Pharmacotherapy of Paraphilias With Long-Acting Agonists of Luteinizing Hormone–Releasing Hormone: A Systematic Review. [CME]
J Clin Psychiatry 2003;64(8):890-897
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: In addition to psychotherapy,
pharmacotherapy is an important treatment option for paraphilias,
especially in sexual offenders. Cyproterone acetate (CPA) and
medroxyprogesterone acetate (MPA) are commonly used but can have
serious side effects. Selective serotonin reuptake inhibitors
(SSRIs) may also be effective in less severe cases. Recent
research shows that luteinizing hormone-releasing hormone (LHRH)
agonists may offer a new treatment option for treatment of
Method: MEDLINE was searched for clinical
trials, case-control studies, case reports, and other clinically
and theoretically important literature published between 1980 and
November 2002 on the treatment of paraphilia with LHRH agonists.
Keywords included LHRH agonists, GnRH-agonists,
antiandrogens, paraphilia, pedophilia, and sex offenders.
Results: We found 4 case reports, 1 case-control
study, 7 open uncontrolled studies, and 1 study comparing
patients receiving CPA with those receiving LHRH agonist
treatment in forensic hospitals. In total, the studies reported
on a sample of 118 treated patients with different forms of
paraphilias (sadism, pedophilia, exhibitionism, voyeurism).
Nearly all of the studies used self-reports to measure the
effects of medication. Duration of follow-up was between 6 months
and 7 years and revealed that there were no relapses if patients
remained under treatment. Patients previously treated with other
agents like CPA, MPA, or SSRIs reported better effects when
taking LHRH agonists.
Conclusion: Although there is a need for further
research, LHRH agonists offer a treatment option for patients
with severe paraphilia. We propose a differentiated pharmacologic
treatment regarding side effects, symptomatology, and severity.