Table 3.

Treatment studies for SSRIs.

Reference Type of study	Patient characteristics	Previous or concurrent treatments for CSBD	Treatment conditions (dose and duration)	Outcome measures	Efficacy
Double-blind studies
Wainberg et al. (2006) USA	N = 28 homosexual men (mean age 36.8 years) with CSBD	23% psychotherapy, 3.8% medication, 19.2% self-help groups	13 Participants citalopram (20–60 mg/d) vs. 15 participants placebo for 12 weeks. Mean daily citalopram dose at week 4 was 25.5 mg and 43.36 mg at week 12.	Clinical Global Impressions scale-Compulsive Sexual Behaviour (CGI-CBS), Compulsive Sexual Behaviour Inventory (CSBI), Yale-Brown Obsessive Compulsive Scale-Compulsive Sexual Behaviour (YBOCS-CSB)	Decreases were observed in CSB symptoms in both groups after 12 weeks. However, stronger decreases in desire for sex, frequency of masturbation, and hours of pornography use per week were observed in the citalopram group. Although there was a significant decrease in CSB symptoms measured with the YBOCS-CSB, the Compulsive Sexual Behaviour Inventory or the CGI-CSB in the whole group, no differences were observable between the two groups. Furthermore, although there was a significant decrease in the number of partners per month and in the frequency of oral and anal sex per month across the whole study population, again no differences occurred between the two groups. The same pattern was found concerning frequency of risky sexual contacts per month.
Lew-Starowicz et al. (2022) Poland	N = 73 heterosexual men (mean age 35.74 years; SD 8.09 years) with CSBD according to ICD-11; 87.7% with problematic pornography use and 100% with compulsive masturbation. No significant differences with respect to CSBD symptoms or demographic characteristics. 15 patients were suffering from sexual dysfunctions, mostly erectile dysfunction.	No previous psychiatric treatment	Group A: Paroxetine 20 mg/d Group B: Naltrexone 50 mg/d Group C: Placebo	Primary outcome: Changes in the severity of CSBD symptoms measured with SAST-R, BPS, and HBI. Additionally, cravings for sexual activity and pornography vieweing were assessed via smartphone-based Ecological Momentary Assessments.	Significant decrease of self-assessed CSBD symptom severity after eight and 20 weeks across all three groups, however, no differences between paroxetine, naltrexone and placebo. In clinical interviews paroxetine and naltrexone were found to be more effective than placebo in reducing CSBD symptoms after eight as well as after 20 weeks. Craving for sexual encounters and pornography viewing was reduced in the paroxetine condition but not in the other two conditions.
Open studies
Kafka (1991) USA	N = 10 men with nonparaphilic sexual addictions (5 men with additional paraphilic disorders) (age range 27–50 years)	Supportive psychotherapy	6 Patients fluoxetine 20–60 mg/day, 1 patient imipramine 225 mg/day, 1 patient lithium 1500 mg/day, 1 patient imipramine 125 mg/day + lithium 600 mg/day, 1 patient fluoxetine 60 mg/day + trazodone 150 mg/day for 12 weeks	Sexual Outlet Inventory	All but one patient (fluoxetine monotherapy) experienced substantial improvement in symptomatology.
Kafka and Prentky (1992) USA	N = 10 men with paraphilic disorder and non-paraphilic sexual addictions vs. N = 10 men with non-paraphilic sexual addictions only 11 men (6 paraphilic and 5 non-paraphilic) met criteria for current major depression using DSM-III-R criteria	10 Men concurrent psychotherapy	Fluoxetine starting at 20 mg/day to a maximum of 60 mg/day. Mean dose at 12 weeks was 39.37 mg/day (SD = 14.81)	Sexual Outlet Inventory	4 men dropped out during the study (1 paraphilic and 3 non-paraphilic) Significant reductions were observed in total sexual outlet, masturbation frequency, frequency of sexual activities, intensity of sexual desire after 12 weeks of treatment. Greater decreases were observed in the paraphilic group in total sexual outlet; however, higher baseline total sexual outlet was observed in the paraphilic group. Overall average reduction of total sexual outlet was 65.2%
Stein et al. (1992) USA	N = 13 men (5 with paraphilic disorder, 5 with non-paraphilic sexual addictions, 3 with sexual thoughts or rituals that met DSM-III-R criteria for obsessive compulsive disorder (OCD); ages between 18–58 years)	Not reported	Fluoxetine up to 80 mg/d; clomipramine up to 400 mg/d Fluvoxamine up to 300 mg/d; Fenfluramine up to 40 mg/d	Clinical Global Impression change score	No change was reported in paraphilic fantasies or behaviours or improvement in non-sexual OCD symptoms; in 2 of 5 patients, decreases reported in non-paraphilic sexual addiction; in 2 of 5 improvement noted in sexual obsessions or compulsions
Kafka (1994) USA	N = 12 men with paraphilia-related disorders (mean age 39.6 years; SD = 7.5 years)	Not reported	Sertraline mean dose 99.0 mg, SD = 62.8 mg/day (range 25–250 mg/day) for 4–64 weeks	Sexual Outlet Inventory	Statistically significant reduction in unconventional total sexual outlet and average time spent per day without adversely affecting conventional total sexual outlet.
Case studies
Elmore (2000) USA	a.) N = 1 man (24 years) with excessive use of telephone sex, excessive masturbation and co-occurring depression b.) N = 1 woman (30 years) with excessive masturbation and compulsive sex with multiple partners, co-occurring mixed personality disorder and PTSD	Not reported	In a.) Paroxetine 20 mg/day for 4 months In b.) Sertraline 200 mg/day for 20 months, partly with trazodone augmentation 150 mg/day for 6 months, amitriptyline augmentation 50 mg/day for 1 year	Self-reported intensity and frequency of CSBs	In a.) Decreases in CSBs after 2 weeks In b.) Decreases in sexual desire, arousal, and sexual activity.
Gola and Potenza (2016) Poland	N = 3 men (24, 32, and 35 years) Problematic pornography use and compulsive masturbation	Cognitive-behavioural therapy (on-going)	Paroxetine 20 mg/day Treatment duration between 14.5 and 20.5 weeks Follow-up 3-month	Self-reported time spent with pornography consumption (daily)	Decreased libido and delayed ejaculation during first 2–4 weeks. Within 10 weeks, normalisation of libido and sexual functioning. After 12 weeks, occurrence of new sexual behaviours (e.g., engaging in paid sexual relationships, extra-marital affair); however, no increase in pornography consumption. Still no increase in pornography consumption after 3-month follow-up