ORIGINAL RESEARCH & REVIEWS Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder Ana García-Blanco, MD, PhD, 1 María P. García-Portilla, MD, PhD, 2,3 Lorena de la Fuente-Tomás, PhD, 2,3 María Batalla, MD, 4 Mónica Sánchez-Autet, MD, PhD, 5 Belén Arranz, MD, PhD, 2,5 Gemma Safont, MD, 2,6 Sergio Arqués, MD, 7 Lorenzo Livianos, MD, PhD, 4,8,9 and Pilar Sierra, MD, PhD 4,8 ABSTRACT Background: In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. Aim: To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. Methods: A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (LþA group); or (iv) lithium plus benzodiazepines (LþB group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify po- tential confounding variables, and linear regression models were used to study the association of the CSFQ- 14 with QoL. Main Outcome Measures: Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. Results: The A group had better total SF scores than the L group and the LþB group. Relative to the A group, the L and LþB groups had worse sexual desire; the L group had worse sexual arousal; and the LþA group and the LþB group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. Clinical Implications: Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. Strengths & Limitations: Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. Conclusions: Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticon- vulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) im- proves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative Received May 3, 2019. Accepted January 30, 2020. 1 La Fe Health Research Institute, Valencia, Spain; 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; 3 Department of Psychiatry, University of Oviedo, Oviedo, Spain; 4 La Fe University and Polytechnic Hospital, Valencia, Spain; 5 Parc Sanitari Sant Joan de Deu, Barcelona, Spain; 6 Department of Psychiatry, University Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain; 7 Arnau Hospital, Valencia, Spain; 8 Department of Medicine, University of Valencia, Valencia, Spain; 9 CIBERESP-17, Valencia, Spain Copyright ª 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jsxm.2020.01.032 J Sex Med 2020;-:1e11 1