are sexual side effects one of the most common reasons young people stop antipsychotics?

“sexual side effects are one of the most common reasons that young people stop taking antipsychotics.”

a host, a clinician educator said on Psychopharmacology and Psychiatry Updates, 2026-09-23, at 00:29. hear it in context →

the episode: Antipsychotics, Prolactin, and Sexual Side Effects (at 00:29). we link the show's own page; we do not re-host audio.

first, the part that holds

sexual side effects do push young people off antipsychotics. in a london cohort of 2,309 people with first-episode psychosis (mean age 26.7), people whose records noted sexual dysfunction stopped their first antipsychotic sooner (hazard ratio 1.59). sexual problems are also common and distressing, and they are underreported.

what we found when we went and looked

we found good evidence that sexual side effects are linked to stopping antipsychotics early. we found no source that counts reasons for stopping and puts sexual side effects near the top for young people. in the largest health-record study we read (2,309 people with first-episode psychosis in south london), sexual dysfunction was linked to stopping the first antipsychotic sooner (hr 1.59, 95% ci 1.03–2.46), but it was the least often recorded side effect. where reasons were actually counted, other things came first. in a 200-person online survey of adults with schizophrenia, the side effects most often named as the reason for stopping were "feeling like a zombie" (22%), drowsiness (21%) and weight gain (20%). a 2026 systematic review of first-episode psychosis lists side effects in general, plus a belief that the medication is no longer needed, as top reasons, and does not list sexual dysfunction as its own category. the only youth-specific source we found that names sexual dysfunction as "one of the main causes" is a conference abstract on 14 boys. there, 45% voiced ideas of stopping, which is not the same as stopping.

assertion by assertion

both directions

for the speaker: the strongest support is the london first-episode cohort. there, clinician-recorded sexual dysfunction was linked to stopping the first antipsychotic about 1.6 times sooner. that was the largest effect of any single side effect in the first-treatment analysis, ahead of movement symptoms (1.33). weight gain and sedation were linked to later stopping across all treatment episodes. a small adolescent study found two-thirds of boys developed sexual dysfunction within four months and nearly half considered stopping. in an adult survey, more than half rated sexual dysfunction very or extremely bothersome. underreporting is well documented, so sexual side effects are likely undercounted wherever reasons are tallied.

against: the claim is about how often, and the frequency data point elsewhere. in the london cohort, sexual dysfunction was the least often recorded side effect. a link with stopping sooner shows how hard a side effect hits the people who have it, not how many people stop because of it. when the adult survey asked what made people stop, drowsiness, feeling like a zombie and weight gain led, at 20–22% each. the first-episode reviews name broader reasons first: side effects in general, feeling the medication is no longer needed, and limited benefit. a danish first-episode study also found 'no longer needed because now better' among the most frequent reasons; we read that only in a non-allowed abstract, so we do not cite it. the one youth source that calls sexual dysfunction a main cause is a 14-person conference abstract that measured thoughts of stopping, not stopping.

what this cannot say

none of these sources directly ranks reasons for stopping by frequency among adolescents and young adults, so the ranking cannot be confirmed or ruled out. the health-record study relies on what clinicians chose to write down, and it cannot separate cause from correlation. the survey was of adults (mean age about 42), was funded by a drugmaker, and recruited people online who reported their own diagnosis. the adolescent data is a conference abstract with 14 participants. underreporting cuts both ways: it may hide a real ranking, but it also means no one has measured it. we could not load one youth-focused review of early psychosis, and a danish first-episode study with self-reported reasons was only available to us on a non-allowed host, so neither is cited here.

sources, each one fetched and read

1. Oral and long-acting injectable antipsychotic discontinuation and relationship to side effects in people with first episode psychosis: a longitudinal analysis of electronic health record data. Therapeutic Advances in Psychopharmacology, 2023. doi:10.1177/20451253231211575 What we read there: 2,309 people with first-episode psychosis (mean age 26.7) at south london and maudsley, 2008–2019. for the first prescribed antipsychotic: sexual dysfunction hr 1.59 (95% ci 1.03–2.46) and extrapyramidal symptoms hr 1.33 (1.08–1.64), both linked to earlier stopping. across all episodes, weight gain hr 0.73 and sedation hr 0.89, both linked to later stopping. sexual dysfunction was the least frequently reported adverse effect; only 37% of patients with antipsychotic-related sexual dysfunction report it spontaneously. Fetched 2026-10-20 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC10725124
2. Sexual disfunction in adolescents with antipsychotics. Evaluation and suitability of the treatment. European Psychiatry (conference abstract), 2021 What we read there: 14 males aged 16–19. sexual dysfunction went from 0% at baseline to 67% at 4 months (SALSEX). 45% expressed ideas to abandon treatment; 33% reported the problem spontaneously. the authors write that 'sexual dysfunction is one of the main causes that make young patients abandon treatment and even follow-up.' Fetched 2026-10-20 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC9475860/
3. Antipsychotic treatment experiences of people with schizophrenia: patient perspectives from an online survey. Patient Preference and Adherence, 2020;14:2043–2054 What we read there: 200 adults (mean age 41.9) with self-reported schizophrenia; funded by a drugmaker. 71% reported sexual dysfunction; 33% rated it extremely and 22% very bothersome. the side effects most often cited as having led to stopping were feeling like a 'zombie' (22%), drowsiness (21%) and weight gain (20%). Fetched 2026-10-20 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC7604247/
4. Medication non-adherence in first episode psychosis: a systematic review. Early Intervention in Psychiatry, 2026 What we read there: 76 studies; samples mostly aged 15–40, with mean ages of 22–29. the three most frequent primary reasons for discontinuation included side effects (38.2%) and distress from side effects (32.4%). the review describes sedation and loss of energy, but does not list sexual dysfunction as a separate category. Fetched 2026-10-20 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC13423583/

speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam