{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:27:59Z","timestamp":1781504879285,"version":"3.54.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T00:00:00Z","timestamp":1625702400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sexual dysfunction may be a side effect of treatment with antipsychotics, antidepressants, and other psychotropic drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To review the evidence concerning male sexual dysfunctions in patients taking psychotropic drugs to provide specific information to nonpsychiatric physicians for the management of these dysfunctions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of Medline and Embase databases was performed up to October 15th, 2020. We included randomized controlled trials comparing the effects of psychotropic drugs versus placebo or versus another drug of the same class, for at least 5 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>We considered studies whose male population could be evaluated separately from the female population and with a separate analysis of the different phases of the male sex cycle.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>We included 41 studies in the final review. There was a significant association between sexual dysfunction and antidepressant drug therapy, compared to placebo (decreased libido OR 1.89, 95% CI:1.40 to 2.56, 22 series, 11 trials, 7706 participants; erectile dysfunction OR = 2.28, 95% CI: 1.31 to 3.97; 11 trials, 3008 participants; ejaculatory dysfunction OR = 7.31, 95% CI: 4.38 to 12.20,19 trials, 3973 participants). When the effects of selective serotonin reuptake inhibitors (SSRIs) were evaluated separately from those of serotonin\/norepinephrine reuptake inhibitors (SNRIs), the use of SNRIs but not that of SSRIs was characterized by significantly higher odds of erectile dysfunction compared to placebo. Only limited data were found regarding the effects of antipsychotics on the phases of the male sexual cycle, as it was shown that aripiprazole and risperidone showed lower and higher odds for erectile or ejaculatory dysfunction, respectively, compared to other atypical antipsychotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>Treatment of male sexual dysfunction in patients taking psychotropics requires a basic knowledge of the different drugs that affect sexual function with different mechanisms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths &amp; Limitations<\/jats:title><jats:p>The effects of psychotropic drugs on erectile function and ejaculation were evaluated separately. The great variability of the mechanisms of action makes it difficult to make comparisons between the effects of the different classes of psychotropic drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Administration of antipsychotics affects male sexual function with different mechanisms, although the increase in prolactin values associated with the administration of first-generation antipsychotics and some atypical, such as risperidone, seems to play a primary role in determining male sexual dysfunction. Most antidepressants cause decreased libido, ejaculatory and erectile dysfunction, however the administration of SNRIs appears to be possibly associated with a specific risk of erectile dysfunction.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.jsxm.2021.05.016","type":"journal-article","created":{"date-parts":[[2021,7,8]],"date-time":"2021-07-08T22:29:58Z","timestamp":1625783398000},"page":"1354-1363","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":56,"title":["Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review"],"prefix":"10.1093","volume":"18","author":[{"given":"Margherita","family":"Trinchieri","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Psychiatric Unit, University of Parma , Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Trinchieri","sequence":"additional","affiliation":[{"name":"Societ\u00e0 Italiana di Psicoanalisi della Relazione SIPRe , Milano , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Perletti","sequence":"additional","affiliation":[{"name":"Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria , Varese , Italy"},{"name":"Faculty of Medicine and Medical Sciences, Ghent University , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Magri","sequence":"additional","affiliation":[{"name":"Urology Secondary Care Clinic, ASST-Nord , Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Stamatiou","sequence":"additional","affiliation":[{"name":"Department of Urology, Tzaneio Hospital , Pireus , Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Urology, Santa Chiara Regional Hospital , Trento , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Montanari","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico \u2013 University of Milan , Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Trinchieri","sequence":"additional","affiliation":[{"name":"Department of Urology, IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico \u2013 University of Milan , Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,8]]},"reference":[{"key":"2023041407040618700_","article-title":"Classification of psychoactive drugs","volume-title":"Encyclopedia of Psychopharmacology","author":"Leonard","year":"2004"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/JCP.0b013e3181a5233f","article-title":"Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis","volume":"29","author":"Serretti","year":"2009","journal-title":"J Clin Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/YIC.0b013e328341e434","article-title":"A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics","volume":"26","author":"Serretti","year":"2011","journal-title":"Int Clin Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s40264-013-0129-4","article-title":"Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis","volume":"37","author":"Reichenpfader","year":"2014","journal-title":"Drug Saf"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ."},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4103\/2277-9175.166648","article-title":"Sexual dysfunctions in the patients hospitalized in psychiatric wards compared to other specialized wards in Isfahan, Iran, in 2012","volume":"4","author":"Ahmadzadeh","year":"2015","journal-title":"Adv Biomed Res"},{"key":"2023041407040618700_","first-page":"217","article-title":"Sexual dysfunction factors in patients with schizophrenia treated with second generation antipsychotics: not only prolactin","volume":"46","author":"Mart\u00edn","year":"2018","journal-title":"Actas Esp Psiquiatr"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1111\/j.1743-6109.2009.01455.x","article-title":"Sexual dysfunctions and suicidality in patients with bipolar disorder and unipolar depression","volume":"6","author":"Dell\u2019Osso","year":"2009","journal-title":"J Sex Med"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1002\/pmh.1330","article-title":"Sexuality-related issues in borderline personality disorder: A comprehensive review","volume":"10","author":"Fr\u00edas","year":"2016","journal-title":"Personal Ment Health"},{"key":"2023041407040618700_","article-title":"Stahl\u2019s essential psychopharmacology: The prescriber\u2019s guide","author":"Stahl","year":"2011","edition":"4th ed."},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.2147\/NDT.S84528","article-title":"The influence of atypical antipsychotic drugs on sexual function","volume":"11","author":"Just","year":"2015","journal-title":"Neuropsychiatr Dis Treat"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1517\/14656566.3.10.1381","article-title":"Antipsychotics: impact on prolactin levels","volume":"3","author":"Goodnick","year":"2002","journal-title":"Expert Opin Pharmacother"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD000440","article-title":"Risperidone versus typical antipsychotic medication for schizophrenia","author":"Hunter","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"2023041407040618700_","article-title":"Risperidone versus olanzapine for schizophrenia","volume":"18","author":"Jayaram","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/j.1875-9114.1994.tb02819.x","article-title":"Risperidone","volume":"14","author":"Cohen","year":"1994","journal-title":"Pharmacotherapy"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/j.1743-6109.2009.01248.x","article-title":"Selective serotonin reuptake inhibitor-induced sexual dysfunction","volume":"6","author":"Corona","year":"2009","journal-title":"J Sex Med"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"736","DOI":"10.4088\/JCP.v67n0507","article-title":"Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies","volume":"67","author":"Clayton","year":"2006","journal-title":"J Clin Psychiatry"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1177\/0269881107083798","article-title":"Review: Bupropion and SSRI-induced side effects","volume":"22","author":"Demyttenaere","year":"2008","journal-title":"J Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1038\/sj.bjp.0704351","article-title":"Differential effects of serotonin reuptake inhibitors on erectile responses, NO-production, and neuronal NO synthase expression in rat corpus cavernosum tissue","volume":"134","author":"Angulo","year":"2001","journal-title":"Br J Pharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1046\/j.1365-2125.1999.00031.x","article-title":"Comparison of the effects of venlafaxine, desipramine, and paroxetine on noradrenaline- and methoxamine-evoked constriction of the dorsal hand vein","volume":"48","author":"Abdelmawla","year":"1999","journal-title":"Br J Clin Pharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/01.JGP.0000204328.50105.b3","article-title":"Cardiovascular changes associated with venlafaxine in the treatment of late-life depression","volume":"14","author":"Johnson","year":"2006","journal-title":"Am J Geriatr Psychiatry"},{"issue":"Suppl 1","key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1038\/sj.ijir.3900500","article-title":"Regulation of pre-synaptic alpha adrenergic activity in the corpus cavernosum","volume":"12","author":"Saenz de Tejada","year":"2000","journal-title":"Int J Impot Res"},{"key":"2023041407040618700_","first-page":"1","article-title":"Sexual dysfunction related to psychotropic drugs: a critical review. Part III: mood stabilizers and anxiolytic drugs","volume":"47","author":"La Torre","year":"2014","journal-title":"Pharmacopsychiatry"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.3390\/jcm8101640","article-title":"Management strategies for antidepressant-related sexual dysfunction: a clinical approach","volume":"8","author":"Montejo","year":"2019","journal-title":"J Clin Med"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","DOI":"10.1016\/j.pnpbp.2019.109804","article-title":"Sexual dysfunctions in schizophrenia: beyond antipsychotics. A systematic review","volume":"98","author":"Dumontaud","year":"2020","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/JCP.0000000000000113","article-title":"Efficacy of tadalafil on erectile dysfunction in male patients using antipsychotics: a double-blind, placebo-controlled, crossover pilot study","volume":"34","author":"de Boer","year":"2014","journal-title":"J Clin Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4081\/aiua.2018.1.44","article-title":"Erectile dysfunction in patients taking psychotropic drugs and treated with phosphodiesterase-5 inhibitors","volume":"90","author":"Mazzilli","year":"2018","journal-title":"Arch Ital Urol Androl"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/0269881108096507","article-title":"Better sexual acceptability of agomelatine (25 and 50 mg) compared with paroxetine (20 mg) in healthy male volunteers. An 8-week, placebo-controlled study using the PRSEXDQ-SALSEX scale","volume":"24","author":"Montejo","year":"2010","journal-title":"J Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1177\/0269881115599385","article-title":"Better sexual acceptability of agomelatine (25 and 50 mg) compared to escitalopram (20 mg) in healthy volunteers. A 9-week, placebo-controlled study using the PRSexDQ scale","volume":"29","author":"Montejo","year":"2015","journal-title":"J Psychopharmacol"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003382.pub2","article-title":"Strategies for managing sexual dysfunction induced by antidepressant medication","author":"Rudkin","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"2023041407040618700_","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD003382.pub3","article-title":"Strategies for managing sexual dysfunction induced by antidepressant medication","author":"Taylor","year":"2013","journal-title":"Cochrane Database Syst Rev"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521005233?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609521005233?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/18\/8\/1354\/49877516\/jsm_18_8_1354.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/18\/8\/1354\/49877516\/jsm_18_8_1354.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,5]],"date-time":"2023-11-05T20:52:32Z","timestamp":1699217552000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/18\/8\/1354\/6956164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,8]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,7,8]]},"published-print":{"date-parts":[[2021,8,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.05.016","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2021,8]]},"published":{"date-parts":[[2021,7,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Erectile and Ejaculatory Dysfunction Associated with Use of Psychotropic Drugs: A Systematic Review","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2021.05.016","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}