This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Original Research

Psychostimulant Augmentation During Treatment With Selective Serotonin Reuptake Inhibitors in Men With Paraphilias and Paraphilia-Related Disorders: A Case Series

Martin P. Kafka and John Hennen

Published: September 30, 2000

Article Abstract

Background: We describe an open trial ofpsychostimulants (primarily methylphenidate sustained release[SR]) added to selective serotonin reuptake inhibitors (SSRIs;primarily fluoxetine) during the course of pharmacologictreatment of men with paraphilias and paraphilia-relateddisorders (PRDs).

Method: Twenty-six men with paraphilias (N = 14)or PRDs (N = 12) were assessed for lifetime mood disorders andattention-deficit/hyperactivity disorder (ADHD) as defined byDSM-IV. All men were assessed at baseline for total sexual outletand average time per day associated with paraphilia/PRD sexualbehaviors. The indications for the addition of a psychostimulantto a stable dose of SSRI included the retrospective diagnosis ofADHD with persistent adult symptoms despite pharmacotherapy withan SSRI (N = 17); residual paraphilia/PRD fantasies, urges, andactivities despite SSRI pharmacotherapy (N = 16); the persistenceor presence of residual depressive symptoms despite SSRIpharmacotherapy (N = 6); relapse or loss of SSRI efficacy duringthe treatment of sexual impulsivity disorders (N = 4); andtreatment of SSRI-induced side effects (N = 4).

Results: SSRI pharmacotherapy (mean ± SDduration = 8.8 ± 11.1 months) had statistically significanteffects in diminishing paraphilia/PRD-related total sexual outlet(p < .001) and average time/day spent in paraphilia/PRD sexualbehavior (p < .001). Addition of methylphenidate SR (mean dose= 40 mg/day; mean ± SD duration = 9.6 ± 8.2 months) wasassociated with additional statistically significant effects onparaphilia/PRD-related total sexual outlet (p = .003) and averagetime per day (p = .04) in addition to improvement of putativeresidual ADHD and depressive symptoms.

Conclusion: Methylphenidate SR can be cautiouslyand effectively combined with SSRI antidepressants to ameliorateparaphilias and paraphilia-related disorders for the indicationslisted above.

Volume: 61

Quick Links:

Continue Reading…

Subscribe to read the entire article


Buy this Article as a PDF