Lithium
Although there has been extensive study of antidepressant-associated sexual side effects in patients with depressive disorders, there has been very little investigation into patients treated with lithium for bipolar disorder or unipolar depression.
A small open-label study of bipolar and schizoaffective male patients taking lithium as their only medication, found that 31.4% reported sexual dysfunction on a sexual function questionnaire. Patients were all reportedly euthymic at the time of inquiry. Just over 23% of patients reported reduction in frequency of sexual thoughts and 20% of men reported loss of erection during sex. Maintaining erections were reported by 14% of patients. Despite these problems, almost all patients reported normal pleasure during sexual activity and were satisfied with their sexual performance. Serum lithium concentrations were similar between patients with and without sexual dysfunction. Overall, patients reported that sexual dysfunction was minor, did not lead to noncompliance, and was not a source of distress. Viagra professional Australia
A point prevalence evaluation of patients with bipolar disorder found similar results, suggesting that patients treated with lithium as their only medication infrequently experience sexual dysfunction. In this study, 104 patients with bipolar disorder (nearly all of whom were euthymic) were asked to rate the current effects of lithium on sexual functioning ‘relative to a period of normal mood when the patient was not taking lithium.’ Several parameters of sexual function were rated according to the change affected by lithium, rated as ‘none, mild, moderate or great’. The authors found that among patients taking monotherapy lithium, only 14% of patients reported sexual side effects and these were almost all mild. The type of sexual side effect was not detailed for lithium. On the other hand, when lithium was combined with benzodiazepines, rates jumped to 40% of patients, and many of the complaints were moderate or great. This study has a number of limitations, principally that ratings were made retrospectively, sometimes many years after starting lithium. The study had no control group and medication was not randomly assigned. If the benzodiazepines indeed caused sexual problems, it is not clear if they caused them independently of lithium or if in combination with the lithium.
Finally, one recent study, published in Italian, reported that ‘clinically stable’ patients with bipolar disorder taking lithium were more likely than age-matched healthy controls to report to have ‘never’ or ‘rarely’:
It is unknown from this study how much the patient’s mood disorder or medication treatment contributed to their sexual complaints.
Hence, there has been very limited study into the effects of lithium on sexual functioning, though lithium appears to have limited adverse sexual side effects. Further prospective studies are needed.