Psychotropic Drug Prescribing Trends in Bahrain: Implications for Sexual Functions

Treatment-emergent sexual dysfunction is a frequent adverse effect of many psychotropic drugs. We have analyzed the prescribing trends and the likelihood of psychotropic-associated sexual dysfunction in outpatients with depression or other psychotic disorders treated by psychiatrists. A retrospective prescription audit was conducted at the Psychiatric Hospital, the only psychiatric facility in Bahrain that offers both inpatient and outpatient services. Psychotropic associated sexual dysfunction was graded as negligible (0), moderate (2+), moderately severe (3+) and uncertain (U) for antidepressants, and for antipsychotics as no effect (0), very low (1+), moderate (2+), moderately severe (3+) and uncertain (U) effect. As antidepressant monotherapy, a significant trend towards prescribing selective serotonin reuptake inhibitors (SSRIs; 3+) and selective norepinephrine reuptake inhibitors (SNRIs; 3+) in females, and tricyclic antide-pressants (TCAs; 2+) in males was apparent. Atypical antidepressant mirtazapine (0) monotherapy was rarely prescribed. Mirtazapine with SSRIs or SNRI was the most often prescribed combinations followed by TCAs with other antidepressants. Risperidone (0 to 3+), an atypical antipsychotic, was the most popular antipsychotic prescribed to augment antidepressants; there was no gender-based difference. Clozapine (0) and olanzapine (1+) were rarely prescribed to augment antidepressant therapy. In Bahrain, the psychotropic prescribing trends suggest that there is a need to optimize drug therapy to achieve the therapeutic goal with minimal adverse impact on sexual function.