Psychotropic Drug Prescribing Trends in Bahrain: Implications for Sexual Functions


Treatment-emergent sexual dysfunction is a frequent adverse effect of many psychotropic drugs. We have analyzed the prescribing trends and the likelihood of psychotropic-associated sexual dysfunction in outpatients with depression or other psychotic disorders treated by psychiatrists. A retrospective prescription audit was conducted at the Psychiatric Hospital, the only psychiatric facility in Bahrain that offers both inpatient and outpatient services. Psychotropic associated sexual dysfunction was graded as negligible (0), moderate (2+), moderately severe (3+) and uncertain (U) for antidepressants, and for antipsychotics as no effect (0), very low (1+), moderate (2+), moderately severe (3+) and uncertain (U) effect. As antidepressant monotherapy, a significant trend towards prescribing selective serotonin reuptake inhibitors (SSRIs; 3+) and selective norepinephrine reuptake inhibitors (SNRIs; 3+) in females, and tricyclic antide-pressants (TCAs; 2+) in males was apparent. Atypical antidepressant mirtazapine (0) monotherapy was rarely prescribed. Mirtazapine with SSRIs or SNRI was the most often prescribed combinations followed by TCAs with other antidepressants. Risperidone (0 to 3+), an atypical antipsychotic, was the most popular antipsychotic prescribed to augment antidepressants; there was no gender-based difference. Clozapine (0) and olanzapine (1+) were rarely prescribed to augment antidepressant therapy. In Bahrain, the psychotropic prescribing trends suggest that there is a need to optimize drug therapy to achieve the therapeutic goal with minimal adverse impact on sexual function.

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K. Al-Khaja, R. Sequeira, M. Al-Haddad and A. Al-Offi, "Psychotropic Drug Prescribing Trends in Bahrain: Implications for Sexual Functions," International Journal of Clinical Medicine, Vol. 3 No. 4, 2012, pp. 276-282. doi: 10.4236/ijcm.2012.34054.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] S.H. Kennedy and R. Sakina, “Sexual Dysfunction, Depression and the Impact of Antidepressants,” Journal of Clinical Psychopharmacology, Vol. 29, 2009, pp. 157-164.
[2] R.J. Baldessarini, “Drug Therapy of Depression and Anxiety Disorders. In: L.L. Brunton, J.S. Lazo and K.L. Parker, Ed., Goodman and Gilman’s The Pharmacological Basis of Therapeutics, McGraw-Hill, New York, 2006, pp. 429-459.
[3] S. MacDonald, J. Halliday, T. MacEwan, V. Sharkey, S. Farrington, S. Wall and R.G. McCreadie, “Nithsdale Schizophrenia Surveys 24: Sexual Dysfunction. Case-control Study,” British Journal of Psychiatry, Vol. 182, 2003, pp. 50-56.
[4] E.O. Laumann, A. Paik and R.C. Rosen, “Sexual Dysfunction in the United States: Prevalence and Predictors,” Journal of American Medical Association, Vol. 281, 1999, pp. 537-544. Erratum in Journal of American Medical Association, Vol. 281, 1999, p. 1174.
[5] A. Ucok, C. Incesu, T. Aker and S. Erkoc, “Sexual Dysfunction in Patients with Schizophrenia on Antipsychotic Medication,” European Psychiatry, Vol. 22, 2007, pp. 328-333.
[6] H. Liu-Seifert, B.J. Kinon, C.J. Tennant, J. Sniadecki and J. Volavka, “Sexual Dysfunction in Patients with Schizophrenia Treated with Conventional Antipsychotics or Risperidone,” Journal of Neuropsychiatric Disease and Treatment, Vol. 5, 2009, pp. 47-54.
[7] B.J. Kinon, J.A. Gilmore, H. Liu-Seifert and U.M. Halbreich, “Prevalence of Hyper-prolactinemia in Schizophrenic Patients Treated with Conventional Antipsychotic Medications or Risperidone,” Psychoneuroendocrinology, Vol. 28 (suppl 2), 2003, pp.55-68.
[8] M. Hummer and J. Hubber, “Hyperprolactinemia and Antipsychotic Therapy in Schizophrenia,” Current Medical Research and Opinion, Vol. 20, 2004, pp. 189-197.
[9] M.J. Gitlin, “Psychotropic Medications and their Effects on Sexual Dysfunction: Diagnosis, Biology, and Treatment Approaches,” Journal of Clinical Psychiatry Vol. 55, 1994, pp.406-413.
[10] M.H. Pollack, S.Reiter and P. Hammerness, “Genitourinary and Sexual Adverse Effects of Psychotropic Medication,” International Journal of Psychiatry in Medicine, Vol. 22, 1992, pp. 305-327.
[11] R.C. Rosen and H. Marin, “Prevalence of Antidepressant-associated Erectile Dysfunction,” Journal of Clinical Psychiatry Vol. 64(Suppl 10), 2003, pp. 5-10.
[12] A.L. Montejo, G. Llorca, J.A. Izquierdo and F. Rico-villademoros, “Incidence of Sexual Dysfunction Associated with Antidepressant Agents: A Prospective Multicentre Study of 1022 Outpatients,” Journal of Clinical Psychiatry, Vol. 62 (suppl 3), 2001, pp. 10-21.
[13] A. L. Montejo, S. Majadas, F. Rico-Villademoros, G. Llorca, J. de la Gandara, M. Franco, M. Martin-Carrasco, L. Aquera and N. Prieto; Spanish working Group for the Study of Psychotropic-related Sexual Dysfunction, “Frequency of Sexual Dysfunction in Patients with a Psychotic Disorder Receiving Antipsychotics,” Journal of Sexual Medicine, Vol. 7, 2010, pp. 3404-3413.
[14] J. Buvat, “Hyperprolactinemia and Sexual Function in Men: a Short Review,” International Journal of Impotence Research, Vol. 15, 2003, pp. 373-377.
[15] M.L. Crismon, T. Argo, and P.F. Buckley, “Schizophrenia”, In: J.T. Dipiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells and L.M. Posey, Ed., Pharmacotherapy: A Pathophysiologic Approach, McGraw-Hill Companies Inc., China, 2008, pp. 1099-1122.
[16] R.A. Endow-Eyer, M.M. Mitchell and J.P. Lacro, “Schizophrenia” In: M.A. Koda-Kimble, L.Y. Young, B.K. Aldredge, R.L. Corelli, B.J. Guglielmo, W.A. Kradjan and B.R.Williams Ed., Applied Therapeutics – The Clinical Use of Drugs, Lippincott Williams and Wilkins, Philadelphia, 2009, pp. 78.1-78.34.
[17] G.L. Stimmel and M.A. Gutierrez, “Sexual Dysfunction and Psychotropic Medications,” CNS Spectrums, Vol. 11, 2006, pp. 24-30.
[18] K.U. Lee, Y.M. Lee, J.M. Nam, H.K. Lee, H.K. Kweon, C.T. Lee and T.Y. Jan, “Antidepressant-induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting,” Psychiatry Investigations, Vol. 7, 2010, pp. 55-59.
[19] A.J. Gelenberg, C. McGahuey, C. Laukes, G. Okayli, F. Moreno, L. Zentner and P. Delgado, “Mirtazapine Substitution in SSRI-induced Sexual Dysfunction,” Journal of Clinical Psychiatry, Vol. 61, 2000, pp. 356-360.
[20] R.S. Gregorian, K.A. Golden, A. Bahce, C. Goodman, W.J. Kwong and Z.M. Khan, “Antidepressant – induced Sexual Dysfunction,” Annals of Pharmacotherapy, Vol. 36, 2002, pp.1577-1589.
[21] A.H. Clayton and A.L. Montejo, “Major Depressive Disorder, Antidepressants, and Sexual Dysfunction,” Journal of Clinical Psychiatry, Vo. 67 (suppl 60), 2006, pp. 33-37.
[22] B.K.Yang and C.F. Donatucci, “Drugs that Effect Male Sexual Dysfunction”, In: J.J. Mulcahy, Ed., Male Sexual Dysfunction: A Guide to Clinical Management. Humana Press Inc., Totowa, New Jersey, 2006, pp. 170.
[23] N.K. Ozmenler, T. Karlidere, A. Bozkurt, S. Yetkins, A. Doruk, L. Sutcigil, A. Cansever, O. Uzun, F. Ozgen and A. Ozsahin, “Mirtazapine Augmentation in Depressed Patients with Sexual Dysfunction due to Selective Serotonin Reuptake Inhibitors,” Human Psychopharmacology, Vol. 23, 2008, pp. 321-326.
[24] S. Kasper and J.P. Olie, “A Meta-analysis of Randomized Controlled Trials of Tianeptine versus SSRI in the Short-term Treatment of Depression,” European Journal of Psychiatry, Vol. 17, 2002, pp.331-340.
[25] M. Bonierbale, C. Lancon and J. Tignol, “The ELIXIR Study: Evaluation of Sexual Dysfunction in 4557 Depressed Patients in France,” Current Medical Research and Opinion, Vol. 19, 2003, pp. 114-124.
[26] M. Atmaca, M. Kuloglu, E. Tezcan and A. Buyukbayram, “Switching to Tianeptine in Patients with Antidepressant-induced Sexual Dysfunction,”. Human Psychopharmacology, Vol. 18, 2003, pp. 277-280.
[27] H. El-Shafey, A. Atteya, S. Abuel-Magd, A. Hassanein, A. Fathy and R. Shamloul, Tianeptine can be Effective in Men with Depression and Erectile Dysfunction. Journal of Sexual Medicine, Vol.3, 2006, pp. 910-917.
[28] R.S. McIntyre, A. Muller, D.A.Mancini and E.S. Silver, “What to Do if an Initial Antidepressant Fails,” Canadian Family Physician, Vol. 49, 2003, 449-457.
[29] I, Schweitzer and V. Tuckwell, “Risk of Adverse Events with the Use of Augmentation Therapy for the Treatment of Resistant Depression,” Drug Safety, Vol.19, 1998, pp.455-464.
[30] Martindale, The Complete Drug Reference, S.C. Sweetman, Ed., Pharmaceutical Press London 2007, pp. 333-336.
[31] D.O. Antonuccio, D. Burns and W.G. Danton, “Antidepressant: A Triumph of Marketing over Science?” Prevention and Treatment, 2002, Available from: http://www. Antidepressantsfacts. com/2002-07-15-Antonuccio-therapy-vs-med.htm/February 2010 (last access on 2011 July 7).
[32] L.L. Carpenter, Z. Jocic, J.M. Hall, S.A. Rasmussen and L.H. Price, “Mirtazapine Augmentation in the Treatment of Refractory Depression. Journal of Clinical Psychiatry, Vol. 60, 1999, pp. 45-49.
[33] N.S. Philip, L.L. Carpenter, A.R. Tyrka and L.H. Price, “Augmentation of Antidepressants with Atypical Antipsychotics: A Review of the Current Literature,” Journal of Psychiatric Practice, Vol. 14, 2008, pp. 34-44.
[34] S. Smith and A. Gillam, “Sexual Dysfunction – the Forgotten Taboo,” Mental Health Nursing, Vol. 25, 2005, pp. 6-9.
[35] R. Gopalakrishnan, K.S. Jacob and A. Kuruvilla, “Sildenafil in the Treatment of Antipsychotic-Induced Erectile Dysfunctions: A Randomized, Double-Blind, Placebo-Controlled, Flexible Dose, Two-Way Crossover Trial. American Journal of Psychiatry, Vol. 163, 2006, pp. 494-499.
[36] J. Volavka, P. Czobor, T.B. Cooper, B. Sheitman, J.P. Lindenmayer, L. Citrome, J.P. McEvoy and J.A. Lieberman, “Prolactin Levels in Schizophrenia and Schizoaffective Disorders Patients Treated with Clozapine, Olanzapine, Risperidone, or Haloperidol,” Journal of Clinical Psychiatry, Vol. 65, 2004, pp. 57-61.
[37] D.M. Gardner, R.J. Baldessarini and P. Waraich, “Modern Antipsychotic Drugs: A Critical Overview. Canadian Medical Association Journal, Vol. 172, 2005, pp. 1703-1711.
[38] D. Novivk, J.M. Haro, E. Perrin, D. Suarez and J.M. Texeria, “Tolerability of Outpatient Antipsychotic Treatment: 36-month Results from the European Schizophrenia Outpatient Health Outcomes (SOHO) Study. European Neuropsychopharmacology, Vol. 19, 2009, pp. 542-550.
[39] S. Miyamoto, G.E. Duncan, C.E. Marx and J.A. Lieberman, “Treatment for Schizophrenia: A Critical Review of Pharmacology and Mechanisms of Action of Antipsychotic Drugs,” Molecular Psychiatry Vol. 10, 2005, pp. 79-104.
[40] K. Komossa, C. Rummel-Kluge, H. Hunger, F. Schmid, Schwarz S, Duggan L, W. Kissling and S. Leucht, “Olanzapine versus Other Atypical Antipsychotics for Schizophrenia”, Cochrane Database System Review, 2010 Mar 17; 3:CD006654
[41] K. Tani, N. Takei, M. Kawai, K. Suzuki, Y. Sekine, T. Toyoda T, Y. Minabe and N. Mori, “Augmentation of Milnacipran by Risperidone in Treatment for Major Depression,” International Journal of Neuropsychopharmacology, Vol. 7, 2004, pp. 55-58.
[42] R.A. Mahmoud, G.I. Pandina, I. Turkoz, C. Kosik-Gonzalez, C.M. Canuso, M.J. Kujawa and G.M. Gharabawi-Garibaldi, “Risperidone for Treatment – Refractory Major Depressive Disorder. A Randomized Trial,” Annals of Internal Medicine, Vol. 147, 2007, pp. 593-602.
[43] M.M. Berner, M. Hagen, and L. Kriston, “Management of sexual dysfunction due to antipsychotic drug therapy,” Cochrane Databse Systemic Reviews, Vol. 24, 2007, pp. CD003546.
[44] L.A. Labbate, “Psychotropics and sexual dysfunction: the evidence and treatments,” Advances in Psychosomatic Medicine, Vol. 29, 2008, pp. 107-130.
[45] A.J. Salerian, W.E. Deibler, B.J. Vittone, S.P. Geyer, L. Drell, N. Mirmirani, J.A. Mirczak, W. Byrd, S.B. Tunick, M. Wax and S. Fleisher, “Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men,” Journal of Sexual and Marital Therapy, Vol. 26, 2000, pp. 133-140.
[46] H.G. Nurenberg, P.L. Hensley, A.J. Gelenberg, M. Fava, J. Lauriello and S. Paine, “Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial,” Journal of American Medical Association, Vol. 289, 2003, pp. 56-64.
[47] H.G. Nurenberg, P.L. Hensley, J.R. Heiman, H.A. Croft, C. Debattista and S. Paine, “Sildenafil treatment of women with antidepressant-associated controlled trial,” Journal of American Medical Association, Vol. 300, 2008, pp. 395-404.
[48] R.N. Marcus, R.D. McQuade and W.H. Carson, D. Hennicken, M. Fava, J.S. Simon, M.H. Trivedi, M.E. Thase and R.M. Berman, “The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a second, multicenter, randomized, double-blind placebo – controlled study,” Journal of Clinical Psychopharmacology, Vol. 28, 2008, pp. 156-165.
[49] D. Baldwin and A. Mayers, “Sexual side-effects of antidepressant and antipsychotic drugs,” Advances in Psychiatric Treatment, Vol. 9, 2003, pp. 202-210.

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