Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men

Abstract

Background: Paraphilias (PAs) and non-paraphilic sexual addictions (NPSAs) may be behaviors that share a common perturbation of central serotonin neuroregulation as a component of their pathophysiology. Fluoxetine was selected as an agent that might mitigate these behaviors, based on the observations that PAs and NPSAs are associated with depression, compulsion, impulsivity, and disinhibited aggression.

Method: Twenty men (PA, N = 10; NPSA, N = 10) recruited through newspaper advertisement were evaluated for depression and sexual behaviors at baseline and 4-week intervals while receiving fluoxetine pharmacotherapy in an open trial. Sixteen men completed the drug trial. Outcome was determined at 12 weeks using a single-factor, repeated-measures design and an analysis of variance. The general linear models procedure was used to test each of nine dependent measures.

Results: Nineteen (95%) of 20 men met non-exclusionary DSM-III-R criteria for dysthymia and 11 men (55%) met criteria for current major depression. At baseline, the paraphilic and the nonparaphilic subgroups were comparable in most intergroup measures of sexual function except total sexual outlet. PAs shared extensive comorbidity with NPSAs (100%). At outcome, statistically significant effects (p < .05) of fluoxetine were found in both groups over time for all variables pertaining to depression and PA/NPSA sexual behaviors. Statistically significant reduction in PA/NPSA response was evident by Week 4, while conventional sexual behavior was not adversely affected by pharmacotherapy.

Conclusion: Men seeking treatment for PAs/NPSAs reported current depressive symptoms accompanied by a positive history of mood disorders, especially dysthymia and major depression. Fluoxetine selectively reduced both PA and NPSA behaviors in men reporting the presence of mild-severe depressive symptoms. Treatment response of PAs/NPSAs at outcome was independent of baseline depression score. Enhancement of central serotonin neurotransmission by fluoxetine may ameliorate symptoms of mood disorder, heightened sexual desire, and compulsivity/impulsivity associated with these conditions.