功能障碍OR=2.28,95%CI:1.31至3.97;11项试验,3008名参与者;射精功能障碍OR=7.31,95%CI:4.38至12.20,19项试验,3973名与会者)。当选择性5-羟色胺再摄取抑制剂(SSRIs)的作用与5-羟色胺/去甲肾上腺素再摄取抑制剂(SNRIs)的作用分开评估时,与安慰剂相比,使用SNRIs而非SSRIs的特点是勃起功能障碍的几率显著较高.关于抗精神病药物对男性性周期各阶段的影响,只有有限的数据被发现,因为它显示,阿立哌唑和利培酮显示勃起或射精功能障碍的几率较低和较高,分别,与其他非典型抗精神病药相比。
在服用精神药物的患者中治疗男性性功能障碍需要对影响性功能的不同药物具有不同机制的基本知识。
分别评价精神药物对勃起功能和射精的影响。作用机制的巨大变异性使得很难在不同类别的精神药物的作用之间进行比较。
服用抗精神病药以不同的机制影响男性性功能,尽管催乳素值的增加与第一代抗精神病药和一些非典型药的使用有关,比如利培酮,似乎在确定男性性功能障碍中起主要作用。大多数抗抑郁药会导致性欲下降,射精和勃起功能障碍,然而,SNRIs的给药可能与勃起功能障碍的特定风险相关.TrinchieriM,TrinchieriM,PerlettiG,etal.与使用精神药物相关的勃起和射精功能障碍:系统评价。JSexMed2021;18:1354-1363。
Sexual dysfunction may be a side effect of treatment with antipsychotics, antidepressants, and other psychotropic drugs.
To review the evidence concerning male sexual dysfunctions in patients taking psychotropic drugs to provide specific information to nonpsychiatric physicians for the management of these dysfunctions.
A systematic search of Medline and Embase databases was performed up to October 15th, 2020. We included randomized controlled trials comparing the effects of psychotropic drugs versus placebo or versus another drug of the same class, for at least 5 weeks.
We considered studies whose male population could be evaluated separately from the female population and with a separate analysis of the different phases of the male sex cycle.
We included 41 studies in the final review. There was a significant association between sexual dysfunction and antidepressant drug therapy, compared to placebo (decreased libido OR 1.89, 95% CI:1.40 to 2.56, 22 series, 11 trials, 7706 participants; erectile dysfunction OR = 2.28, 95% CI: 1.31 to 3.97; 11 trials, 3008 participants; ejaculatory dysfunction OR = 7.31, 95% CI: 4.38 to 12.20,19 trials, 3973 participants). When the effects of selective serotonin reuptake inhibitors (SSRIs) were evaluated separately from those of serotonin/norepinephrine reuptake inhibitors (SNRIs), the use of SNRIs but not that of SSRIs was characterized by significantly higher odds of erectile dysfunction compared to placebo. Only limited data were found regarding the effects of antipsychotics on the phases of the male sexual cycle, as it was shown that aripiprazole and risperidone showed lower and higher odds for erectile or ejaculatory dysfunction, respectively, compared to other atypical antipsychotics.
Treatment of male sexual dysfunction in patients taking psychotropics requires a basic knowledge of the different drugs that affect sexual function with different mechanisms.
The effects of psychotropic drugs on erectile function and ejaculation were evaluated separately. The great variability of the mechanisms of action makes it difficult to make comparisons between the effects of the different classes of psychotropic drugs.
Administration of antipsychotics affects male sexual function with different mechanisms, although the increase in prolactin values associated with the administration of first-generation antipsychotics and some atypical, such as risperidone, seems to play a primary role in determining male sexual dysfunction. Most antidepressants cause decreased libido, ejaculatory and erectile dysfunction, however the administration of SNRIs appears to be possibly associated with a specific risk of erectile dysfunction. Trinchieri M, Trinchieri M, Perletti G, et al. Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review. J Sex Med 2021;18:1354-1363.