Sexual side effects in patients using long-acting depot antipsychotics

Background: Sexual dysfunction in patients with schizophrenia may be related to the disease itself, as well as to psychosocial factors, physical health and the use of psychotropic medications. Sexual side effects have a considerable impact on quality of life and are a major factor in non-adherence to prescribed antipsychotic drugs. Most studies investigated patients using oral antipsychotics with a short duration of treatment whereas depot antipsychotics and sexual functioning during maintenance treatment are infrequently studied. The aim of this study is to investigate the frequency of sexual dysfunction in patients using depot antipsychotics. Methods: In a cross-sectional study, 53 outpatients using depot antipsychotics were included. At the day of a new depot injection, three questionnaires evaluating sexual side effects were administered: the Antipsychotics and Sexual Functioning Questionnaire (ASFQ), the Subjects' Reaction to Antipsychotics (SRA) and a new questionnaire, the Response to AntiPsychotics (RAP), the latter takes the full dose interval with bloodlevel fluctuations of the medications into account. Results: Most patients were male (n=37; 70%). The mean age was 44.0 years (±10.0) and ranged from 25 to 66. 79% of the patients were diagnosed with schizophrenia. Other diagnoses were schizoaffective disorder (13%), psychotic disorder NOS (4%) and bipolar disorder (4%). Most patients (60%) have been using the current antipsychotic for more than 2 years, while 89% of patients have been using any antipsychotic for more than 2 years. 66% of the patients reported at least one sexual dysfunction in one or more of the three questionnaires. Depending on the instrument between 43-55% of the patients reported at least one sexual dysfunction (ASFQ: 47%; SRA 55%; RAP 47%). Discussion: Sexual dysfunction is frequently occurring in patients using long-acting depot antipsychotics. This result is consistent with previously reported sexual side effects of the oral equivalents of the used depot antipsychotics. In contrast to most studies on oral antipsychotics, in the present study the fast majority of patients have been taking antipsychotics for many years and we are confident about the dose of the antipsychotic and the compliance. The current results indicate that sexual dysfunction is a persistent problem in patients using antipsychotics.