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

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.