Fluoxetine and naltrexone showed similar results for compulsive sexual behavior disorder

Compulsive sexual behavior disorder involves persistent difficulty controlling sexual impulses or behaviors, sometimes with harmful effects on daily life. Research on medications for the condition is limited, and this study compared two medicines that have sometimes been used in care.

Researchers enrolled 80 people diagnosed with the disorder using International Classification of Diseases-11 criteria. The group included 79 men and one woman. Participants were randomly assigned in equal numbers to receive either fluoxetine or naltrexone: 40 received each medication.

Fluoxetine is an antidepressant in a group called selective serotonin reuptake inhibitors, often shortened to SSRIs. Naltrexone is used in some settings for substance use disorders. Participants started fluoxetine at 20 milligrams a day or naltrexone at 25 milligrams a day. Treatment lasted eight weeks, followed by six weeks without treatment.

The researchers repeatedly measured symptoms with the Hypersexual Disorder: Current Assessment Scale, known as HD:CAS. They analyzed results using an approach that included everyone who had been randomized, whether or not they completed treatment as planned. They also conducted a per-protocol analysis, which looks at participants who followed the study plan more closely.

At the main eight-week endpoint, there was no statistically significant difference in the reduction of HD:CAS scores between the two groups. In other words, the study did not find evidence that naltrexone worked better than fluoxetine on its main symptom measure.

The pattern of change over time differed between the medicines. The abstract does not provide the size of those changes, but it reports that symptom improvement followed different trajectories in the two groups. This may be useful information for future research and for discussions about individual treatment choices, but it does not show that one option is overall more effective.

Side effects and stopping treatment also differed. Two participants receiving fluoxetine were withdrawn because of adverse events: hives and elevated liver enzymes. The study reports that four participants receiving fluoxetine, or 10.3%, discontinued treatment. Six participants receiving naltrexone, or 15%, discontinued treatment.

This was a randomized controlled trial, a design that can make comparisons between treatments more reliable than an uncontrolled study. But it was also open-label, so participants and researchers knew which medicine was being taken. That knowledge can influence reported experiences and assessments. The study was relatively small and lasted only eight weeks of treatment.

The six-week period without treatment was part of the study design, but the supplied abstract does not report results from that period. It also does not establish long-term benefits or safety. Because nearly every participant was male, the findings cannot automatically be extended to women.

The researchers concluded that different symptom patterns and side-effect profiles may help guide individualized decisions. More studies, including larger and more diverse groups of participants and longer follow-up, would be needed to confirm the findings and clarify which people may benefit most from each medication.