To find out optimal treatment of bipolar patient with minimum sexual side effects.


Bipolar effective disorder  characterized by episodes of mania, hypomania ,depressive, mix features and period of euthymia. It hits  both male and female equally.In its all phases there  some sexual dysfunction is associated with it.Pathophysiology is intricate due to effects of disease and sexual side effects of medication.In male hypersexuality elevated sexual desire during manic  phase and in depressive phase low sexual desire ,erectile dysfunc Sexual dysfunction  and orgasmic disorders are found.In female hyposexual desire lack of lubrication and dysparunea are reported in depressive phase while high sexual urge in manic or hypomanic and  hypomanic phase. Sexual  dysfunction contribute to nin adherence of medication in the patient. A balanced treatment that keep mood near normal and sexual function close to normal is required.


Internet search was made using key word bipolar disorder,bipolar depression  sexual dysfunction,mood stabilizers antipsychotics anti depressant.


Sexual dysfunctions are more common  27% and is twice as high in bipolar patients  compared with normal population.

Sexual dysfunction in patients taking antipsychotics range 45 to 80 % in make and 30 to 80% in female patients.

Women with bipolar disorder showed sexual distress  54% and 39% were not satisfied with their sexual life.


Treatment of sexual dysfunction in a bipolar patient is very challenging. Neurotransmitters involved in pathohysiology  of two disorder overlap .However they when desire results are required for  both disorder ,they work in opposite direction. If dopamine is enhanced to increase libido it mmay flare up manic  phase.Sexual dysfunction will occur if dopamine is antagonized by antipsychotics. Mood stabilizer

Like lithium effect libido, erection, and  orgasm .carmbmzapine induces heptic enzyme that metabolize testosterone. Divalproic sodium has its own sexual side effects. We can rely more on aripiprazole ,or lamotrogine. Although olanzapine ,clozapine,qutiapine ,zaprasidone too don’t  raise prolactin.However olanzapine ans clozapine can cause metabolic syndrome a very cause of sexual dysfunction.Treatment of SD of bipolar is more trouble some.Most of antidepressant not safe.SSRI can flare up mania or hypomania and have its own sexual side effect,Combo of fluoxetine and olanzapine can causeSD.We are left with a few choces of Aripiprazole, lamtrogen  ,Qutiapen XR .In case of hypogonadism  testosterone can become flaring agent.` Caution has to be  taken frequent check up for mood changes and cover of some safe mood stabilizer s administered .If patient has compliant of PME combo off olanzapine and fluoxetine or occasiona cautiousl use of depoxetine may be considerd.Sex therapy and anesthetic  gel can be safer choice.


SD  in bipolar treatment has to be tailored according to patient requirment






Bipolar disorder and erectile dysfunction both have  high incidence of diabetes substance abuse. Low testosterone  and low sleep may be underlying  cause of sexual dysfunction is found in bipolar depressed people.

33% of patient on litium  suffer sexual dysfunction



sexual dysfunction in patients taking antipsychotics is mediated through their anti dopaminiergic,anti histamine ,anti cholinergic,alpha adrenergic effects .