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Chapter 5-Physician's Guide To Management of HD
Sexual Disorders
Many patients with HD become uninterested in sexual activity. Others may continue to enjoy healthy sexual activity well into the course of the illness. Occasional patients may desire and pursue excessive sexual activity or engage in inappropriate sexual behaviors, such as public masturbation, or voyeurism.
The spouse, usually the wife, may be distressed and fearful because the individual with HD may become aggressive if sexual demands are not met. Spouses may be afraid to talk about the problem unless interviewed alone.
Interventions are difficult in these circumstances, probably because of the patient's impaired judgement and the strength of the drive. Open communication about sex between the doctor and the family can help to destigmatize this sensitive topic. With open discussion among the parties, distressing sexual behaviors can sometimes be adapted into more acceptable acts.
Patients engaging in these behaviors should be assessed and treated for comorbid conditions, such as mania. We have found antiandrogenic therapy helpful in a few of these cases.
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Antidepressant Induced Sexual Dysfunction
See Also Erectile Dysfunction Causes http://www.fpnotebook.com/URO23.htmhttp://www.fpnotebook.com/PSY149.htmCauses
See Medication Induced Sexual Dysfunction http://www.fpnotebook.com/PSY172.htm Tricyclic Antidepressants http://www.fpnotebook.com/PSY157.htm MAO inhibitors http://www.fpnotebook.com/PSY151.htm Selective Serotonin Reuptake Inhibitor (SSRI) http://www.fpnotebook.com/PSY162.htm Fluvoxamine (Luvox) (54% http://www.fpnotebook.com/PSY166.htm Incidence sexual dysfunction)
Sertraline (Zoloft) (56% http://www.fpnotebook.com/PSY167.htm Incidence sexual dysfunction)
Paroxetine (Paxil) (65% http://www.fpnotebook.com/PSY165.htm Incidence sexual dysfunction)
Management: Approach
Observe for 4 to 6 weeks for adverse effects to subside
Adjust current Antidepressant dosing
Decrease Antidepressant dosage
Alter timing of daily dose
Consider 2 day drug holiday
Sertraline (Zoloft)
Paroxetine (Paxil)
Not effective for Fluoxetine (Prozac)
Consider adjunctive therapy (see below)
Substitute another Antidepressant
Minimal to no sexual dysfunction
Nefazodone (Serzone) http://www.fpnotebook.com/PSY155.htm Bupropion (Wellbutrin) http://www.fpnotebook.com/PSY153.htm Mirtazapine (Remeron) http://www.fpnotebook.com/PSY152.htm Low risk of sexual dysfunction (10-15%)
Fluvoxamine (Luvox) http://www.fpnotebook.com/PSY152.htm Citolopram (Celexa) http://www.fpnotebook.com/PSY163.htm Venlafexine (Effexor) http://www.fpnotebook.com/PSY156.htmManagement: Adjunctive therapy to improve sexual function
Approach to specific sexual dysfunction problems
Orgasm: all of the agents below
Libido: Amantadine, Buspar, Periactin, Yohimbine
Erection: Amantadine, Buspar, Periactin, Yohimbine
As Needed dosing
Amantadine 100 to 400 mg PO prn 2 days before coitus
Amantadine-Rimantadine http://www.fpnotebook.com/ID117.htm Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
Buspar 15-60 mg PO prn 1 to 2 hours before coitus
Periactin 4-12 mg PO prn 1 to 2 hours before coitus
Dexadrine 5-20 mg PO prn 1 to 2 hours before coitus
Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
Erectile dysfunction http://www.fpnotebook.com/URO76.htm Daily Dosing
Amantadine 75-100 mg PO bid to tid
Bupropion 75 mg PO bid to tid
Buspar 5-15 mg PO bid
Dexadrine 2.5 to 5 mg bid to tid
Pemoline 18.75 mg PO qd
Pemoline Cylert (ADHD) http://www.fpnotebook.com/PED143.htm Yohimbine 5.4 mg PO tid
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This is just a long shot, but it appears like drugs containing benzodiazepines, Amphetamines (Ritalin), or barbiturates all have the tendency to affect the patient's inhibitions. There are more I haven't found yet.
Is it possible the JHD patients are on drugs for other HD symtpoms which may contain any of these? Have their doctor's analyzed the drugs they ARE on to determine what, if anything, may cause social inhibitions?
The below descriptions came from the Effects of Drugs on the Nervous System from the Neuroscience for Kids website.
Effects of benzodiazepines on the Brain
http://faculty.washington.edu/chudler/roof.htmlEFFECT:
Drugs, like Rohyuponol, can produce amnesia (memory loss) and muscle relaxation and make people lower their inhibitions. An inhibition is when you feel like you can't do something. When inhibitions are lowered, people feel as if an obstacle has been removed. Therefore, they can talk more freely and feel less shy.
SCIENTIFIC REASON WHY
The benzodiazepines influence behavior by interacting with receptors
on neurons in the brain that use the neurotransmitter called GABA. When
GABA binds to receptors, it usually inhibits a neuron and acts to reduce
neuronal activity. When benzodiazepines attach to GABA receptors, they
increase GABA binding to other receptors. In this way, benzodiazepines
enhance the effects of GABA and reduce brain activity.
The fact that there are receptors for benzodiazepines in the brain
suggests that the brain makes its own type of benzodiazepine. The brain
has been found to make its own morphine, the endorphins, but the brain's
own benzodiazepine has not yet been discovered.
Amphetamines
http://faculty.washington.edu/chudler/amp.htmlinclude drugs like dextroamphetamine, benzedrine, Ritalin and many other chemicals. Amphetamines were originally developed as a treatment for asthma, sleep disorders (narcolepsy) and hyperactivity.
EFFECT:
Many of the effects of amphetamines are similar to cocaine. Addiction to
and withdrawal from amphetamines are both possible. Amphetamine use
also causes tolerance to its effects. This means that more and more
amphetamine must be used to get "high." Like cocaine withdrawal,
amphetamine withdrawal is characterized by severe depression and fatigue.
Users will go to extreme measures to avoid the "downer" that comes
when the effect of amphetamines wears off.
-Feelings of happiness and power
barbiturates
http://faculty.washington.edu/chudler/barb.htmlThere are many different types of barbiturates. The names of some
common ones (and brand names) include Pentobarbital (Nembutal),
Secobarbital (Seconal), Amobarbital (Amytal) and Phenobarbital (Luminal); slang names for these barbiturates include yellow jackets, reds, blues, Amy's, and rainbows.
EFFECT:
In low doses: barbiturates reduce anxiety; reduce respiration, reduce
blood pressure, reduce heart rate and reduce rapid eye movement
(REM)sleep. The barbiturate called pentobarbital is known as "truth serum."
In higher doses: barbiturates can actually increase some types of behavior
and act like a stimulant. These effects may be caused by depressing
inhibitory brain circuits. In other words, barbiturates at these doses
act to remove inhibitory behavior.
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Young People With Sexual Misconduct
I applaud you both for speaking so honestly and open to this list as it's only through sharing our experiences that we can learn and hopefully help our loved ones with HD.
Inappropriate sexual behavior is a known, but rarely discussed potential aspect of HD that can be devastating to families, hindering finding appropriate treatment or care for this problem.
The only reference I recall on this has been the PGHD (below) and most literature only addresses the adultwhere as the course of action for a young personmight need to be handled a lot differently.
These are young people who have been robbed of any opportunity to have a "normal" sex life because of HD, but that doesn't stop them from thinking of or wanting intimate relationships and it's natural, when
they see an attractive member of the opposite sex to vividly become acutely aware of those needs.
Kelly went through a period of what would be considered inappropriate sexual behavior, but hers was more on the line of the lack of self-esteem/HD, alcohol and drugs all mixed together where she made some poor choices in her life.
I don't have any experience to offer any suggestions but am hopeful that other's who do will open up their hearts and write about what helped them in resolving inappropriate sexual behavior problems in HD, in
particular with young adults.
Thank you, both, again for your bravery!
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