Compulsive sexual behaviour: two drugs work similarly well in Swedish study

People with compulsive sexual behaviour disorder lose control over sexual urges and behaviour – often with consequences for relationships, work and well-being. A team from the ANOVA centre at Karolinska University Hospital, Karolinska Institutet and Umeå University has, for the first time, compared two drugs head to head in a randomised trial. Eighty participants, almost all men, took either fluoxetine, an SSRI antidepressant, or naltrexone, an opioid antagonist, for eight weeks, followed by six weeks without treatment. The results were published in the journal BMJ Mental Health.

Symptoms fell in both groups, with no statistically significant difference between the drugs. Naltrexone appeared to work earlier – but the authors call this preliminary, because the trial was not designed to test speed. Most participants had side effects, mostly mild to moderate; reduced sexual desire was reported in both groups, and nausea was more common with naltrexone. Two people in the fluoxetine group stopped because of severe side effects.

'Naltrexone appears to have the potential to provide faster symptom relief,' says lead author Josephine Savard. At the same time she stresses: 'We still have limited knowledge about how pharmacological treatment works for Compulsive Sexual Behaviour Disorder.' Limitations: almost all participants were men, long-term effects are unknown, and it remains unclear who benefits most from which drug. The work was funded by the Swedish Research Council, Umeå University and the Stockholm and Västerbotten regions, among others; the authors report no conflicts of interest. Treatment belongs under medical supervision.