Quetiapine (Seroquel) and Hypersexuality
Quetiapine (Seroquel) is not typically associated with hypersexuality; in fact, antipsychotics like quetiapine more commonly cause decreased sexual desire and sexual dysfunction rather than hypersexuality.
Antipsychotics and Sexual Function
Common Sexual Side Effects of Antipsychotics
- Most antipsychotics, including quetiapine, are more frequently associated with:
- Decreased libido
- Erectile dysfunction
- Delayed or absent orgasm
- Overall sexual dysfunction
Atypical Antipsychotics and Hypersexuality
- While rare, hypersexuality has been reported with certain atypical antipsychotics:
- Aripiprazole has the strongest association with hypersexuality, likely due to its partial dopamine agonist properties 1, 2
- Clozapine has been reported to cause hypersexuality in some cases 3
- Olanzapine has very few reported cases 4
- Quetiapine (Seroquel) does not have well-documented cases of causing hypersexuality in the literature
Mechanism of Antipsychotic-Related Sexual Effects
Typical Mechanisms for Sexual Dysfunction
- Dopamine blockade in the mesolimbic pathway (decreases sexual desire)
- Increased prolactin levels (impairs sexual function)
- Anticholinergic effects
- Sedation
- Alpha-adrenergic blockade
Proposed Mechanisms for Rare Cases of Hypersexuality
- Partial dopamine agonism in the mesolimbic circuit (seen with aripiprazole)
- Serotonergic effects through 5-HT1A partial agonism and 5-HT2A antagonism 2
- Individual variations in receptor sensitivity and metabolism
Clinical Considerations
Differential Diagnosis for Hypersexuality
- Primary psychiatric conditions:
- Bipolar disorder (manic episodes)
- Impulse control disorders
- Dementia with disinhibition
- Substance use disorders
- Medication effects:
- Dopamine agonists used for Parkinson's disease
- Some antidepressants (bupropion)
- Steroids and hormone treatments
Management Approach
- If hypersexuality develops while on quetiapine:
- Consider alternative causes before attributing to medication
- Evaluate for manic symptoms or other psychiatric conditions
- Consider medication interactions
- Consult with psychiatrist about potential dose adjustment or medication switch
- Monitor for resolution of symptoms if medication is changed
Conclusion
Quetiapine (Seroquel) is much more likely to cause decreased sexual function than hypersexuality. If a patient experiences hypersexuality while taking quetiapine, clinicians should first rule out other causes such as comorbid psychiatric conditions, other medications, or substance use before attributing the symptom to quetiapine. In the rare event that quetiapine is suspected as the cause, consultation with a psychiatrist about potential medication changes would be appropriate.