What about sex, pregnancy and antipsychotics?

People with psychosis are less able to develop good psychosexual relationships and, for some, treatment with an antipsychotic can improve sexual functioning.

However, sexual dysfunction has been reported as a side-effect of all antipsychotics. According to the Maudsley Prescribing Guidelines (tenth edition) up to 45% of people taking typical antipsychotics experience sexual dysfunction. Whether you will be affected varies with the individual and all the effects are reversible.

Antipsychotics can decrease libido and may increase prolactin levels. This can cause periods to stop in women and a lack of libido, breast enlargement and the production of breast milk in both men and women. You may find it harder to get aroused and men may have particular problems with erection and ejaculation.

Clozapine, olanzapine, aripiprazole and quetiapine appear to have the fewest effects, however this may vary between each individual. If you are advised to stay on a drug which is causing you problems there are a number of other medications that can be prescribed to allow a return to normal sexual function.

If you are experiencing any of the above problems you should contact your doctor.

Women wishing to get pregnant who take antipsychotic medication are advised to discuss a planned pregnancy as soon as possible. Some women, particularly if they have suffered repeated relapses, may be best maintained on antipsychotics during and after pregnancy. This may minimise exposure of antipsychotic medication to the foetus by avoiding the need for higher doses should relapse occur.

The majority of information about using antipsychotics during pregnancy relates to the older, typical antipsychotics. It is assumed that there is only a small risk of complications if a woman takes typical antipsychotics whilst pregnant. Data about the atypical antipsychotics is now appearing. Clozapine, olanzapine, quetiapine and risperidone do not seem to be associated with the risk of malformation to the foetus.

Breast feeding

There are no published controlled studies on the safety of psychotropic medication during breast feeding.

The benefit of breastfeeding needs to be weighed up with the risk of drug exposure to the infant. The Maudsley Prescribing Guidelines recommend that as far as possible, the same medication used during pregnancy should be continued during breast feeding, at the lowest effective dose.