Lithium and Libido: Few Studies, Some Problems in Bipolar Patients

Patients who take antipsychotic and antidepressant medications frequently experience sexual side effects, necessitating dose adjustments. Lithium is a cornerstone treatment for many patients with bipolar disorder, but few studies have investigated its effect on sexual function.

Recently, researchers set out to determine the incidence of treatment-emergent sexual dysfunction with lithium and identify potential management approaches. By conducting a systematic computerized literature search of preclinical and clinical studies, they examined 13 relevant papers and published their results in Human Psychopharmacology and Clinical Experience.

The preclinical studies shed light on the etiology of lithium-related sexual dysfunction, noting that the drug could significantly reduce testosterone levels and impair nitric oxide-mediated control of male erectile tissue. Additionally, 6 clinical reports suggested that lithium might reduce sexual thoughts and desire, worsen erectile function, and reduce sexual satisfaction.

Lithium-treated patients who reported sexual dysfunction also demonstrated a lower level of overall functioning, higher rates of lithium-related adverse effects, and poor medication adherence.

Those who received concurrent benzodiazepines had a significantly elevated risk for sexual dysfunction.

Only 1 study addressed how to manage lithium-related sexual dysfunction. In that placebo-controlled study, men who took lithium and 240 mg aspirin daily reported less overall sexual dysfunction and improved erectile function.

The authors suggested that, at this time, the best management strategy is to ask all lithium patients whether they experienced sexual difficulties prior to starting lithium or periodically during treatment. They stressed that such inquiries are especially important when starting new medications and periodically thereafter, as they could determine whether instances of sexual dysfunction are connected to lithium or the newer medications.

While researchers and clinicians often focus on the sexual implications of other drugs used for mental illnesses, they tend to overlook lithium’s potential effects on sexuality, the authors noted.

Indeed, little information is available on the incidence, associated factors, and management of lithium-related sexual dysfunction. More studies are needed, but in the meantime, clinicians should be aware of the possibility that lithium might affect patients’ quality of life and medication adherence.