<1>
Unique Identifier
 95014096
Authors
 Gitlin MJ.
Institution
 Department of Psychiatry, UCLA School of Medicine 90024-6968.
Title
 Psychotropic medications and their effects on sexual function: diagnosis,
 biology, and treatment approaches. [Review]
Source
 Journal of Clinical Psychiatry. 55(9):406-13, 1994 Sep.
Local Messages
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Abstract
 BACKGROUND: The recognition and treatment of sexual side effects caused by
 psychotropic agents have become topics of increasing clinical concern.
 Gaps in our understanding of the biology of sex and in our knowledge of
 the effect of Axis I disorders on sexual functioning have made both
 recognition of sexual side effects and a coherent treatment approach to
 these side effects difficult. METHOD: The author reviews case reports,
 case series, and animal studies derived from a MEDLINE search for English
 language articles on the topics of the effects of psychiatric disorders on
 sexual functioning, the biology of sex, rates of sexual dysfunction
 associated with each medication class, and treatment approaches when these
 side effects occur. RESULTS: In evaluating sexual function in patients
 taking psychotropic medications, clinicians should first consider other
 potential causes of sexual dysfunction. In general, dopamine increases
 sexual behavior, serotonin inhibits it, while norepinephrine has
 conflicting effects. Sexual side effects have been described in
 association with all the major classes of psychotropic medications.
 Neuroleptics are often associated with sexual side effects. Priapism, seen
 with neuroleptics and trazodone, should be treated as a urological
 emergency. Anxiolytics cause mild, nonspecific sexual side effects as do
 the mood stabilizers. Among the antidepressants, the more powerful
 serotonergic medications--e.g., the serotonin selective reuptake
 inhibitors (SSRIs), clomipramine, and MAO inhibitors--may cause more
 sexual side effects than the tricyclics. Potential strategies to treat
 antidepressant-induced sexual side effects include lowering the dose,
 waiting, and switching to another agent. A number of specific antidotes,
 such as cyproheptadine and yohimbine, have been reported to reverse these
 side effects in a limited number of cases. CONCLUSION: Clinicians must be
 aware of and specifically ask about medication-induced sexual side
 effects. More effective treatments of these side effects must await much
 needed double-blind studies of various approaches, especially those to
 treat SSRI-induced sexual dysfunction. [References: 85]
Registry Numbers
 0 (Antidepressive Agents). 0 (Antipsychotic Agents). 0 (Monoamine
 Oxidase Inhibitors). 0 (Serotonin Uptake Inhibitors). 50-67-9
 (Serotonin). 51-61-6 (Dopamine).

<2>
Unique Identifier
 94196541
Authors
 Warot D.
Institution
 Departement de Pharmacologie Clinique, Hopital Pitie-Salpetriere, Paris.
Title
 [Value of autoquestionnaires in the evaluation of sex disorders related to
 drugs]. [French]
Original Title
 Interet des autoquestionnaires dans l'evaluation des troubles sexuels lies
 aux medicaments.
Source
 Therapie. 48(5):441-3, 1993 Sep-Oct.
Local Messages
 TITLE NOT IN LIBRARY. REQUEST COPY VIA INTER-LIBRARY LOAN.
Abstract
 Symptoms can be assessed by the subject or the patient himself.
 Drug-related sexual dysfunction may be of clinical relevance for
 medication compliance. Three kinds of self-rating scales are available:
 yes/no questionnaire, multiple choice questionnaire and visual analogue
 scales. Self-rating can be absolute (intensity score) or relative
 (improving or worsening score), over last rating or over baseline.
 Self-rating necessarily implies: comprehension of the vocabulary and the
 instructions by the subject; cooperation of the subject; and careful
 checking of the answers by the clinician. Main metrologic qualities are
 sensitivity, reliability and validity. To assess changes in sexual
 function, the "golden" sexual function questionnaire does not seem to
 exist. Separate questionnaires are provided for men and women with
 appropriate changes for specific items. The number of questions varies
 from 4 to 20 even more. Several aspects of the male and female sexuality
 must be studied. Two main questions can be raised: 1) is there any
 relation between responses obtained with self-reported questionnaire and
 responses to questioning by a clinician? is there any relation between
 self-reported sexual dysfunction and objective measures of sexual function
 like plethysmography?

<3>
Unique Identifier
 93322342
Authors
 Balon R. Yeragani VK. Pohl R. Ramesh C.
Institution
 Department of Psychiatry, Wayne State University School of Medicine,
 Detroit, Mich.
Title
 Sexual dysfunction during antidepressant treatment.
Source
 Journal of Clinical Psychiatry. 54(6):209-12, 1993 Jun.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 BACKGROUND: The reported incidence of sexual dysfunction associated with
 antidepressant medication varies from 1.9% to 92%. The majority of studies
 reporting incidences were not systematically conducted. METHOD: We
 interviewed 60 patients (22 men and 38 women, with anxiety and mood
 disorders) who were being treated with various antidepressants. We used a
 questionnaire focused on sexual side effects and other side effects.
 RESULTS: The incidence of sexual dysfunction during antidepressant use in
 our study is 43.3%. The sexual dysfunction was not limited to any
 particular diagnostic group nor to any particular antidepressant. There
 was no significant correlation between sexual dysfunction and
 anticholinergic side effects. The incidence of painful orgasm with
 antidepressants was 18% among males in our study. CONCLUSION: The
 relatively high incidence of sexual dysfunction associated with
 antidepressant treatment in this systematic study emphasizes the
 importance of a detailed inquiry about sexual side effects as this
 interferes with treatment compliance.
Registry Numbers
 0 (Antidepressive Agents). 303-49-1 (Clomipramine). 50-49-7
 (Imipramine). 54910-89-3 (Fluoxetine).

<4>
Unique Identifier
 93350718
Authors
 Donatucci CF. Lue TF.
Institution
 Department of Urology, University of California School of Medicine, San
 Francisco 94143-07387.
Title
 Erectile dysfunction in men under 40: etiology and treatment choice.
Source
 International Journal of Impotence Research. 5(2):97-103, 1993 Jun.
Abstract
 We undertook a retrospective review of 100 impotent men under age 40 to
 determine the underlying etiologic factors in the group and to evaluate
 the role of surgery in their care. Although patients ranged in age from 18
 to 40 (mean--32.2 years), the number of patients increased steadily with
 advancing years. The majority of patients (72) had vasculogenic impotence
 (arteriogenic--15, venogenic--46, mixed--11), followed by psychogenic
 (13), neurogenic (12) and other causes (4). The differential diagnosis did
 not correlate with age. Contributing factors were present in 76%, trauma
 and substance abuse being most common. Essentially equal numbers of
 patients were treated surgically (40) and with intracavernous injection of
 vasoactive agents (39). Considerably fewer had a vacuum constriction
 device (5), oral medication (5), psychotherapy (4), other therapy (4), and
 none (3). The majority of patients referred to our tertiary urologic
 practice for treatment of vasculogenic impotence were sent by other
 urologists. Although the referral source did not appear to influence the
 choice of treatment, it probably has accounted for the preponderance of
 vasculogenic impotence in this series.
Registry Numbers
 0 (Vasoconstrictor Agents).

<5>
Unique Identifier
 92254455
Authors
 Lundberg PO.
Title
 [Sexual dysfunction--problem because of physical illness or medication].
 [Swedish]
Original Title
 Sexuella funktionshinder--problem pa grund av kroppslig sjukdom och
 lakemedel.
Source
 Vardfacket. 15(16):XXII-XXIV, 1991 Sep 26.
Local Messages
 TITLE NOT IN LIBRARY. REQUEST COPY VIA INTER-LIBRARY LOAN.

<1>
Unique Identifier
 91065585
Authors
 Sullivan G. Lukoff D.
Institution
 Rehabilitation Service, Brentwood Veterans Affairs, West Los Angeles,
 California.
Title
 Sexual side effects of antipsychotic medication: evaluation and
 interventions. [Review]
Source
 Hospital & Community Psychiatry. 41(11):1238-41, 1990 Nov.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 Sexual side effects of antipsychotic medications, which include
 disturbances of erection and ejaculation, changes in libido, and priapism
 in men and decreased libido, orgasmic dysfunction, and menstrual
 irregularities in women, are estimated to occur in 30 to 60 percent of
 persons taking the drugs. The authors review side effects associated with
 specific drugs and present guidelines for assessing whether sexual
 dysfunction is related to medication. Pharmacological interventions that
 may reduce antipsychotic-induced sexual dysfunction include gradually
 reducing the dose or changing the type of medication and administering
 other medications such as bethanechol, neostigmine, cyproheptadine, and
 bromocriptine that are known to improve sexual dysfunction. [References:
 52]
Registry Numbers
 0 (Antipsychotic Agents).

<2>
Unique Identifier
 89259142
Authors
 Susset JG. Tessier CD. Wincze J. Bansal S. Malhotra C. Schwacha MG.
Institution
 Department of Urology, Providence Veterans Administration Medical Center,
 Rhode Island.
Title
 Effect of yohimbine hydrochloride on erectile impotence: a double-blind
 study.
Source
 Journal of Urology. 141(6):1360-3, 1989 Jun.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 A double-blind, partial crossover study on the therapeutic effect of
 yohimbine hydrochloride on erectile dysfunction was done in 82 sexually
 impotent patients. All patients underwent a multifactorial evaluation,
 including determination of penile brachial blood pressure index,
 cavernosography, sacral evoked response, testosterone and prolactin
 determination, Derogatis sexual dysfunction inventory and daytime arousal
 test. After 1 month of treatment with a maximum of 42.0 mg. oral yohimbine
 hydrochloride daily 14 per cent of the patients experienced restoration of
 full and sustained erections, 20 per cent reported a partial response to
 the therapy and 65 per cent reported no improvement. Three patients
 reported a positive placebo effect. Maximum effect takes 2 to 3 weeks to
 manifest itself. Yohimbine was active in some patients with arterial
 insufficiency and a unilateral sacral reflex arc lesion, and in 1 with low
 serum testosterone levels. The 34 per cent response is encouraging,
 particularly in a Veterans Administration population presenting with a
 high incidence of diabetes and vascular pathological conditions not found
 in regular office patients. Only few and benign side effects were
 recorded, which makes this medication worth an attempt, often as a first
 line of treatment even at a dose of 8 tablets.
Registry Numbers
 146-48-5 (Yohimbine).

<3>
Unique Identifier
 89039269
Authors
 McWaine DE. Procci WR.
Institution
 Department of Psychiatry, Harbor-UCLA Medical Center, Torrance.
Title
 Drug-induced sexual dysfunction. [Review]
Source
 Medical Toxicology & Adverse Drug Experience. 3(4):289-306, 1988 Jul-Aug.
Local Messages
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Abstract
 A large body of data, as well as clinical experience, link prescribed
 medications and substances of abuse with sexual dysfunction. This review
 surveys the relevant literature and summarises key points relating various
 classes of medications and their possible sexual side effects.
 Surprisingly, there were very few carefully designed, well organised,
 systematic studies of the effects of medication upon sexual performance.
 The preponderance of data is in the form of either case studies or
 collections of patient reports of side effects. As a result, there are
 great variations in the reported rates of sexual disturbances associated
 with the administration of a given medication. A further difficulty is the
 lack of precision in the use of terms which describe the various sexual
 disorders. A final problem is the almost total lack of data concerning
 both disordered and normal sexual functioning in females. [References:
 121]

<4>
Unique Identifier
 89150821
Authors
 Hawton K.
Institution
 Warneford Hospital, Oxford.
Title
 Erectile dysfunction and premature ejaculation. [Review]
Source
 British Journal of Hospital Medicine. 40(6):428-36, 1988 Dec.
Local Messages
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Abstract
 In parallel with the increased recognition of organic causes of erectile
 dysfunction, several new physical methods of treatment have been developed
 for this problem. These include intracavernosal injections of
 vasodilators, penile prostheses, vascular surgery, vacuum condoms, and
 medication. However, psychological treatment approaches are still of
 considerable importance in the treatment of both erectile dysfunction and
 premature ejaculation. [References: 43]

<5>
Unique Identifier
 89178815
Authors
 Miller NS. Gold MS.
Institution
 New York Hospital/Cornell Medical Center, White Plains 10605.
Title
 The human sexual response and alcohol and drugs. [Review]
Source
 Journal of Substance Abuse Treatment. 5(3):171-7, 1988.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 The effects of alcohol and drugs on sexual function are important to
 consider in clinical histories and medication prescribing practices.
 Virtually all aspects of the human sexual response are affected by alcohol
 and drugs: 1. Desire (libido) is reduced. 2. Performance. Impotency as
 defined by lack of erection and ejaculation occurs. 3. Dissatisfaction
 ensues. These effects of alcohol and drugs can be understood and
 illustrated by examining the phases of excitement, plateau, orgasm, and
 resolution in the human sexual response. The important first step in the
 treatment of sexual dysfunction is to identify the alcohol/drug/medication
 use. The next is to recognize the profound effect it can have on the human
 sexual response. Furthermore, knowledge of the mechanism of action of the
 drugs and a basic conception of the physiology and psychology of sexual
 performance are necessary to predict the course of the sexual dysfunction.
 In many instances, the sexual dysfunction is reversible even after chronic
 alcohol/drug/medication use. [References: 31]
Registry Numbers
 64-17-5 (Alcohol, Ethyl).

<6>
Unique Identifier
 87226445
Authors
 Morales A. Condra M. Owen JA. Surridge DH. Fenemore J. Harris C.
Title
 Is yohimbine effective in the treatment of organic impotence? Results of a
 controlled trial.
Source
 Journal of Urology. 137(6):1168-72, 1987 Jun.
Local Messages
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Abstract
 Yohimbine is an alpha-adrenoceptor blocker that has been used in the
 treatment of erectile dysfunction. Adequate trials of this substance in a
 clearly defined organically impotent population are not available. We
 conducted a randomized, controlled study with partial cross-over of
 yohimbine versus placebo in 100 organically impotent men. The first phase
 of the study showed a positive response in 42.6 per cent of the patients
 receiving yohimbine versus 27.6 per cent in the placebo group. Although
 favorable to the test medication these values did not reach statistical
 significance (p equals 0.42). A similar pattern was noted in the second
 phase of the study. The over-all response rate of 43.5 per cent was
 consistent with a previous noncontrolled trial but it was much lower than
 previous studies. The response rate of organically impotent patients to
 yohimbine is at best marginal. Owing to its ease of administration, safety
 and modest effect it still is used in those patients who do not accept
 more invasive methods. Adrenoceptors are involved in the erectile process,
 although other neurotransmitter systems also are putative modulators of
 penile erection, including cholinergic, dopaminergic and vasoactive
 intestinal polypeptide pathways. It is beyond reasonable expectation that
 a single agent be of value for all cases of organic impotence. However,
 yohimbine has shown modest effectiveness at the doses used in this trial
 (18 mg. per day). Higher doses or a different route of administration may
 produce different effects.
Registry Numbers
 146-48-5 (Yohimbine).

<7>
Unique Identifier
 86224712
Authors
 Harrison WM. Rabkin JG. Ehrhardt AA. Stewart JW. McGrath PJ. Ross D. 
 Quitkin FM.
Title
 Effects of antidepressant medication on sexual function: a controlled
 study.
Source
 Journal of Clinical Psychopharmacology. 6(3):144-9, 1986 Jun.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 There has been little systematic study of the types of sexual dysfunction
 produced by antidepressant medication or of the frequency with which this
 type of adverse effect occurs. The authors report results of a
 double-blind study in which the effects of imipramine, phenelzine, and
 placebo on specific aspects of sexual function were assessed in depressed
 outpatients before and after 6 weeks of treatment. Both active treatments
 were associated with a high incidence of adverse changes in sexual
 function and produced significantly more adverse effects on sexual
 function than placebo. Orgasm and ejaculation were impaired to a greater
 extent than erection. Adverse sexual function changes secondary to
 antidepressant medication occurred frequently in both men and women,
 although men reported a higher incidence. Antidepressant-related sexual
 dysfunction may be of clinical importance for medication compliance in
 view of current recommendations that antidepressants be administered for
 longer periods as maintenance therapy or for prophylaxis.
Registry Numbers
 0 (Antidepressive Agents). 50-49-7 (Imipramine). 51-71-8 (Phenelzine).

<1>
Unique Identifier
 81044930
Authors
 Martin LM.
Title
 Erectile impotence--it can be highly treatable.
Source
 Geriatrics. 35(12):79-83, 1980 Dec.
Local Messages
 LIBRARY OWNS TITLE. CHECK JOURNAL LISTING FOR VOLUME & ISSUE.
Abstract
 In brief, the treatment of impotence is the treatment of the underlying
 cause whenever possible. When irreversible organic impotence is found,
 however, penile prosthesis should be considered. Both hydraulic inflatable
 and semirigid rod types are available. Morbidity with the procedure is
 relatively low in experienced hands and patient satisfaction has been
 reported as quite high. Pharmacogenic impotence may require a change or
 reduction of medication. Depression usually responds to some combination
 of antidepressants, psychotherapy, or electroconvulsive therapy, while
 modern short-term sex therapy has proved effective in reversing many of
 the anxiety-related cases. Deep-seated, anxiety-based impotence may
 require extensive psychotherapy, but many cases of recent-onset
 psychogenic impotence can be managed quite successfully with education,
 reassurance, and the optional short-term use of testosterone.

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