Psychostimulant Augmentation During Treatment With Selective Serotonin Reuptake Inhibitors in Men With Paraphilias and Paraphilia-Related Disorders: A Case Series
J Clin Psychiatry 2000;61(9):664-670
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: We describe an open trial of
psychostimulants (primarily methylphenidate sustained release
[SR]) added to selective serotonin reuptake inhibitors (SSRIs;
primarily fluoxetine) during the course of pharmacologic
treatment of men with paraphilias and paraphilia-related
Method: Twenty-six men with paraphilias (N = 14)
or PRDs (N = 12) were assessed for lifetime mood disorders and
attention-deficit/hyperactivity disorder (ADHD) as defined by
DSM-IV. All men were assessed at baseline for total sexual outlet
and average time per day associated with paraphilia/PRD sexual
behaviors. The indications for the addition of a psychostimulant
to a stable dose of SSRI included the retrospective diagnosis of
ADHD with persistent adult symptoms despite pharmacotherapy with
an SSRI (N = 17); residual paraphilia/PRD fantasies, urges, and
activities despite SSRI pharmacotherapy (N = 16); the persistence
or presence of residual depressive symptoms despite SSRI
pharmacotherapy (N = 6); relapse or loss of SSRI efficacy during
the treatment of sexual impulsivity disorders (N = 4); and
treatment of SSRI-induced side effects (N = 4).
Results: SSRI pharmacotherapy (mean ± SD
duration = 8.8 ± 11.1 months) had statistically significant
effects in diminishing paraphilia/PRD-related total sexual outlet
(p < .001) and average time/day spent in paraphilia/PRD sexual
behavior (p < .001). Addition of methylphenidate SR (mean dose
= 40 mg/day; mean ± SD duration = 9.6 ± 8.2 months) was
associated with additional statistically significant effects on
paraphilia/PRD-related total sexual outlet (p = .003) and average
time per day (p = .04) in addition to improvement of putative
residual ADHD and depressive symptoms.
Conclusion: Methylphenidate SR can be cautiously
and effectively combined with SSRI antidepressants to ameliorate
paraphilias and paraphilia-related disorders for the indications