Antipsychotics and Sexual Dysfunction

Antipsychotics and Impotence
Impotence, or erectile dysfunction (ED), is a condition in which the penis does not become firm enough, or stay firm enough, for sexual intercourse. A man may occasionally experience difficulty getting or keeping an erection. However, erectile dysfunction is when a man has repeated problems with erections. Impotence is a relatively rare side effect of antipsychotic use, but may still occur.
Antipsychotic use is not the only possible cause of impotence. In fact, there are many possible causes. Some of the more common causes of impotence may include:

Why Do Antipsychotics Cause Sexual Dysfunction?

There are several possible reasons antipsychotics may lead to sexual dysfunction. Most of the reasons are directly related to how the medications work in the body. Additionally, many of the medical conditions treated by antipsychotics are themselves associated with sexual problems. Specifically, antipsychotics are likely to cause sexual side effects because they:
  • Block dopamine
  • Increase prolactin levels
  • Have anticholinergic effects.
All antipsychotics block dopamine in the body. Dopamine is a body chemical, or neurotransmitter, that plays an important role in sexual function (among other actions). It is thought that by blocking dopamine, antipsychotics may also reduce sex drive. However, dopamine is also responsible for many of the beneficial effects of antipsychotics, such as the treatment of delusions (believing things that are not true) and hallucinations (seeing or hearing things that are not there).
Antipsychotics also increase the amount of prolactin in the body. High prolactin levels can cause erectile dysfunction, reduced sex drive, and difficulty achieving orgasm.
Not all antipsychotics increase prolactin levels to the same degree. For example, risperidone (Risperdal®) and the older antipsychotic haloperidol (Haldol®) are known to increase prolactin levels more so than some other antipsychotics, such as quetiapine (Seroquel®), ziprasidone (Geodon®), aripiprazole (Abilify®), and clozapine (Clozaril®, FazaClo®).
Some older antipsychotics, such as chlorpromazine (Thorazine®) and thioridazine (Mellaril®), have anticholinergic activity. This means they block the action of acetylcholine, a neurotransmitter in the body. Medications with anticholinergic actions may cause impotence, or erectile dysfunction. Another problem is that people taking certain antipsychotics may be given anticholinergic medications, such as benztropine (Cogentin®), to treat other antipsychotic side effects, including unusual body movements or restlessness.
Finally, it is important to keep in mind that some of the health problems antipsychotics are used to treat can cause sexual dysfunction. For example, both schizophrenia and depression are associated with decreased sex drive and sexual activity. Studies have shown that up to 80 percent of people with schizophrenia, and up to 75 percent of people with depression, have problems with sexual function.
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