Two medications demonstrated comparable results in treating compulsive sexual behaviour disorder
Naltrexone and fluoxetine demonstrated similar results in the treatment of people with compulsive sexual behaviour disorder in a new study from Karolinska Institutet. Published in BMJ Mental Health, the study found no clear differences between the medications after eight weeks of treatment, although symptom patterns changed differently over time.
Compulsive sexual behaviour disorder is characterised by recurring difficulties in controlling sexual impulses and behaviours, which can lead to distress and negative consequences in everyday life. Although the condition is estimated to affect two to three per cent of the population, knowledge about pharmacological treatment remains limited.
In the new study, researchers compared the antidepressant selective serotonin reuptake inhibitor (SSRI) fluoxetine with naltrexone, a medication used, among other things, to treat substance use disorders. Both medications are sometimes prescribed for compulsive sexual behaviour disorder, but evidence regarding their effects has so far been limited.
A total of 80 individuals who met the diagnostic criteria for the disorder participated in the study. Participants were randomly assigned to receive either fluoxetine or naltrexone for eight weeks, followed by a six-week treatment-free period. The study was conducted at ANOVA, Karolinska University Hospital in Stockholm.
Different symptom trajectories over time
The researchers found that symptoms decreased in both treatment groups during the intervention period, but there was no statistically significant difference between the medications after eight weeks of treatment. However, differences were observed in how symptoms developed over time. Individuals treated with naltrexone experienced an early reduction in symptoms, whereas improvements in the fluoxetine group emerged later during the treatment period.
“Knowledge about pharmacological treatment for compulsive sexual behaviour disorder is still limited. Our findings suggest that treatment choices may need to be based on the patient’s individual circumstances, preferences and which adverse effects are considered acceptable,” says Josephine Savard, consultant psychiatrist at ANOVA and researcher at Karolinska Institutet and Umeå University.
The researchers also examined how well participants tolerated the treatments. Most reported some form of side effect, although these were generally mild to moderate in severity. The most common adverse effects differed between the medications. Reduced sexual desire was reported in both groups, while nausea was more common among those receiving naltrexone. Two participants treated with fluoxetine discontinued treatment due to pronounced or severe adverse effects.
The researchers emphasise that further studies are needed to investigate long-term effects and to identify which patients may benefit most from each treatment. They also note that the study population consisted almost entirely of men, meaning that the findings cannot automatically be generalised to women.
The study was conducted by researchers from ANOVA, Karolinska University Hospital, Karolinska Institutet and Umeå University. Funding was provided by, among others, the Swedish Research Council, Umeå University, ALF funding from Region Stockholm and Region Västerbotten, as well as several Swedish research foundations. The researchers report no conflicts of interest.
Publication
Randomised controlled trial of fluoxetine versus naltrexone in compulsive sexual behaviour disorder. Savard J, Piwowar M, Adebahr R, Byström M, Hallberg J, Dhejne C, Görts Öberg K, Jokinen J. BMJ Mental Health, 6 October 2026, doi: 10.1136/bmjment-2026-302953.