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Zakhem GA, Goldberg JE, Motosko CC, Cohen BE, Ho RS. Sexual dysfunction in men taking systemic dermatologic medication: A systematic review. J Am Acad Dermatol 2019; 81:163-172. [PMID: 30905792 DOI: 10.1016/j.jaad.2019.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/09/2019] [Accepted: 03/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms. OBJECTIVE In this review, we identify the available evidence of sexual adverse effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptoms where possible. METHODS A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating the use of systemic dermatologic medications in men with evidence of sexual adverse effects. Subsequently, a secondary in-depth literature review was performed for each individual medication. RESULTS There were 5497 articles reviewed in the primary systematic review, and 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual adverse effects as a primary outcome in patients taking finasteride. LIMITATIONS Many included studies were limited by sample size and methodology. CONCLUSION The information in this review may serve as a reference of adverse effects when deciding on a therapeutic agent and a guide to help identify patients to screen for sexual dysfunction.
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Affiliation(s)
- George A Zakhem
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Julia E Goldberg
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Catherine C Motosko
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Brandon E Cohen
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York; Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Roger S Ho
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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Relation between Sexual Dysfunctions and Epilepsy, Type of Epilepsy, Type of Antiepileptic Drugs: A Prospective Study. Urologia 2017; 84:88-92. [DOI: 10.5301/uro.5000222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/20/2022]
Abstract
Introduction The aim of this study was to evaluate the incidence of sexual dysfunctions in males with epilepsy, the type of epilepsy, the frequency of seizures, the type of antiepileptic drugs (AEDs), the serum hormonal profile and the presence of psychiatric comorbidity. Methods Sixty-one patients focused on type of epilepsy, frequency of seizures, AEDs, hormonal profile and presence of mood disorders. We excluded all patients with severe neurologic and psychiatric impairment and patient who were not able to fill questionnaires. Mean age was 31.2 years (range 18-50 years); 31 patients (50.8%) had an idiopathic generalised epilepsy and 30 (49.2%) a focal epilepsy; among them, latter 18 (60%) had probably symptomatic type and 12 (40%) symptomatic type. Sexual functions were evaluated by “International Inventory of Erectile Function” questionnaire. Results Out of 61 enrolled patients, 22 (36.7%) showed sexual dysfunctions: erectile dysfunctions in 14 (23%), orgasmic dysfunctions in (11.5%) and sexual drive dysfunctions in 12 (19.7%). Out of 61 patients, 36 were subjected to blood measurement of sexual hormones and 21 (58.3%) showed hormonal modifications. Conclusions Sexual dysfunction are present in 36.7% of enrolled males with epilepsy; there is any association between sexual dysfunctions and various AEDs in the treatment, except for carbamazepine (CBZ); there is not any association between sexual dysfunctions and frequency of seizures; hormonal changes are associated with sexual dysfunction in males with epilepsy treated with AEDs but not with the orgasmic dysfunction; there is not any association between hormonal changes and type of AEDs, except for CBZ; depression is associated with sexual dysfunctions.
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Safron A. What is orgasm? A model of sexual trance and climax via rhythmic entrainment. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:31763. [PMID: 27799079 PMCID: PMC5087698 DOI: 10.3402/snp.v6.31763] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 01/07/2023]
Abstract
Orgasm is one of the most intense pleasures attainable to an organism, yet its underlying mechanisms remain poorly understood. On the basis of existing literatures, this article introduces a novel mechanistic model of sexual stimulation and orgasm. In doing so, it characterizes the neurophenomenology of sexual trance and climax, describes parallels in dynamics between orgasms and seizures, speculates on possible evolutionary origins of sex differences in orgasmic responding, and proposes avenues for future experimentation. Here, a model is introduced wherein sexual stimulation induces entrainment of coupling mechanical and neuronal oscillatory systems, thus creating synchronized functional networks within which multiple positive feedback processes intersect synergistically to contribute to sexual experience. These processes generate states of deepening sensory absorption and trance, potentially culminating in climax if critical thresholds are surpassed. The centrality of rhythmic stimulation (and its modulation by salience) for surpassing these thresholds suggests ways in which differential orgasmic responding between individuals-or with different partners-may serve as a mechanism for ensuring adaptive mate choice. Because the production of rhythmic stimulation combines honest indicators of fitness with cues relating to potential for investment, differential orgasmic response may serve to influence the probability of continued sexual encounters with specific mates.
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Affiliation(s)
- Adam Safron
- Department of Psychology, Northwestern University, Evanston, IL, USA;
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Abstract
Sexual functioning is important to assess in patients with psychiatric illness as both the condition and associated treatment may contribute to sexual dysfunction (SD). Antidepressant medications, mood stabilizers, antipsychotics, and antianxiety agents may be associated with SD related to drug mechanism of action. Sexual adverse effects may be related to genetic risk factors, impact on neurotransmitters and hormones, and psychological elements. Effective strategies to manage medication-induced sexual dysfunction are initial choice of a drug unlikely to cause SD, switching to a different medication, and adding an antidote to reverse SD. Appropriate interventions should be determined on a clinical case-by-case basis.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Andrew R Alkis
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Nishant B Parikh
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Jennifer G Votta
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
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Yang Y, Wang X. Sexual dysfunction related to antiepileptic drugs in patients with epilepsy. Expert Opin Drug Saf 2015; 15:31-42. [PMID: 26559937 DOI: 10.1517/14740338.2016.1112376] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Epilepsy is a common disease that is mostly treated with antiepileptic drugs (AEDs). However, the sexual dysfunction (SD) side effects related to the use of AEDs have not received sufficient attention. AREAS COVERED The purpose of this review is to examine the current evidence on SD-related side effects of AEDs. The incidence, clinical features and major types of SD are summarized. Furthermore, various AEDs that may cause SDs are addressed in detail. Finally, we briefly summarize the treatments for SD related to AEDs. EXPERT OPINION SD related to AEDs is common. Symptoms include erectile dysfunction (ED), hyposexuality, hypersexuality and ejaculatory dysfunction. Traditional AEDs such as valproate and enzyme-inducing AEDs (EIAEDs) may produce high incidences of decreased libido. Recently, sexual function changes related to new AEDs have been reported. Topiramate, pregabalin and gabapentin may cause SD, whereas oxcarbazepine, lamotrigine and levetiracetam may improve sexual function. Although the treatment for SD related to AEDs remains unclear, switching to another AED may be an option. Further studies are necessary to better understand and treat SD related to AEDs.
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Affiliation(s)
- Yong Yang
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology , Chongqing 400016 , China
| | - Xuefeng Wang
- a Department of Neurology , The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Neurology , Chongqing 400016 , China
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Interactions between antiepileptic drugs and hormones. Seizure 2015; 28:12-7. [PMID: 25797888 DOI: 10.1016/j.seizure.2015.02.022] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022] Open
Abstract
Antiepileptic drugs (AEDs) are known to have endocrine side effects in both men and women. These can affect fertility, sexuality, thyroid function, and bone health, all functions of major importance for well-being and quality of life. The liver enzyme inducing antiepileptic drugs (EIAEDs), like phenobarbital, phenytoin, and carbamazepine, and also valproate (VPA), a non-EIAED, are most likely to cause such side effects. AED treatment can alter the levels of different sex hormones. EIAEDs increase sex hormone binding globulin (SHBG) concentrations in both men and women. Over time, this elevation can lead to lower levels of bioactive testosterone and estradiol, which may cause menstrual disturbances, sexual problems, and eventually reduced fertility. VPA can cause weight gain in both men and women. In women, VPA can also lead to androgenization with increased serum testosterone concentrations, menstrual disturbances, and polycystic ovaries. Lamotrigine has not been shown to result in endocrine side effects. The newer AEDs have not yet been thoroughly studied, but case reports indicate that some of these drugs could also be suspected to cause such effects if endocrine changes commence after treatment initiation. It is important to be aware of possible endocrine side effects of AEDs as they can have a major impact on quality of life, and are, at least partly, reversible after AED discontinuation.
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Calabrò RS, Marino S, Bramanti P. Sexual and reproductive dysfunction associated with antiepileptic drug use in men with epilepsy. Expert Rev Neurother 2014; 11:887-95. [DOI: 10.1586/ern.11.58] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tewari A, Grover S, Sooriakumaran P, Srivastava A, Rao S, Gupta A, Gray R, Leung R, Paduch DA. Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy. BJU Int 2011; 109:596-602. [DOI: 10.1111/j.1464-410x.2011.10402.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Sexual dysfunction is a key adverse effect leading to medication noncompliance. Psychotropic drugs associated with sexual dysfunction include antiepileptic drugs, antidepressants, and antipsychotics. Gabapentin, frequently used off-label to treat psychiatric and pain disorders, has previously been reported to cause sexual dysfunction at a minimum total daily dose of 900 mg. This report addresses dose-dependent gabapentin-induced sexual dysfunction reaching total sexual dysfunction (loss of libido, anejaculation, anorgasmia, and impotence) at a total daily dose of only 300 mg.
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Perloff MD, Thaler DE, Otis JA. Anorgasmia with Gabapentin May Be Common in Older Patients. ACTA ACUST UNITED AC 2011; 9:199-203. [DOI: 10.1016/j.amjopharm.2011.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
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Abstract
Gabapentin has been used effectively for neuropathic pain with mild side effects. Two cases of gabapentin-induced sexual dysfunction are reported and discussed.
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Abstract
BACKGROUND Bipolar disorder is a common and debilitating psychiatric illness. Several antiepileptic drugs (AEDs) have been approved for the treatment of bipolar disorder. Gabapentin gained a large market share of AED use in the late 1990s in spite of a lack of randomized clinical trial (RCT) evidence and no labeled indication from the U.S. Food and Drug Administration for its use in psychiatric illness. This article describes the results of a literature review, the purpose of which was to examine the characteristics of studies conducted in humans concerning the efficacy of gabapentin in bipolar disorder. METHODS Publications relevant to this topic were identified based on a PUBMED search as well as an examination of references from a published systematic review and citations from relevant review articles. RESULTS The search located 29 studies published between 1997 and 2007, with the greatest number of articles published in 1998 and 1999. Of these 29 publications, 15 involved uncontrolled case series, while 6 were single case reports. The sample size in the studies was generally small, and often we could not identify the funding source. Despite the generally weak study design in the identified publications, the authors of the articles often commented on the promising nature of gabapentin therapy for bipolar disorder. However, 4 small, randomized trials in heterogeneous populations demonstrated little if any evidence of such efficacy. Nine letters to the editor demonstrated a similar pattern. CONCLUSIONS The large number of case series concerning gabapentin is striking. The number of reports and their distribution in many different journals created a type of "echo chamber" effect, through which the sheer number of publications and citations may give legitimacy to the practice of using gabapentin for bipolar disorder. Although the case series were generally of poor quality, their publication in peer-reviewed journals may have been partially responsible for the widespread use of an ineffective medication.
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Sheorajpanday RVA, De Deyn PP. Epileptic fits and epilepsy in the elderly: general reflections, specific issues and therapeutic implications. Clin Neurol Neurosurg 2007; 109:727-43. [PMID: 17703874 DOI: 10.1016/j.clineuro.2007.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 06/12/2007] [Accepted: 07/07/2007] [Indexed: 01/11/2023]
Abstract
Seizures and epilepsy are commonly encountered in the elderly. Diagnosis is not always straightforward as reliable history is often difficult to obtain and EEG findings can be non-specific. When to treat and how may be difficult choices as adequate studies in elderly are rather scarce. Treatment should be based on careful assessment and comparison of risk/benefit profiles of various anti-epileptic drugs (AEDs) in this specific elderly population. Since most AEDs are effective in terms of seizure control in the elderly, the choice of treatment is often determined by tolerability, pharmacokinetic profile and drug interactions of AEDs. As recently introduced AEDs have a better safety profile compared to older agents it seems logical to initiate treatment in the frail elderly patient with those more modern AEDs. In this review some distinctive clinical features of epilepsy in the elderly are discussed in three sections (general issues, special issues and selected treatment options with special reference to medicinal treatment).
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Abstract
Many drugs may have effects on sexual function. Sexual function is complex and psychological and relationship issues are likely to have greater impacts on sexual function in women than drugs. Although it is important to understand the effects of drugs on sexual function, physicians should use caution in "medicalization" of sexual function in women [106].
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Affiliation(s)
- J Chris Carey
- Department of Obstetrics and Gynecology, Denver Health, 777 Bannock Street, Mail Code 0660, Denver, CO 80204, USA.
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Kuba R, Pohanka M, Zákopcan J, Novotná I, Rektor I. Sexual Dysfunctions and Blood Hormonal Profile in Men with Focal Epilepsy. Epilepsia 2006; 47:2135-40. [PMID: 17201714 DOI: 10.1111/j.1528-1167.2006.00851.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the incidence of sexual dysfunction in men with focal epilepsy and to establish their hormonal profiles. METHODS We prospectively analyzed sexual functions and hormone blood levels in 40 male patients (age ranged from 18 to 44 years, with an average age of 27.6+/-5.6 years) with refractory focal epilepsy. We used the Czech version of the structured questionnaire entitled International Inventory of Erectile Function (IIEF) to assess the patients' sexual functions. The subscales of this questionnaire separately evaluate erectile function (IIEF I), orgasmic function (IIEF II), sexual desire (IIEF III), intercourse satisfaction (IIEF IV), and overall satisfaction with sex life (IIEF V). In all of the patients, the following blood tests were performed: quantitative assessment of blood levels of prolactin (PRL), total testosterone (total-T), free androgen index (FAI), sexual hormone-binding globulin (SHBG), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), progesterone (PRG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). All these quantitative laboratory data were correlated with other clinical variables and with the results of the IIEF. chi2 and Wilcoxon tests were used for the statistical analysis. A p-value<0.05 was considered to be statistically significant. RESULTS At least one of the types of sexual dysfunction, as defined by IIEF (IIEF I, II, and III), was found in 22 (55%) of the 40 patients (55%). Erectile dysfunction (IIEF I) was found in six (15%) of 40 patients, orgasmic dysfunction (IIEF II) in six (15%) of 40 patients, and loss of sexual desire (IIEF III) in 16 (40%) of 40 patients. According to other subscales of IIEF, 22 (55%) of 40 patients were not satisfied with sexual intercourse (IIEF IV), and 20 (50%) of 40 patients were not satisfied with their sex livee (IIEF V). None of the subscales of IIEF was significantly correlated with the age of the patients or with the duration of epilepsy. In patients with at least one of the sexual dysfunctions (IIEF I, II, and III), we found a statistically significant increase of FSH and SHBG, and a decrease of DHEAS and FAI in comparison with those in the patients with normal sexual functions. In patients with erectile dysfunction, we found the same changes and a significant increase of E2. In patients with orgasmic dysfunction, we found a statistically significant decrease of DHEAS. In patients with dysfunction of sexual desire, we noticed a significant increase of SHBG and a decrease of DHEAS and FAI. All patients with orgasmic dysfunction were being treated with carbamazepine (CBZ) in monotherapy or combination therapy. In patients with at least one type of sexual dysfunction (IIEF I, II, and III), we found a higher proportion of valproate treatment in monotherapy or combination therapy in comparison with CBZ. CONCLUSIONS Our study showed a relatively high incidence of sexual dysfunction and dissatisfaction with sexual intercourse and sex life, as defined by the IIEF I-V questionnaire, in men with refractory focal epilepsy. The most frequent dysfunction in these patients is the impairment of sexual desire. However, our study indicates some specific hormonal changes related to various types of sexual dysfunction that are not related to antiepileptic drug treatment.
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Affiliation(s)
- Robert Kuba
- Department of Neurology, Masaryk University, St. Anne's Hospital, Brno, Czech Republic.
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Hitiris N, Barrett JA, Brodie MJ. Erectile dysfunction associated with pregabalin add-on treatment in patients with partial seizures: five case reports. Epilepsy Behav 2006; 8:418-21. [PMID: 16446121 DOI: 10.1016/j.yebeh.2005.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 12/08/2005] [Accepted: 12/09/2005] [Indexed: 11/25/2022]
Abstract
Sexual dysfunction has been reported in both men and women with epilepsy. Associated factors are diverse but include, among others, antiepileptic drugs. We present the cases of 5 men who reported mild to moderate erectile dysfunction or impotence for the first time when treated with the new antiepileptic drug pregabalin as add-on therapy.
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Affiliation(s)
- Nikolas Hitiris
- Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK
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Chue P. Gabapentin treatment for premature ejaculation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:644-5. [PMID: 15503740 DOI: 10.1177/070674370404900919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Berger JJ. Amenorrhea in a Patient After Treatment With Gabapentin for Complex Regional Pain Syndrome Type II. Clin J Pain 2004; 20:192-4. [PMID: 15100596 DOI: 10.1097/00002508-200405000-00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 35-year-old woman suffered a traumatic injury to her right sciatic nerve requiring nerve exploration and external neurolysis. Following the surgery, the patient developed complex regional pain syndrome (CRPS) type II and was treated with gabapentin for pain control. Three months after the initiation of gabapentin therapy (1800 mg/day), the patient reported complete cessation of her menses. Based on hormonal tests, her gynecologist concluded that her amenorrhea was secondary to gabapentin therapy. The patient was weaned off the gabapentin over 6 days with return of her menses 2 weeks later. I conclude that gabapentin has the potential to cause amenorrhea with return of menses occurring after discontinuation of the drug.
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Affiliation(s)
- Jerry J Berger
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
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Kaufman KR, Gerner R. Adjunctive oxcarbazepine in comorbid anxiety and affective disorder with hyponatremic seizure: case analysis and literature review. Epilepsy Behav 2003; 4:766-70. [PMID: 14698716 DOI: 10.1016/j.yebeh.2003.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Rational polypharmacy is required for management of refractory psychiatric disorders. Antiepileptic drugs are increasingly used as primary or adjunctive agents in the treatment of affective, schizoaffective, anxiety, and impulse control disorders. In this case report, the authors present the first case of hyponatremic seizure associated with oxcarbazepine in adjunctive treatment of comorbid affective/anxiety disorders.
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Affiliation(s)
- Kenneth R Kaufman
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, 08901, New Brunswick, NJ, USA.
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Drabkin R, Calhoun L. Anorgasmia and withdrawal syndrome in a woman taking gabapentin. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:125-6. [PMID: 12655912 DOI: 10.1177/070674370304800211] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Antiepileptic drugs (AEDS) are used regularly in the treatment of patients with bipolar disorders. Carbamazepine and valproic acid (sodium valproate) are effective as antimanic treatments, and the success of these medications has prompted investigation of other AEDs as possible treatments in patients with mood disorders. Lamotrigine appears to be the most promising of the newer AEDs with respect to effects in mood disorders. Current evidence suggests efficacy of this drug both as monotherapy and as an adjunctive agent in bipolar depression, and studies are underway to clarify its efficacy in mood stabilisation and rapid cycling, as currently available data are equivocal. Use of gabapentin is not as well supported in the literature, although data from open trials using it as an adjunctive agent suggest that it may be helpful in patients with bipolar depression. There have been some open trials and case reports supporting the use of topiramate as an adjunctive agent for the treatment of mania; however, data from controlled trials are not yet available. Further controlled trials of lamotrigine, gabapentin or topiramate as monotherapy and adjunctive treatment are needed to clarify their potential roles in the treatment of patients with mood disorders.
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Affiliation(s)
- Kathryn J Macdonald
- Mood Disorder Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
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Abstract
Sexual dysfunction is underreported in persons with epilepsy. The evaluation of sexual physiology in small samples of epilepsy patients shows abnormal sexual functioning, and points to low free testosterone levels as a contributing factor. Abnormal sexual physiology in epilepsy patients may be due to antiseizure medication-related altered testosterone metabolism and abnormal central gonadotropin secretion due to epileptic physiology in the brain. More information exists on the sexual side effects of "classic" antiseizure medications than the "new generation" of antiseizure medications; barbiturates appear to have the greatest risk. More active surveying for sexual dysfunction should be undertaken in epilepsy clinics; a simple, self-reported scale of sexual functioning is available. Testosterone replacement for men, dehydroepiandrosterone for women, and sildenafil for restoring sexual performance are appropriate.
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Affiliation(s)
- Cynthia L. Harden
- Department of Neurology and Neuroscience, Comprehensive Epilepsy Center, Weill Medical College of Cornell University, 525 East 68th Street, Room K-615, 10021, New York, NY, USA
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Current Awareness. Pharmacoepidemiol Drug Saf 2001. [DOI: 10.1002/1099-1557(200011)9:6<533::aid-pds492>3.0.co;2-i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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