Sexual Side-Effects

The mnemonic "OSCAR" is a guide to sensible prescribing as it highlights the 5 steps towards rational pharmacotherapy. These steps are:

Psychiatric medications (especially antidepressants and antipsychotics) may have side-effects affecting any or all of the 3 phases of the sexual response cycle (desire, arousal and orgasm). The Arizona Sexual Experience Scale (ASEX) is a reliable and valid tool for measuring sexual side-effects.


Switching from one medication to another may be associated with withdrawal and rebound symptoms.

Always discuss the best switch strategy with your physician and avoid stopping your treatment without guidance .

Many adults suffer with Attention Deficit Hyperactivity Disorder, most having experienced disabling symptoms since childhood . A short 6-item questionnaire, developed by the World Health Organization, assists with making the diagnosis of adult ADHD. 4 or more checkmarks in the shaded area indicate that the individual may have ADHD. When checked for reliability and validity, this screening tool correctly identified more than 2/3 of cases. Patients who screen positive undergo further evaluation, including a full history, before a firm diagnosis of ADHD is made. Care is taken to rule out other psychiatric disorders which may coexist with ADHD. Stimulants are usually the fist line of treatment starting with the smallest dose possible.

O  Optimize: Diagnosis, Dose, Duration of trial, Adherence

S  Switch: To another agent if the initial medication fails

C  Combine: Use 2 antidepressants at same time

A  Augment: Add agent to "boost" effect of initially prescribed antidepressant

R  Review all the steps taken so far to ensure prescribing was rational