Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-15T05:59:30.428Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychopharmacologic Treatments for Nonparaphilic Compulsive Sexual Behaviors

Published online by Cambridge University Press:  07 November 2014

Martin Kafka
Get access Rights & Permissions [Opens in a new window]

Abstract

This article reviews the use of pharmacologic agents to treat nonparaphilic compulsive sexual behaviors (paraphilia-related disorders). Recent data suggest that serotonergic antidepressants, especially serotonin reuptake inhibitors (SRIs), may be effective in treating nonparaphilic sexual behaviors characterized by hypersexuality. The rationale, prescriptive use, and limitations of SRIs are reviewed, as are the proposed mechanisms of action, prescriptive use, and side effects of medications that lower serum testosterone (including triptorelin and the antiandrogens medroxyprogesterone acetate and cyproterone acetate). The potential use of psychostimulants, mood stabilizers, and atypical antipsychotics for paraphilia-related disorders in specific clinical situations is discussed. Practical guidelines, augmentation strategies with adjunctive psychopharmacologic agents, and indications regarding pharmacologic combinations of the above medications are suggested.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 1: The Epidemiology, Psychopharmacology, and Neurobiology of Compulsive Sexual Behavior , January 2000 , pp. 49 - 59
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Coleman, E. Is your patient suffering from compulsive sexual behavior? Psychiatric Annals. 1992;22:320–325.CrossRefGoogle Scholar
2.Black, DW. Compulsive sexual behavior: a review. J Practical Psychiatry Behav Health. 1998;4:217–229.Google Scholar
3.Kafka, MRParaphilia-related disorders: common, neglected, and misunderstood. Har Rev Psychiatry. 1994;2:39–40.CrossRefGoogle ScholarPubMed
4.Kafka, MP, Hennon, J. The paraphilia-related disorders: an empirical investigation of nonparaphilic hypersexuality disorders in 206 outpatient males. J Sex Marital Ther. In press.Google Scholar
5.Black, DW, Kehrberg, LLD, Flumerfelt, DL, Schlosser, SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry. 1997;154:243–249.Google ScholarPubMed
6.Kafka, MP, Prentky, RA. Preliminary observations of DSM-III-R Axis I comorbidity in men with paraphilias and paraphilia-related disorders. J Clin Psychiatry. 1994;55:481–487.Google ScholarPubMed
7.Kafka, MP, Prentky, RA. Attention deficit hyperactivity disorder in males with paraphilias and paraphilia-related disorders: a comorbidity study. J Clin Psychiatry. 1998;59:388–396.CrossRefGoogle ScholarPubMed
8.Raymond, NC, Coleman, E, Ohlerking, F, Christenson, GA, Miner, M. Psychiatric comorbidity in pedophilic sex offenders. Am J Psychiatry. In press.Google Scholar
9.Diagnostic and Statistical Manual of Mental Disorders. 3rd ed rev. Washington, DC: American Psychiatric Association; 1987.Google Scholar
10.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
11.Breitner, IE. Psychiatric problems of promiscuity. South Med J. 1973;66:334–336.CrossRefGoogle ScholarPubMed
12.Kafka, MP, Prentky, R. A comparative study of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1992;53:345–350.Google ScholarPubMed
13.Kafka, MP. Hypersexual desire in males: an operational definition and clinical implications for men with paraphilias and paraphilia-related disorders. Arch Sex Behav. 1997;26:505–526.CrossRefGoogle Scholar
14.Kafka, MP, Prentky, R. Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1992;52:351–358.Google Scholar
15.Kafka, MP. Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Ann Clin Psychiatry. 1994;6:189–195.CrossRefGoogle ScholarPubMed
16.Kafka, MP. A monoamine hypothesis for the pathophysiology of paraphilic disorders. Arch Sex Behav. 1997;26:337–352.Google ScholarPubMed
17.Kinsey, AC, Pomeroy, WB, Martin, CE. Total sexual outlet. In: Sexual Behavior in the Human Male. Philadelphia, Pa: W.B. Saunders Co; 1948:193–217.Google Scholar
18.Laumann, EO, Gagnon, JH, Michael, RT, Michaels, S. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago, Ill: University of Chicago Press; 1994.Google Scholar
19.Seidman, SN, Reider, RO. Sexual behavior through the life cycle: an empirical approach. In: Oldham, JM, Riba, MB, eds. Review of Psychiatry. Washington, DC: American Psychiatric Press; 1995:639–676.Google Scholar
20.Carnes, P. Out of the Shadows: Understanding Sexual Addiction. Minneapolis, Minn: CompCare; 1983.Google Scholar
21.Everitt, BJ, Bancroft, J. Of rats and men: the comparative approach to male sexuality. In: Bancroft, J, Davis, CM, Ruppel, HJ Jr, eds. Annual Review of Sex Research. Mt Vernon, Iowa: Society for the Scientific Study of Sex; 1991:77–118.Google Scholar
22.Mas, M. Neurobiological correlates of masculine sexual behavior. Neurosci Biobehav Rev. 1995;19:261–277.CrossRefGoogle ScholarPubMed
23.Baum, MJ, Starr, MS. Inhibition of sexual behavior by dopamine antagonists or serotonin agonist drugs in castrated male rats given estradiol or dihydrotestosterone. Pharmacol Biochem Behav. 1980;13:47–67.CrossRefGoogle ScholarPubMed
24.Bitran, D, Hull, EM. Pharmacological analysis of rat male sexual behavior. Neurosci Biobehav Rev. 1987;11:365–389.CrossRefGoogle Scholar
25.Kinsey, AC, Pomeroy, WB, Martin, CE. Sexual Behavior in the Human Male. Philadelphia, Pa: W.B. Saunders Co; 1948.Google Scholar
26.Kinsey, AC, Pomeroy, WB, Martin, CE, Gebhard, PH. Sexual Behavior in the Human Female. Philadelphia, Pa: W.B. Saunders Co; 1953.Google Scholar
27.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994:522–532.Google Scholar
28.Carnes, P. Don't Call It Love: Recovery from Sexual Addiction. New York, NY: Bantam Books; 1991.Google Scholar
29.Kafka, MP. Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1991;52:60–65.Google ScholarPubMed
30.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994:493–538.Google Scholar
31.Kavoussi, RJ, Coccaro, EF. Impulsive personality disorders and disorders of impulse control. In: Hollander, E, ed. Obsessive-Compulsive-Related Disorders. Washington DC: American Psychiatric Press; 1993:179–202.Google Scholar
32.Meltzer, H. Role of serotonin in depression. In: Whitaker-Azmitia, PM, Peroutka, SJ, eds. The Neuropharmacology of Serotonin. Vol 600. New York, NY: New York Academy of Sciences; 1990:486–500.Google Scholar
33.Kahn, RS, Westenberg, HGM, Verhoevan, WMA. Effect of serotonin precursor uptake inhibitors in anxiety disorders: a double blind comparison of 5-hydroxytryptophan, clomipramine and placebo. Int Clin Psychopharmacol. 1987;2:33–45.CrossRefGoogle ScholarPubMed
34.Montejo-Gonzalez, AL, Llorca, G, Izquierdo, JA. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23:176–194.CrossRefGoogle Scholar
35.Ashton, AK, Hamer, R, Rosen, R. Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther. 1997;23:165–175.CrossRefGoogle Scholar
36.Pearson, HJ. Paraphilias, impulse control, and serotonin [letter]. J Clin Psychopharmacol. 1990;10:233.CrossRefGoogle ScholarPubMed
37.Federoff, JP. Serotonergic drug treatment of deviant sexual interests. Annals of Sex Research. 1993;6:105–121.CrossRefGoogle Scholar
38.Greenberg, DM, Bradford, JMW. Treatment of the paraphilic disorders: a review of the role of the selective serotonin reuptake inhibitors. Sexual Abuse: Journal of Treatment and Research. 1997;9:349–360.CrossRefGoogle Scholar
39.Perilstein, RD, Lipper, S, Friedman, LJ. Three cases of paraphilias responsive to fluoxetine treatment. J Clin Psychiatry. 1991;52:169–170.Google ScholarPubMed
40.Bradford, JMW. An open pilot study of sertraline in the treatment of outpatients with pedophilia. In: Oldham, JM, Fiester, SJ, eds. Proceedings of the 148th Annual Meeting of the American Psychiatric Association. Washington, DC: American Psychiatric Press; 1995.Google Scholar
41.Greenberg, DM, Bradford, JMW, Curry, S, O'Rourke, A. A comparison of treatment of paraphilias with three serotonin reuptake inhibitors: a retrospective study. Bull Am Acad Psychiatry Law. 1996;24:525–532.Google ScholarPubMed
42.Kruesi, MJP, Fine, S, Valladares, L, Phillips, RA, Rapoport, JL. Paraphilias: a double-blind crossover comparison of clomipramine versus desipramine. Arch Sex Behav. 1992;21:587–593.CrossRefGoogle ScholarPubMed
43.Gessa, GL, Tagliamonte, A. Role of brain serotonin and dopamine in male sexual behavior. In: Sandler, M, Gessa, GL, eds. Sexual Behavior: Pharmacology and Biochemistry. New York, NY: Raven Press; 1975.Google Scholar
44.Segraves, RT. Drugs and desire. In: Lieblum, SR, Rosen, RC, eds. Sexual Desire Disorders. New York, NY: Guilford Press; 1988:313–340.Google Scholar
45.Pfaus, JG, Everitt, BJ. The psychopharmacology of sexual behavior. In: Bloom, FE, Kupfer, DJ, eds. Psychopharmacology: The Fourth Generation of Progress. New York, NY: Raven Press Ltd; 1995:743–758.Google Scholar
46.Bowers, MB, Woert, MV, Davis, L. Sexual behavior during L-DOPA treatment for parkinsonism. Am J Psychiatry. 1971;127:1691–1693.CrossRefGoogle ScholarPubMed
47.Angrist, BM, Gershon, S. Clinical effects of amphetamine and L-dopa on sexuality and aggression. Compr Psychiatry. 1976;17:715–722.CrossRefGoogle ScholarPubMed
48.Hallowell, EM, Ratey, JJ. Driven To Distraction. New York, NY: Pantheon Books; 1995.Google Scholar
49.Comings, D. Role of genetic factors in human sexual behavior based on studies of Tourette syndrome and ADHD probands and their relatives. Am J Med Genet. 1994;54:227–241.CrossRefGoogle ScholarPubMed
50.Kaplan, PM, Bartlik, BD. Sexuality and attention deficit hyperactivity disorder: a case series and literature review. Primary Psychiatry. 1997; January:49–55.Google Scholar
51.Stoll, AL, Pillay, SS, Diamond, L, Workum, SB, Cole, JO. Methylphenidate augmentation of selective serotonin reuptake inhibitors: a case series. J Clin Psychiatry. 1996;57:72–76.Google ScholarPubMed
52.Nierenberg, AA, Dougherty, D, Rosenbaum, JF. Dopaminergic agents and stimulants as antidepressant augmentation strategies. J Clin Psychiatry. 1998;59(suppl 5):60–63.Google ScholarPubMed
53.Bodkin, JA, Lasser, RA, Wines, JD Jr, Gardner, DM, Baldessarini, RJ. Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy. J Clin Psychiatry. 1997;58:137–45.CrossRefGoogle ScholarPubMed
54.Bryne, SE, Rothschild, AJ. Loss of antidepressant efficacy during maintenance therapy: possible mechanisms and treatments. J Clin Psychiatry. 1998;59:279–288.CrossRefGoogle Scholar
55.Goldberg, JF, Kocsis, JH. Relapse during SSRI treatment of depression. Medscape Mental Health Website. Available at: http://www.medscape.com. Accessed November 1, 1996.Google Scholar
56.Bartlik, BD, Kaplan, P, Kaplan, HS. Psychostimulants apparently reverse sexual dysfunction secondary to selective serotonin reuptake inhibitors. J Sex Marital Ther. 1995;21:264–271.CrossRefGoogle Scholar
57.Archer, J. The influence of testosterone on human aggression. Br J Psychol. 1991;82:1–28.CrossRefGoogle ScholarPubMed
58.Bradford, J, Maclean, D. Sex offenders, violence, and testosterone: a chemical study. Can J Psychiatry. 1981;29:335–343.CrossRefGoogle Scholar
59.Hucker, SJ, Bain, J. Androgenic hormones and sexual assault. In: Marshall, WL, Laws, DR, Barbaree, HE, eds. Handbook, of Sexual Assault. New York, NY: Plenum Press; 1990: 93–102.CrossRefGoogle Scholar
60.Seim, HC, Dwyer, M. Evaluation of serum testosterone and luteinizing hormone levels in sex offenders. Family Practice Research Journal. 1988;7:175–180.Google ScholarPubMed
61.Holmes, KK, Mardh, P, Sparling, PF, Weisner, PJ. Sexually Transmitted Diseases. New York, NY: McGraw-Hill; 1990.Google Scholar
62.Kalichman, SC, Greenberg, J, Abel, GG. HIV-seropositive men who engage in high-risk sexual behaviour: psychological characteristics and implications for prevention. AIDS Care. 1997;9:441–450.CrossRefGoogle ScholarPubMed
63.Bradford, JMW. Pharmacological treatment of the paraphilias. In: Oldham, JM, Riba, MB, eds. Review of Psychiatry. Washington DC: American Psychiatric Press; 1995:755–778.Google Scholar
64.Albin, J, Vittek, J, Gordon, GG. On the mechanism of the antiandrogenic effect of medroxyprogesterone acetate. Endocrinology. 1973;93:417–422.CrossRefGoogle ScholarPubMed
65.Langevin, R, Paitich, D, Hucker, S, et al.The effect of assertiveness training, provera and sex of therapist in the treatment of genital exhibitionism. J Behav Ther Exp Psychiatry. 1979;10:275–282.CrossRefGoogle Scholar
66.Gottesman, HG, Schubert, DSP. Low-dose oral medroxyprogesterone acetate in the management of paraphilias. J Clin Psychiatry. 1993;54:182–188.Google ScholarPubMed
67.Liang, T, Tymoczko, JL, Chan, KMB, Hung, HC, Liao, S. Androgen action: receptors and rapid response. In: Martini, L, Motta, M, eds. Androgens and Antiandrogens. New York, NY: Raven Press; 1977:77–89.Google Scholar
68.Bradford, JMW, Pawlak, A. Effects of cyproterone acetate on sexual arousal patterns of pedophiles. Arch Sex Behav. 1993;22:629–640.CrossRefGoogle ScholarPubMed
69.Rosler, A, Witzium, E. Treatment of men with paraphilia with a long-acting analogue of gonadotrophin-releasing hormone. N Engl J Med. 1998;388;416–422.CrossRefGoogle Scholar
70.Dickey, R. The management of a case of treatment resistant paraphilia with a long acting LHRH agonist. Can J Psychiatry. 1992:37;567–569.CrossRefGoogle ScholarPubMed