This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.
Pharmaceutical Treatment Options for Paraphilic Disorders by Derrick Meyers
In this blog I will review the primary pharmaceutical treatment options for paraphilic disorders (for further information, refer to this article). The two types of pharmaceutical treatments commonly used are hormonal or anti-androgens, and anti-depressants. How they work, dosage, effectiveness, and side effects vary between the two types of drugs.
How They Work
Androgens are hormones, specifically male hormones. Testosterone is manufactured by the testicles and adrenal glands. The definition for a hormone is, “a chemical substance that is secreted into the bloodstream by specific glands.” Hormones travel via the circulatory system to the specific organ needed. Organs have specific receptors for hormones, and recognition of a hormone depends on the activation of a certain receptor for that hormone. The amount of testosterone can be altered in two ways. The first way is to inhibit the hypothalamus, which tells the testicles and adrenal glands to produce testosterone. Leuprolide acetate and triptorelin are two drugs that do this. The second way is to introduce a chemical compound that can compete with testosterone to grab onto the receptor. Flutamide is a drug that does this, and it’s chemical structure (seen here) is very similar to testosterone.
MPA, a drug that affects the hypothalamus, can be taken in an injection or orally with a tablet. The usual dose for injection is between 300 and 500 milligrams. The tablet form has a dose of 300 milligrams, but the injection is preferred since the tablet is not as effective when it is absorbed by the stomach. The dose of medication should be as low as possible so side effects can be reduced. Most of the time the dose is slowly lowered if symptoms have declined. 500 milligrams a day of Leuprolide acetate, a drug that affects receptors, can be taken for the first month. 250 milligrams a day is taken for five and a half months, and 750 milligrams a day of flutamide during the whole six and a half months of treatment.
Hormone controlling drugs are effective in reducing sexual desire, arousal, and sexual behavior. They start to take effect after one to three weeks, and by four months at the very latest. It is not clear if the effectiveness of these drugs will continue once taking them has stopped.
Taking hormone controlling drugs come with some severe side effects. They include weight gain, fatigue, sleepiness, depression, dry skin, varicose viens, breasts forming, hair loss, shrinking of the testicles, gallbladder problems, increased blood pressure, a greater risk for diabetes, and possible osteoporosis. Most of the side effects are eliminated after individuals have stopped taking these drugs.
How They Work
The drugs fluoxetine, fluvoxamine, imipramine, clomipramine, desipramine, buspirone, and lithium carbonate were reviewed in above-linked the article. Most of these drugs are either SSRIs (selective serotonin reuptake inhibitor) or tricyclic antidepressants (TCAs). SSRIs basically work by preventing serotonin from being reabsorbed into the axon terminal button, and serotonin stays in the gap between brain cells known as the synapse. Tricyclic antidepressants work by preventing serotonin and norepinephrine from being reabsorbed, and serotonin and norepinephrine stays in the synapse. These drugs typically are used to treat depression and how they work to treat paraphilic disorders is not clear. A hypothesis suggests that, “When the synaptic transmission of serotonin is too low because too much of it is re-absorbed in the synapse, increased central dopamine neurotransmission occurs, which is supposed to result in a regulatory dysfunction of sexual behavior.” This is a very technical way of saying that serotonin levels are too low.
The dose for fluoxetine is 40 to 60 milligrams a day, the dose for clomipramine varies from 150 to 250 milligrams a day, the dose for imipramine is between 150-300 milligrams a day, the dose for desipramine is between 75-200 milligrams a day, Buspirone is between 10 and 25 milligrams a day, and lithium carbonate is between 300-1,200 milligrams a day. These drugs are usually prescribed at the lowest dose, and if not effective gradually increased.
At first glance the effects from these drugs seem to be great, but when looking at the studies, it’s clear that there are obvious flaws and shortcomings. No follow ups were conducted, the subjects were also undergoing psychotherapy, and placebo effects may have resulted. In the end it is not clear if these drugs are effective in reducing symptoms associated with paraphilic disorders.
The SSRIs and tricyclic antidepressants have some side effects, but are not as serious as the hormone controlling drugs listed above. The minor side effects include loss of libido, erectile dysfunction, headache, vomiting, diarrhea, insomnia, weight loss or gain. The more serious side effects are physical dependence, and in rare situations cardiovascular problems. Some of the side effects for Buspirone include drowsiness, vomiting, constipation, diarrhea, headache, fatigue, and insomnia. Some common side effects for lithium carbonate include increased thirst and urination, dry mouth, headache, decreased memory, muscle weakness, vomiting, diarrhea, and constipation.