From the Guidelines
Quetiapine is not typically associated with hypersexuality, and patients experiencing increased sexual urges while taking quetiapine should consult their physician immediately to rule out an adverse reaction or underlying bipolar disorder. Hypersexuality with quetiapine is rare and paradoxical, but has been reported in isolated case studies 1. The exact mechanism of this effect is unclear, but it may be related to quetiapine's complex pharmacology, including its effects on dopamine, serotonin, and histamine receptors. Dopamine modulation in particular can affect sexual behavior, and individual variations in receptor sensitivity or metabolism could explain why some patients experience this paradoxical effect.
Some studies have reported the efficacy of selective serotonin reuptake inhibitors (SSRIs) in treating premature ejaculation, which may be related to hypersexuality in some cases 1. However, the use of SSRIs in patients taking quetiapine requires caution due to the risk of serotonin syndrome, a potentially serious complication characterized by symptoms such as clonus, tremor, hyperreflexia, and agitation.
If a patient experiences increased sexual urges while taking quetiapine, the physician may consider adjusting the dose, switching to a different antipsychotic medication such as risperidone or olanzapine, or adding a mood stabilizer if bipolar disorder is suspected. Patients should never adjust or discontinue quetiapine without medical supervision, as abrupt cessation can lead to withdrawal symptoms or worsening of the underlying condition. Key considerations in managing quetiapine-induced hypersexuality include:
- Monitoring for signs of serotonin syndrome
- Adjusting the dose or switching to a different medication if necessary
- Adding a mood stabilizer if bipolar disorder is suspected
- Educating patients about the risks and benefits of treatment and the importance of medical supervision.
From the Research
Quetiapine Induced Hypersexuality
- Quetiapine has been associated with both decreased and increased libido in different studies 2, 3.
- A study published in 2005 found that the most frequent sexual dysfunction (SD) associated with quetiapine was diminished libido in both male and female subjects 2.
- However, another study published in 2006 reported a case of increased libido associated with quetiapine, characterized by an increased drive to masturbate and spontaneous ejaculations at night time 3.
- Quetiapine has also been implicated in cases of compulsive disorders, including hypersexuality, with sometimes serious social and familial consequences 4.
- The exact mechanisms of quetiapine-induced hypersexuality are not fully understood, but it is thought to be related to the drug's unique pharmacological profile, including its effects on dopamine and alpha-adrenergic receptors 3, 5, 6.
Case Reports
- There have been several case reports of priapism associated with quetiapine use, including a case of priapism caused by a single 300-mg dose of quetiapine 5.
- Another case report described a patient who developed priapism while taking a standard daily dose of quetiapine, which was successfully managed with cavernosal aspiration and intracavernosal injection of phenylephrine 6.
Clinical Implications
- Patients taking quetiapine should be monitored for behavioral changes, including increased libido or compulsive disorders, and informed of the possible adverse effects of the drug 4.
- If quetiapine-induced hypersexuality or other compulsive disorders occur, they can be managed by withdrawing the drug, reducing the dosage, or switching to another neuroleptic 4.