Table 1.
Study results of patients treated with pharmacotherapy.
| Study | Samples and Diagnoses | Treatment | Duration of Treatment | Main Results | Side Effects |
|---|---|---|---|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | |||||
| Abouesh and Clayton (1999) [20] | two men with voyeuristic (A) and exhibitionistic (B) disorder | Paroxetine: A: 20 mg/day; B: 30 mg/day. |
A: three months of treatment and then four months without B: six months of treatment and two months follow-up |
Improved impulse control, decrease in fantasies and behaviors. | NR |
| Chow and Choy (2002) [21] | one woman sex offender with pedophilia | Sertraline (50 mg/day) + psychotherapy | 12 months | Decrease in intensity and frequency of fantasies, increased impulse control. | NR |
| Baltieri and De Andrade (2009) [22] | one man with exhibitionism and pedophilia | (1) Sertraline (200 mg/day) + topiramate (200 mg/day) + haloperidol (300 mg/mo) + psychotherapy; (2) addition of MPA (300 mg/2 tmo). |
four months of treatment and three months follow-up | (1) No decrease in fantasies; (2) absence of fantasies and deviant behaviors. |
NR |
| Emmanuel et al. (1991) [23] | one man with voyeurism | Fluoxetine (60 mg/day) | 3 months | Suppression of thoughts and deviant behaviors. | NR |
| Perilstein et al. (1991) [24] | three men | Fluoxetine | - | Improvement of impulse control | NR |
| Saleh and Berlin, (2004) [25] | one man with exhibitionism | Fluoxetine | 6 months | Urge reduction and sexual desire. | Delayed ejaculation |
| Shiwach and Prosser (1998) [26] | one man with masochism | Fluoxetine (80 mg/day) + psychotherapy | 42 weeks | Decreased fantasies and arousal. | NR |
| Steroidal antiandrogens | |||||
| Amelung et al. (2012) [27] | one hundred and eleven patients with pedophilia |
(1) seven with CPA (300–600 mg/biweek) and seven with GnRHa + Psychotherapy; (2) ninety-six with psychotherapy. SSRI as an add-on if necessary. |
3 months | (1) Decreased deviant behavior and increased self-efficacy. | NR |
| Bradford et al. (1993) [28] | nineteen patients with multiple paraphilias (1) + placebo (2) | (1) CPA (50–200 mg/day); (2) placebo (50–200 mg/day). |
8 months | Decreased TS, FSH, LH, decreased BPRS scores. | Without any significant variations |
| Boons et al. (2020) [29] | twelve sex offenders with pedophilia | (1) CPA + CBT; (2) triptorelin + CBT. |
- | Decrease in fantasies, urges, and behaviors. | (1) Gastric problems, reduced blood pressure; (2) weight gain, loss of bone mass. |
| Cooper and Cernovsky (1994) [30] | one man with pedophilia |
(1) CPA (100–200 mg/day); (2) leuprolide acetate (7.5 mg/mo). |
38 months | (1) Decrease in values; (2) suppressed TS levels, arousal, and self-report measures. | NR |
| Kiersch (1990) [31] | eight men with pedophilia | MPA (DepoProvera) (100–400 mg/week) + Saline (100–400 mg/week) |
64 weeks | Remission fantasies, arousal with nondeviant stimuli. Decreased fantasies and frequency of masturbation with MPA. Decreased fantasies with saline. Decrease with saline, increase with MPA. | Glaucoma Migraine |
| Kravitz et al. (1995) [32] | twenty-nine men with various paraphilias | MPA (300 mg/week) + Group therapy MPA | 6 months | Suppression of fantasies and deviant activities, increased ability to control impulses. | Muscle cramps, weight gain, migraine, fatigue, lethargy, drowsiness, depression, anxiety, pulmonary embolism. |
| Krueger et al. (2006) [33] | one man with pedophilia | MPA (300 mg/day) | 4 years | Reduced sexual impulses. | Gynecomastia, obesity, adrenal insufficiency, Cushing’s syndrome. |
| Lehne and Money (2000) [34] | one man with multiple paraphilias | MPA | forty years’ follow-up | Decrease in TS levels, cessation of deviant urges. | Erectile dysfunction, weight gain, fatigue. |
| Meyer et al. (1992) [35] | forty sex offenders with various paraphilias | MPA (400 mg/week) + psychotherapy + Group therapy | from 6 months to 12 years | Eighteen percent reiteration of abuse with MPA, 35% reiteration after termination, 58% reiteration without MPA. | Weight gain, migraine headaches, cramps, increased blood pressure, diabetes mellitus. |
| GnRH agonists or analogs | |||||
| Choi et al. (2018) [36] | seven sex offenders with various paraphilias | Leuprolide acetate + psychotherapy | 12 months | Decreased sexual fantasies, sexual interest, decreased scores on the questionnaires. | Feminization, fatigue, hot flushes. |
| Saleh (2005) [37] | one patient with hypersexuality and exhibitionism |
Leuprolide acetate (7.5 mg/mo) + psychotherapy | 5 months | Decreased urge and sexual drive, decreased LH, FSH, TS levels. | NR |
| Dickey (1992) [38] | one man with multiple paraphilias | Leuprolide acetate | 32 months | Decreased TS levels, LH, decreased frequency of masturbation and cessation of deviant behavior. | NR |
| Habermeyer et al. (2011) [39] | one man with homosexual pedophilia | Leuprorelin (11.25 mg/3 mo) | - | Decreased TS levels, decreased activation of the amygdala. | NR |
| Schiffer et al. (2009) [40] | one man with pedophilia | Leuprorelin (11.25 mg/3 mo) |
9 months | Decrease in processing of visual stimuli in subcortical areas. | NR |
| Dickey (2002) [41] | one man with multiple paraphilias | Leuprolide acetate | 10 years | Decreased TS levels, increased ability to control. | Osteoporosis |
| Landgren et al. (2020) [42] | fifty-two men with pedophilia | (1) degarelix (120 mg); (2) placebo. |
2 weeks | Decreased scores on scale of risk. | (1) Hepatobiliary enzyme increase, suicidal ideation; (2) NR. |
| Landgren et al. (2022) [43] | 52 men with pedophilia | (1) degarelix (120 mg) [25]; (2) placebo [25]. |
10 weeks | Reduced SDI, HBI, decreased deviant interest. | NR |
| Rösler and Witton (1998) [44] | thirty patients with severe paraphilias | Triptorelin (3.75 mg/mo) + psychotherapy | 8–42 months | Decreased questionnaire scores, decreased hormone levels, decreased fantasies. | Osteoporosis, hot flushes, muscle tension, erectile dysfunction. |
| Rousseau et al. (1990) [45] | one patient with exhibitionism | Flutamide + LHRH agonist | 52 weeks | TS decrease, DHT, remission of deviant activities, decrease in sexual fantasies. | Hot flushes |
| Other drugs | |||||
| Shiah et al. (2006) [46] | one man with fetishism | Topiramate (200 mg/day) | 6 months | Reduction in symptoms, development of ability to control. | NR |
| Vayisoglu (2023) [47] | one patient with exhibitionism | Bupropion (150 mg/day) | 6 months | Reduction of deviant fantasies and impulses. | NR |
| Pearson et al. (1992) [48] | one patient with exhibitionism and telephone scatology. | Buspirone (25 mg/day) + psychotherapy | 30 months | Termination of deviant behaviors, suppression of deviant fantasies. | NR |
Between brackets are reported the number of participants exposed or that reported the symptoms. BPRS: Brief Psychiatric Rating Scale; NR: not reported; day: daily dose; mo: monthly dose; 2 tmo: dose administered twice a month; week: weekly dose; biweek: biweekly dose; SDI: Sexual Desire Inventory; HBI: Hypersexual Behavior Inventory; TS: testosterone; MPA: medroxyprogesterone acetate.