Anticonvulsants

Little is known about the effects of anticonvulsants on sexual functioning in bipolar patients despite their many years of use. Although there are some reports addressing anticonvulsant effects on sexual function in patients with epilepsy, evaluating this limited information is difficult because sexual dysfunction often accompanies epilepsy. There are a few case reports of ejaculatory failure related to carbamazepine and gabapentin, but the frequency of this possible effect is unknown. Little is known about sexual side effects of the commonly used anticonvulsant, divalproex. At best there are a few case reports suggesting that divalproex may reduce libido or the ability to achieve orgasm in women, though there are no prospective controlled studies to delineate the extent of this possible problem. There is a suggestion that lamotrigine may have some advantages over the other anticonvulsants regarding sexual side effects, but this is preliminary. Read more about female viagra here.

In one study of 62 patients, women and men showed modest overall improvement in sexual function scores when switched from another anticonvulsant to lamotrigine. Because of the lack of control group and the possible confound of epilepsy of sexual function, it is difficult to extend these findings to patients with mood disorders, though it suggests that lamotrigine may have fewer sexual side effects than other anticonvulsants.

Phenytoin and carbamazepine induce metabolism of androgens, while divalproex inhibits this metabolism. This would suggest that phenytoin and carbamazepine could be problem prone and valproate less problem prone, though prospective study is lacking. Valproic acid has not been studied prospectively in samples of patients with bipolar disorder for its effects on androgens and sexual functioning. There are, however, several case reports of reduced libido or orgasm inability in patients with mood disorders treated with divalproex.

A cross-sectional, nonrandomized study of 75 men with epilepsy found that sexual dysfunction was more commonly associated with phenytoin (n = 25) and carbamazepine (n = 25) than with control patients (n = 25) or lamotrigine (n = 25) treated patients. Lamotrigine-treated patients reported sexual symptoms at approximately the same rate as a normal control group. In this study, patients rated sexual functioning on a rating scale that measured ‘sexual interest and potency’ as well as had blood measured for gonadal hormones, including luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone and estradiol. Mean sexual function scores for lamotrigine were slightly higher, and statistically greater compared with the carbamazepine and phenytoin groups. The effect size, however, was quite small. Additionally, testosterone concentrations were lower in the carbamazepine- and phenytoin-treated patients compared with the lamotrigine treated patients, which were similar to controls. Although this information may not be extended to patients without epilepsy, it appears that lamotrigine is less prone toward causing sexual dysfunction than carbamazepine and phenytoin, though none of the anticonvulsants may seriously affect sexual functioning.

Anxiolytic Drugs

Benzodiazepines
The benzodiazepines have not been prospectively studied regarding their effects on sexual function. There are a number of retrospective reports suggesting that clonzepam may be problematic for sexual functioning, though other reports suggest that it might not be problematic. All of the benzodiazepines have been suggested to cause sexual dysfunction, but there are no prospective studies examining sexual function in patients taking this class of medication for an anxiety disorder. Considering the frequency of their use, the lack of reports suggests that the side effects may be of minor importance. Moreover, without baseline measure before drug initiation, some of the reported sexual dysfunction may be related to the mood or anxiety disorders for which they are prescribed. The few reports available for review are cross-sectional or retrospective in small samples and rating scales were not necessarily employed. Decreases in libido, arousal, and orgasm have all been reported. In one study, detailed in the ‘Lithium’ section above, the authors found that benzodiazepines combined with lithium in the treatment of bipolar disorder patients caused 40% of patients to experience sexual side effects, which was considerably higher than the 14% rate in patients taking only lithium. The study did not evaluate if the effects were specifically associated with arousal, orgasm or libido for the combination of lithium and benzodiazepines. On the other hand, an early small placebo-controlled study in normal patients without anxiety found that diazepam ‘facilitated sexual behaviors in normals’. Viagra in Canada

While some sexual dysfunction in patients with anxiety disorders taking benzodiazepines may be attributable to benzodiazepines, the effects of benzodiazepines on sexual function clearly need further prospective study to determine the extent and clinical relevance.

Buspirone
Buspirone is an anxiolytic that does not appear to have sexual side effects, though it has not been specifically studied in prospective studies for its propensity to cause sexual side effects. Interestingly, as noted in the antidepressant section, buspirone may reverse sexual dysfunction associated with serotonin reuptake antidepressant use. It appears that this benefit is only with relatively high doses, approximately 45–60mg per day. Without further study, it remains unknown if buspirone monotherapy causes any adverse or salutary sexual effects.