New findings on drug treatment for Compulsive Sexual Behaviour Disorder

“We still have limited knowledge about how pharmacological treatment works for Compulsive Sexual Behaviour Disorder. This is the first study to compare these two medications,” says Josephine Savard, researcher at the Department of Medicine, Karolinska Institutet in Huddinge and senior consultant psychiatrist at ANOVA, Karolinska University Hospital.

There are currently no medications specifically developed for Compulsive Sexual Behaviour Disorder. In the present study, researchers compared fluoxetine, an antidepressant medication, with naltrexone, a medication used to treat addiction-related conditions.

“SSRIs, a class of antidepressants, reduce impulsivity and help suppress compulsive thoughts. They are usually considered the first-line treatment for Compulsive Sexual Behaviour Disorder. However, because the underlying neurobiological mechanisms share similarities with those of other addictive disorders, the addiction medication naltrexone is also used,” says Jussi Jokinen, senior consultant psychiatrist and Professor of Psychiatry at the Department of Clinical Science, Umeå University.

No difference in the reduction of symptoms

The study included 80 participants who were randomly assigned to receive either fluoxetine or naltrexone. After eight weeks, the researchers found no significant difference in the degree to which symptoms had decreased. However, there were indications that the medications may act at different rates.

“Naltrexone appears to have the potential to provide faster symptom relief, but the study was not designed to investigate such differences. Therefore, these findings should be regarded as preliminary,” says Josephine Savard.

Instead, the results may support more individualised treatment decisions. Since the two medications have a similar overall effect on symptoms, physicians and patients can jointly determine which treatment may be most appropriate based on individual needs and side effects. Both medications can cause fatigue and reduced sexual desire, although these effects were reported to varying degrees.

Continued research on drug treatment is important

Compulsive Sexual Behaviour Disorder was recently classified as a disorder by the World Health Organization and is estimated to affect 2–3 per cent of the population. The diagnosis is characterised by persistent difficulties in controlling sexual impulses and behaviours despite negative consequences for the individual. Patients are often offered both medication and various forms of psychotherapy.

“Many patients want pharmacological treatment, which makes it important to continue conducting well-designed medication studies. As part of this study, we carried out extensive biological sampling. The next step will be to investigate whether we can identify clinical and neurobiological predictors of treatment response, in other words whether there is a way to predict how a patient will respond to a specific treatment,” says Jussi Jokinen.

About the study

Savard J, Piwowar M, Adebahr R, Byström M, Hallberg J, Dhejne C, Görts Öberg K, Jokinen J. Randomised controlled trial of fluoxetine versus naltrexone in compulsive sexual behaviour disorder. BMJ Mental Health. 2026;29:e302953. https://doi.org/10.1136/bmjment-2026-302953