Skip to main content
SpringerLink
Log in

Beeinträchtigung der Sexualfunktion durch Psychopharmaka und psychotrope Substanzen

Adverse side-effect on sexual function caused by psychotropic drugs and psychotropic substances

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Ungestörte Sexualität spielt für die Lebensqualität, auch psychisch kranker Menschen, eine erhebliche Rolle. Erkenntnisse über die komplexe neuronale und endokrine Steuerung der Sexualfunktion legen Störmöglichkeiten durch Substanzen nahe, die diese Regelkreise beeinflussen, also insbesondere auch durch Psychopharmaka und abhängigkeitserzeugende Substanzen. Die Abgrenzung von unmittelbaren oder mittelbar durch die Krankheit selbst hervorgerufenen Funktionsdefiziten ist allerdings in der Praxis schwierig. Sowohl klassische trizyklische Antidepressiva als auch Serotoninwiederaufnahmehemmer verursachen häufig Beeinträchtigungen in mehreren Aspekten der sexuellen Funktions- und Erlebnisfähigkeit. Dies gilt ebenso für Neuroleptika, wobei auch hier nicht der Pharmakotherapie zuzuordnende Auswirkungen der Erkrankung Schizophrenie die Beurteilung schwierig machen. Bei den zur Behandlung substanzbezogener Störungen eingesetzten medikamentösen Strategien führt insbesondere das Substitut Methadon in vielen Fällen zu sexuellen Funktionsstörungen. Die Beachtung medikamenteninduzierter sexueller Funktionsstörungen hat für die Compliance hohe Bedeutung, Abhilfemöglichkeiten bestehen insbesondere in Anpassung der Medikation, zusätzlicher Medikamentengabe, z. B. von Partialantagonisten und Erektiva, sowie in einer störungsspezifischen Psychotherapie und Psychoedukation.

Summary

Unhindered sexuality plays an important role in the quality of life and this also holds true for patients with psychiatric illnesses. Knowledge concerning the complex neuronal and endocrine control mechanisms of sexual function reveals areas of possible dysfunction caused by the interactions between the control system, psychiatric drugs and addictive psychoactive substances. The differentiation of the cause of the dysfunction between being caused by the underlying illness and caused by other factors is difficult in practice. Both classical tri-cyclic antidepressants and selective serotonin uptake inhibitors can frequently cause adverse effects in multiple dimensions of sexual function. This same is true for neuroleptics, whereby the differentiation between symptoms of schizophrenia and side-effects from the medication can make an evaluation difficult. The medication-based strategy used to treat opiate dependency by administration of methadone causes sexual dysfunction in many cases. The consideration of medication-induced sexual dysfunction has a great importance with regard to compliance. Possible solutions can be modification of the medication regime, additional medication, e.g. partial antagonists and PD5 inhibitors, as well as dysfunction-specific psychotherapy and psychoeducation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Aizenberg D, Zemishlany Z, Dorfman-Etrog P, Weizman A (1995) Sexual dysfunction in male schizophrenic patients. J Clin Psychiatry 56:137–141

    CAS  PubMed  Google Scholar 

  2. Aizenberg D, Modai I, Landa A et al (2001) Comparison of sexual dysfunction in male schizophrenic patients maintained on treatment with classical antipsychotics versus clozapine. J Clin Psychiatry 62:541–544

    Article  CAS  PubMed  Google Scholar 

  3. Bart G, Borg L, Schluger JH et al (2003) Suppressed prolactin response to dynorphin A1–13 in methadone-maintained versus control subjects. J Pharmacol Exp Ther 306:581–587

    Article  CAS  PubMed  Google Scholar 

  4. Bitter I, Basson BR, Dossenbach MR (2005) Antipsychotic traetment and sexual functioning in first-time neuroleptic-treated schizophrenic patients. Int Clin Psychopharmaco l20:19–21

    Article  Google Scholar 

  5. Bliesener N, Albrecht S, Schwager A et al (2005) Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence, J Clin Endocrinol Metab 90:203–206

    Google Scholar 

  6. Bonierbale M, Lançon C, Tignol J (2003) The ELIXIR study: evaluation of sexual dysfunction in 4557 depressed patients in France, Curr Med Res Opin 19(2):114–124

    Google Scholar 

  7. Brennemann W, Stitz B, Van Ahlen H et al (1993) Treatment of idiopathic erectile dysfunction in men with the opiate antagonist naltrexone – a double-blind study. J Androl 14:407–410

    CAS  PubMed  Google Scholar 

  8. Brown RT, Zueldorff M (2007) Opioid substitution with methadone and buprenorphine: Sexual dysfunction as a side effect of therapy. Heroin Addict Relat Clin Probl 9:35–44

    Google Scholar 

  9. Brown R, Balousek S, Mundt M, Fleming M (2005) Methadone maintenance and male sexual dysfunction, J Addict Dis 24:91–106

    Google Scholar 

  10. Cicero TJ, Bell RD, Wiest WG et al (1975) Function of the male sex organs in heroin and methadone users. New Engl J Med 292:882–887

    Article  CAS  PubMed  Google Scholar 

  11. Clayton A (2001) Recognition and assessment of sexual dysfunction associated with depression. J Clin Psychiatry 62(Suppl 3):5–9

    Article  PubMed  Google Scholar 

  12. Cohen S, Kühn K-U, Bender S et al (2007) Sexual impairment in psychiatric inpatients: Focus on depression. Pharmacopsychiatry 40:58–63

    Article  CAS  PubMed  Google Scholar 

  13. Cushman P (1972) Sexual behavior in heroin addiction and methadone maintenance. NY State J Med 72:1261–1265

    Google Scholar 

  14. Cutler AJ (2003) Sexual dysfunction and antipsychotic treatment. Psychoneuroendocrinology 5(Suppl 2):69–82

    Article  Google Scholar 

  15. Daniell HW, Lentz R, Mazer R (2006) Open-label pilot study of testosterone patch therapy in men with opioid-induced androgen deficiency. J Pain 7:200–210

    Article  CAS  PubMed  Google Scholar 

  16. Eap CB, Buclin T, Baumann P (2002) Individual variability of the clinical pharmacokinetics of methadone. Clin Pharmacokinet 41:1153–1193

    Article  CAS  PubMed  Google Scholar 

  17. Fortier P, Mottard JP, Trudel G, Even S (2003) Study of sexual-related characteristics in young adults with schizophrenia treated with novel neuroleptics and in a comparison group of young adults. Schizophr Bull 29:559–572

    PubMed  Google Scholar 

  18. Friedman S, Harrison G (1984) Sexual histories, attitudes, and behavior of schizophrenic and „normal“ women. Arch Sex Behav 13:555–567

    Article  CAS  PubMed  Google Scholar 

  19. Hallinan R, Byrne A, Agho K et al (2007) Hypogonadism in men receiving methadone and buprenorphine maintenance treatment. Int J Androl 30:1–9

    Article  Google Scholar 

  20. Hartmann U, Becker AJ, Ückert S, Stief C (2006) Sexualstörungen – sexuelle Funktionsstörungen. In: Förstl, Hautzinger M, Roth G (Hrsg) Neurobiologie psychisher Störungen. Springer, Heidelberg, S 763–806

  21. Howes OD, Wheeler MJ, Pilowsky LS (2007) Sexual function and gonadal hormones in patients taking antipsychotic treatment for schizophrenia or schizoaffective disorder. 68:361–367

  22. Hummer M, Kemmler G, Kurz M et al (1999) Sexual disturbances during clozapine and haloperidol treatment for schizophrenia. Am J Psychiatry 156:631–633

    CAS  PubMed  Google Scholar 

  23. Kalyani RR, Gavini S, Dobs AS (2007) Male hypogonadism in systemic disease. Endocrinol Metab Clin N Am 36:333–348

    Article  CAS  Google Scholar 

  24. Kelly DL, Conley RR (2006) A randomized double-blind 12-week study of quetiapine, risperidon or fluphenazine on sexual functioning in people with schizophrenia. Psychoneuroendocrinology 31:340–346

    Article  CAS  PubMed  Google Scholar 

  25. Kennedy SH, Dickens SE, Eisfeld BS et al (1999) Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord 56:201–208

    Article  CAS  PubMed  Google Scholar 

  26. Kockott G, Fahrner EM (2004) Sexuelle Funktionsstörungen. In: Kockott G, Fahrner EM (Hrsg) Sexualstörungen. Thieme, Stuttgart New York, S 1–76

  27. Masters WH, Johnson VE (1970) Human sexual inadequacy. Little Brown, Boston

  28. McCann E (2000) The expression of sexuality in people with psychosis: breaking the taboos. J Adv Nurs 32:132–138

    Article  CAS  PubMed  Google Scholar 

  29. Mendelson JH, Mendelson JE, Patch V (1975) Plasma testosterone levels in heroin addiction and during methadone maintenance. J Pharmacol Exp Ther 192:211–217

    CAS  PubMed  Google Scholar 

  30. Montejo AL, Llorca GL, Izquierdo JA, Rico-Villadermos F (2001) Incidence of sexual dysfunction associated with antidepressant agents: a prospective muliticenter study of 1022 outpatients. J Clin Psychiatry 62(Suppl 3):10–21

    CAS  PubMed  Google Scholar 

  31. Nestoros JN, Lehmann HE, Ban TA (1981) Sexual behavior of the male schizophrenic: the impact of illness and medications. Arch Sex Behav 10(5):421–442

    Article  CAS  PubMed  Google Scholar 

  32. Nurnberg HG, Hensley PL, Heiman JR et al (2008) Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA 300(4):395–404

    Article  CAS  PubMed  Google Scholar 

  33. Rado S (1926) The psychic effects of intoxicants: An attempt to evolve a psycho-analytical theory of morbid cravings. Int J Psychoanal 7:396–413

    Google Scholar 

  34. Riecher-Rössler A, Schmid C, Bleuer S, Birhäuser M (2009) Antipsychotika und Hyperprolaktinämie: Pathophysiologie, klinische Bedeutung, Abklärung und Therapie. Neuropsychiatr 23(2):71–83

    PubMed  Google Scholar 

  35. Robinson DS, Roberts DL, Smith JM et al (1996) The safety profile of nefazodone. J Clin Psychiatry 57(Suppl 2):31–38

    CAS  PubMed  Google Scholar 

  36. Ryback RS (2004) Naltrexone in the treatment of adolescent sexual offenders. J Clin Psychiatry 65:982–986

    Article  CAS  PubMed  Google Scholar 

  37. Sathe RS, Komisaruk BR, Ladas AK, Godbole SV (2001) Naltrexone-induced augmentation of sexual response in men. Arch Med Res 32:221–226

    Article  CAS  PubMed  Google Scholar 

  38. Scherbaum N, Heigl-Evers A (1996) Psychodynamische Aspekte der Substitutionstherapie Heroinabhängiger mit Methadon. Psychother Psychosom Med Psychol 46:47–51

    CAS  PubMed  Google Scholar 

  39. Smith S, O‘Keane V, Murray R (2002) Sexual dysfunction in patients taking conventional antipsychotic medication. Br J Psychiatry 181:49–55

    Article  CAS  PubMed  Google Scholar 

  40. Taylor MJ (2006) Strategies for managing antidepressant-induced sexual dysfunction: a review. Curr Psychiatry Rep 8(6):431–436

    Article  PubMed  Google Scholar 

  41. Teusch L, Scherbaum N, Böhme H et al (1995) Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Pharmacopsychiatry 28:84–92

    Article  CAS  PubMed  Google Scholar 

  42. Thase ME, Clayton AH, Haight BR et al (2006) A double-blind comparison between bupropion XL and venlafaxine XR: sexual functioning, antidepressant efficacy and tolerability. J Clin Psychopharmacol 26(05):482–488

    Article  CAS  PubMed  Google Scholar 

  43. Wang PS, Gilman SE, Kessler RC et al (2000) Initiation of and adherence to treatment for mental disorders: examination of patient advocate group members in 11 countries. Med Care 38(9):926–936

    Article  CAS  PubMed  Google Scholar 

  44. Weig W (2006) Sexuelle Funktionsstörungen aus nervenärztlicher Perspektive. Nervenarzt 77:101–109

    Article  CAS  PubMed  Google Scholar 

  45. Weig W (2000) Die Rolle von Psychiatrie und Psychotherapie in der Sexualmedizin nach der Markteinführung von Viagra®. Nervenarzt 71:218–221

    Article  CAS  PubMed  Google Scholar 

  46. Westheide J, Cohen S, Bender S et al (2007) Sexual dysfunction in psychiatric inpatients, The role of antipsychotic medication. Pharmacopsychiatry 40(4):1405

    Google Scholar 

  47. Westheide J, Cvetanovska G, Albrecht C et al (2008) Prolactin, subjective well-being and sexual dysfunction: an open label observational study comparing quetiapine with risperidone. J Sex Med 5(12):2816–2826

    Article  CAS  PubMed  Google Scholar 

  48. Zajecka J (2001) Strategies for treatment of antidepressant-related sexual dysfunction. J Clin Psychiatry 62(Suppl 3):35–43

    CAS  PubMed  Google Scholar 

  49. Zettel S, Hartlapp J (1997) Sexualstörungen durch Krankheit und Therapie. Springer, Berlin Heidelberg

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Referententätigkeit für Janssen-Cilag.

Author information

Authors and Affiliations

  1. LVR-Klinikum, Kliniken der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    S. Cohen

  2. Universitätsklinik Bonn, Bonn, Deutschland

    K.U. Kühn & B. Sträter

  3. LVR-Klinikum, Kliniken der Universität Duisburg-Essen, Duisburg-Essen, Deutschland

    N. Scherbaum

  4. Magdalenen-Klinik, Georgsmarienhütte, Bischofsstraße 28, 49074, Osnabrück, Deutschland

    W. Weig

Authors
  1. S. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K.U. Kühn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Sträter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Scherbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Weig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Weig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohen, S., Kühn, K., Sträter, B. et al. Beeinträchtigung der Sexualfunktion durch Psychopharmaka und psychotrope Substanzen. Nervenarzt 81, 1129–1139 (2010). https://doi.org/10.1007/s00115-010-3074-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-010-3074-9

Schlüsselwörter

Keywords

Search

Navigation