Psychostimulant augmentation during treatment with selective serotonin reuptake inhibitors in men with paraphilias and paraphilia-related disorders: a case series.

Abstract

BACKGROUND:

We describe an open trial of psychostimulants (primarily methylphenidate sustained release [SR]) added to selective serotonin reuptake inhibitors (SSRIs; primarily fluoxetine) during the course of pharmacologic treatment of men with paraphilias and paraphilia-related disorders (PRDs).

METHOD:

Twenty-six men with paraphilias (N = 14) or PRDs (N = 12) were assessed for life-time mood disorders and attention-deficit/hyperactivity disorder (ADHD) as defined by DSM-IV. All men were assessed at baseline for total sexual outlet and average time per day associated with paraphilia/PRD sexual behaviors. The indications for the addition of a psychostimulant to a stable dose of SSRI included the retrospective diagnosis of ADHD with persistent adult symptoms despite pharmacotherapy with an SSRI (N = 17); residual paraphilia/PRD fantasies, urges, and activities despite SSRI pharmacotherapy (N = 16); the persistence or presence of residual depressive symptoms despite SSRI pharmacotherapy (N = 6); relapse or loss of SSRI efficacy during the treatment of sexual impulsivity disorders (N = 4); and treatment of SSRI-induced side effects (N = 4).

RESULTS:

SSRI pharmacotherapy (mean +/- SD duration = 8.8+/-11.1 months) had statistically significant effects in diminishing paraphilia/PRD-related total sexual outlet (p < .001) and average time/day spent in paraphilia/PRD sexual behavior (p < .001). Addition of methylphenidate SR (mean dose = 40 mg/day; mean +/- SD duration = 9.6+/-8.2 months) was associated with additional statistically significant effects on paraphilia/PRD-related total sexual outlet (p = .003) and average time per day (p = .04) in addition to improvement of putative residual ADHD and depressive symptoms.

CONCLUSION:

Methylphenidate SR can be cautiously and effectively combined with SSRI antidepressants to ameliorate paraphilias and paraphilia-related disorders for the indications listed above.

• Authors: M P Kafka, J Hennen
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 61 Issue 9 Pg. 664-70 (Sep 2000) ISSN: 0160-6689 [Print] United States
• PMID: 11030487 (Publication Type: Case Reports, Clinical Trial, Journal Article)

Chemical References

• Central Nervous System Stimulants
• Serotonin Uptake Inhibitors
• Methylphenidate

Topics

• Adult
• Ambulatory Care
• Attention Deficit Disorder with Hyperactivity (diagnosis, drug therapy, epidemiology)
• Central Nervous System Stimulants (therapeutic use)
• Comorbidity
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Therapy, Combination
• Humans
• Male
• Mental Disorders (epidemiology, psychology)
• Methylphenidate (therapeutic use)
• Middle Aged
• Paraphilic Disorders (drug therapy, epidemiology, psychology)
• Secondary Prevention
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sexual Behavior (drug effects, psychology)
• Treatment Outcome