The clinical English language literature on sexual deviance and treatment with serotonergic medications is reviewed. Evidence is presented to support the hypothesis that serotonergic medications decrease deviant sexual interests without impairing non-deviant sexual interests. Criteria for selecting which medication to prescribe are reviewed and the clinical data on response to treatment, time to treatment response, and relapse are summarized. Specific recommendations for the treatment of sexual deviance with serotonergic medications are given. Finally, recommendations for future research are described.
Get full access to this article
View all access options for this article.
References
1.
APA. (1987). Diagnostic and statistical manual of mental disorders, Third Edition, Revised. Washington, DC: American Psychiatric Association.
2.
APA. (1980). Tardive dyskinesia . American Journal of Psychiatry, 137, 163-172.
3.
Bartholomew, A.A. (1968). A long-acting phenothiazine as a possible agent to control deviant sexual behavior. American Journal of Psychiatry , 124, 917-923.
4.
Berlin, F., & Meinecke, C.F. (1981). Treatment of sex offenders with antiandrogenic medication: conceptualization, review of treatment modalities and preliminary findings. American Journal of Psychiatry, 138, 601-607.
5.
Bianchi, M.D. (1990). Fluoxetine treatment of exhibitionism. American Journal of Psychiatry, 147, 1089-1090.
6.
Bradford, J. (1983). The hormonal treatment of sexual offenders. Bulletin of the American Academy of Psychiatry and the Law, 11, 159-607.
7.
Bradford, J., & McLean, D. (1984). Sexual offenders, violence and testosterone. Canadian Journal of Psychiatry , 29, 335-343.
8.
Cesnik, J.A., & Coleman, E. (1989). Use of lithium carbonate in the treatment of autoerotic asphyxia. American Journal of Psychotherapy, XLIII, 277-286.
9.
Cesnik, J.A., & Coleman, E. (1990). Skoptic syndrome: The treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy. American Journal of PsychotherapyXLIV, 204-217.
10.
Coleman, E., Cesnik, J., Moore, A.M., & Dwyer, S.M. (1992). An exploratory study of the role of psychotropic medications in the treatment of sex offenders. Journal of Offender Rehabilitation, 18, 75-88.
11.
Davies, T.S. (1970). Cyproterone acetate in sexual misbehavior. Medicine, Science, and the Law,10. 237-242.
12.
Davies, T.S. (1974). Cyproterone acetate for male hypersexuality. Journal of International Medical Research, 2, 159-163.
13.
Dickey, R. (1992). The management of a case of treatment resistant paraphilia with a long acting LHRH agonist. The Canadian Journal of Psychiatry, 37, 567-569.
14.
Egan, G.P., & Hammad. G.E.M. (1976). Sexual disinhibition with L-tryptophan. British Medical Journal, 2, 701.
15.
Emory, L.E., Cole, CM, & Meyer, W.J. (1992). The Texas experience with DepoProvera: 1980-1990 . Journal of Offender Rehabilitation, 189, 125-139.
16.
Everitt, B.J. (1978). A neuroanatomical approach to the study of monoamines and sexual behavior. In J.B. Hutchison (Eds.), Biological determinants of sexual behavior (pp. 555-574). Chichester: John Wiley & Sons.
17.
Everitt, B.J., & Hansen, S. (1983). Catecholamines and hypothalamic mechanisms. In D. Wheatley (Eds.), Psychopharmacologoy and sexual disorders (pp. 3-14). Oxford: Oxford University Press.
18.
Fedoroff, J.P. (1988). Buspirone in the treatment of transvestic fetishism . Journal of Clinical Psychiatry, 49-408-409.
19.
Fedoroff, J.P. (1989). Buspirone and transvestic fetishism (reply to letter). Journal of Clinical Psychiatry, 50, 437.
20.
Fedoroff, J.P. (1992). Buspirone hydrochloride in the treatment of an atypical paraphilia. Archives of Sexual Behavior, 21, 401-406.
21.
Fedoroff, J.P., & Fedoroff, I.C. (1992). Buspirone and paraphilic sexual behavior. Journal of Offender Rehabilitation, 18, 89-108.
22.
Fedoroff, J.P., Wisner-Carlson, R., Dean, S., & Berlin, F.S. (1992). Medroxy-progesterone acetate in the treatment of paraphilic sexual disorders: Rate of relapse in paraphilic men treated with long-term group psychotherapy with or without medroxyprogesterone acetate . Journal of Offender Rehabilitation, 18, 109-123.
23.
Field, L.H. (1973). Benperidol in the treatment of sex offenders. Medicine, Science and the Law, 13, 195.
24.
Foote, RM (1944). Diethylstilbesterol in the management of psychopathological states in males. Journal ofnervous and Mental Disease, 99, 928-935.
25.
Gagne, P. (1981). Treatment of sex offenders with Medroxyprogesterone acetate. American Journal of Psychiatry, 160, 127-137.
26.
Garattini, S., Bonaccorsi, A., Jori, A., & Samanin, R. (1974). Appetite suppressant drugs: Past, present, and future. In L. Lasagna (Eds.), Obesity: Causes, consequences and treatment (pp. 70-80). New York: Medcom Press.
27.
Goldbloom, D.S., Kennedy, S. (1991). Adverse interaction of fluoxetine and cyproheptadine in two patients with bulimia nervosa. Jocrrnal of Clinical Psychiatry, 52, 261-262.
28.
Graf, K.J., & Eletreby, M.F. (1978). The role of the anterior pituitary gland in progestageninduced proliferative mammary gland changes in the beagle. Arineim. Forsch., 28, 54-58.
29.
Gurani, P.D., & Dwyer, M. (1986). Serum testosterone levels in sex offenders. Journal of Offender Counseling, Services and Rehabilitation, 11, 39-45.
Hollander, E., & McCarley, A. (1992). Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. Journal of Clinical Psychiatry , 53, 207-209.
32.
Hucker, S.J., Langevin, R., & Bain, J. (1988). A double blind trial of Provera for pedophiles . Annals of Sex Research. 1, 227-242.
33.
Hullin, R.P., & Jerram, T. (1976). Sexual disinhibition with L-trytophan. British Medical Journal, 2, 1010.
34.
Kafka, M.P. (1991a). Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry, 52, 60-65.
35.
Kafka, M.P. (1991b). Successful treatment of paraphilic coercive disorder (a rapist) with fluoxetine hydrochloride. British Journal of Psychiatry, 158, 844-847.
36.
Kerbeshian, J., & Bird, L. (1991). Tardive syndrome and recurrent paraphilic masturbatory fantasy. American Journal of Psychiatry, 36, 155-157.
37.
Kline, M.D. (1989). Fluoxetine and anorgasmia. American Journal of Psychiatry. 146, 804-805.
38.
Kruesi, M.J.P., Fine, S., Valladares, L., Phillips, R.A., & Rapoport. J.L. (1992). Paraphilias: A double-blind crossover comparison of clomipramine versus desipramine. Archives of Sexual Behavior, 21, 587-593.
39.
Langevin, R., Bain, J., Ben-Aron, M.H., Coultard, R., Day, D., Handy, L., Heasman, G., Hucker, S.J., Purins, J.E., Roper, V., Russon, A.E., Webster, C.D., & Wortzman, G. (1985). Sexual aggression: Constructing a predictive equation. A controlled pilot study. In R. Langevin (Eds.), Erotic preference, gender identity and aggression in men. (pp. 39-76). Hillsdale, NJ: Lawrence Erlbaum Associates .
40.
Langevin, R., Paitich, D., Ramsay, G., Anderson, C., Kamrad, J., Pope, S., Geller, G., Pearl, L., & Newman, S. (1979). Experimental studies in the etiology of genital exhibitionism. Archives of Sexual Behavior, 8, 307-331.
41.
Langevin, R., Wright, P., & Handy, L. (1988). What treatment do sex offenders want? Annals of Sex Research, 1, 353-385.
42.
Laschet, U. & Laschet, L. (1971). Psychopharmacotherapy of sex offenders with cyproterone acetate. Pharmakopsychiatrie und Neuro-psychopharmakologie: Advances in Theroretical and Clinical Research, 4, 99-104.
43.
Laschet, U.(Ed.). (1973). Antiandrogen in the treatment of sex offenders: Mode of action and therapeutic outcome . Baltimore: Johns Hopkins University Press.
44.
Laschet, U., & Laschet, L. (1975). Antiandrogens in the treatment of sexual deviations in men. Journal of Steroid Biochemistry, 6, 821-826.
45.
Lorifice, L.S. (1991). Fluoxetine treatment of a fetish. Journal of Clinical Psychiatry, 52, 41.
46.
McCormick, S., Olin, J., Brotman, A.W. (1990). Reversal of fluoxetine-induced anorgsmia by cyproheptadine in two patients. Journal of Clinical Psychiatry, 51, 383-384.
47.
McLean, J.D., Forsythe, R.G., & Kaplan, L.A. (1983). Unusual side effects of clomipramine associated with yawning. Canadian Joumal of Psychiatry, 28, 569-570.
48.
Meyerson, B.J., & Malmnas, C. (1978). Brain monoamines and sexual behavior. In J.B. Hutchinson (Eds.), Biological determinants of sexual behavior (pp. 521-554). Chichester: John Wiley & Sons.
49.
Modell, J.G. (1989). Repeated observations of yawning, clitoral enlargement, and orgasm asssociated with fluoxetine administration. Journal of Clinical Psychopharmacology, 9, 63-65.
50.
Money, J. (1970). Use of an androgen-depleting hormone in the treatment of male sex offenders. Journal of Sex Research, 6, 165-172.
51.
Monteiro, W.O., Novhirvani, H.F., Marks, I.M., & Lelliott, P.T. (1987). Anorgasmia from clomipramine in obsessive-compulsive disorder. A controlled trial. British Journal of Psychiatry, 151, 107-112.
52.
Pearson, H.J., Marshall, W.L., Barbaree, H.E., & Southmayd, S. (1992). Treatment of a compulsive paraphilic with buspirone . Annals of Sex Research, 5, 239-246.
53.
Perilstein, R.D., Lipper, S., & Friedman, L.J. (1991). Three cases of paraphilias responsive to fluoxetine treatment. Journal of Clinical Psychiatry , 52, 169-170.
54.
Price, J., & Grunhaus, L.J. (1990). Treatment of chlomipramine-induced anorgasmia with yohimbine: Case report. Journal of Clinical Psychiatry, 51, 32-33.
55.
Rada, RT, Laws, D.R., Keller, R., Stivastava, L., & Peake, G. (1983). Plasma androgens in violent and non-violent sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 11, 149-158.
56.
Ray, W.A., Griffin, M.R., Downey, W. (1989). Benzodiazepines of long and short elimination half-life and the risk of hip fracture. Journal of the American Medical Association, 252, 3303-3307.
57.
Rodenburg, M., Sheldon, L., & Owen, J.A. (1992). Sexual disinhibition with L-tryptophan. Canadian Journal of Psychiatry, 37, 666-667.
58.
Ruby, R., Brady, K.T., & Norris, G.T. (1993). Clomipramine treatment of sexual preoccupation . Journal of Clinical Psychopharmacology, 13, 158-159.
59.
Segraves, R.T. (1989). Effects of psychotropic drugs on human erection and ejaculation. Archives of General Psychiatry, 46, 275-284.
60.
Smith, B., & Prockop, D.J. (1962). Central nervous system effects of ingestion of L tryptophan by normal subjects. New England Journal of Medicine , 267, 1338-1341.
61.
Steele, T.E., & Howell, E.F. (1986). Cyproheptadine for imipramine-induced anorgasmia . Journal of Clinical Psychopharmacology, 6, 326-327.
62.
Sovner, S. (1984). Treatment of tricyclic antidepressant-induced orgasmic inhibition with cyproheptadine. Journal of Clinical Psychopharmacology, 4, 169.
63.
Stein, D.J., Hollander, E., Anthony, D.T., Schneier, F.R., Fallon, B.A., Liebowitz, M.R., & Klein, D.F. (1992). Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. Journal of Clinical Psychiatry , 53, 267-271.
64.
Sterkmans, P., & Geerts, F. (1966). Is benperidol (RF 504) the specific drug for the treatment of excessive and disinhibited sexual behavior? Acta Neurologica et Psychiatrica Belgica, 66, 1030-1040.
65.
Stevenson, R.W.D., & Solyom. L. (1990). The aphrodisiac effect of fenfluramine: Two case reports of a possible side effect to the use of fenfluramine in the treatment of bulimia. Journal of Clinical Psychopharmacology, 10, 69-71.
66.
Symmers, W. (1968). Carcinoma of the breast in transsexual individuals after surgery and hormonal interference with primary and secondary sex characteristics . British Medical Journal, 2, 83-85.
67.
Whittaker, L.H. (1959). Oestrogens and psychosexual disorders. Medical Journal of Australia, 2, 547-549.
