What is Post SSRI Sexual Dysfunction (PSSD) & Should You Be Worried?

what is poste SSRI

Taking SSRIs (Selective Serotonin Reuptake Inhibitors) for depression or anxiety can sometimes lead to sexual dysfunction. This condition is called Post SSRI Sexual Dysfunction (PSSD). The risk of PSSD is low but still notable—about 1 in 216 people who take SSRIs may end up with PSSD. In general, PSSD affects about 4.3 in every 100,000 people. [1]

So, in this article, we will discuss what PSSD is, symptoms, causes, how you can get diagnosed, what are the available treatment options, and the antidepressants least likely to cause ED. Let’s get started!

Understanding SSRIs and Their Use

SSRIs (Selective Serotonin Reuptake Inhibitors) are common medicines for treating anxiety and depression. The role of these meds is to increase serotonin levels in the brain that are possible to control mood and sleep. Some of the common SSRIs a doctor may advise for you to use include Zoloft (sertraline), Prozac (fluoxetine), and Celexa (citalopram). [2]

In general, SSRIs are effective for treating depression, but sexual side effects are pretty common. About 25% to 73% of people taking SSRIs may experience sexual issues. [3] These effects can start as soon as 30 minutes after taking the medication.

Sexual side effects of SSRIs may include:

  • Erectile dysfunction (ED)
  • Trouble reaching orgasm (anorgasmia)
  • Delayed or weaker orgasm
  • Low libido (low desire for sex)
  • Genital irritation or arousal issues
  • Genital numbness or lack of sensation
  • Rarely, genital anesthesia (numbness or lack of pleasure)

It used to be thought these side effects would go away once you stopped taking the meds, but research now suggests they can stick around even after stopping the medication.

Antidepressants Most Likely to Cause ED

Certain SSRIs can have sexual side effects, including erectile dysfunction (ED). Here’s how some common SSRIs stack up in terms of ED risk:

  • Zoloft
  • Lexapro
  • Paxil
  • Prozac

What is Post SSRI Sexual Dysfunction (PSSD)?

PSSD stands for Post SSRI Sexual Dysfunction. It’s a condition some people experience after stopping antidepressant medication like SSRIs. [4] Even though SSRIs can cause sexual side effects during treatment, PSSD is when those issues linger after stopping the meds. In June 2019, the European Medicines Agency officially recognized PSSD as a potential long-term sexual issue after stopping SSRIs. [5]

The exact number of people with PSSD isn’t known because there’s not a lot of research on it yet. Diagnosis can be tough, which adds to the lack of data. Some experts say that around 10% of people of sexually active age in developed countries use antidepressants long-term. This means nearly 20% of the population might struggle with sexual dysfunction. [6]

Different kinds of sexual issues can come up with PSSD. These might include:

  1. Erectile Dysfunction: This is when it’s hard to get or keep an erection. [7]
  2. Decreased Libido: This is a lower sex drive than usual.
  3. Anorgasmia: This is when it’s tough to reach orgasm.

Signs and Symptoms of PSSD

PSSD can cause a variety of sexual issues. [8] Common symptoms include:

  • Genital anesthesia or lack of sensation
  • Weak or pleasure-less orgasms (anhedonic orgasm)
  • Lower sex drive
  • Premature ejaculation
  • Erectile dysfunction (ED)
  • Reduced nipple sensitivity
  • Decreased vaginal lubrication

Possible Causes of PSSD

Post-SSRI Sexual Dysfunction (PSSD) can happen after taking certain medications like SSRIs. Experts do not fully know why this happens, but it probably results from alterations in the brain and body chemistry. Medications may interfere with the balance of functioning between the two neurotransmitters and receptors affecting sexual function.

Here’s a look at what the experts think might be in play:

  • Neurotransmitter Interference
  • Gene Expression Changes
  • Dopamine-Serotonin Interactions
  • Hormonal Changes
  • Serotonin System Disruption
  • Chronic Serotonin Elevation

Who is Most Affected by PSSD?

PSSD may affect any person because sexual dysfunction can affect people from all walks of life. It is not related to factors such as sex, age, or ethnicity that could have an impact on the quality of life, self-esteem, or relationships, for example.

People who have some tendencies towards depression and anxiety are the ones at higher risk. 30 to 50% of people who have some pre-existing sexual dysfunction can get worsened by antidepressants; moreover, pain, sensitivity, or a trauma problem can cause this risk.

Psychological and Emotional Impact of PSSD

PSSD has impacts both mentally and emotionally. It can cause frustration and embarrassment, and may take away the self-esteem of a person. Relationships are also greatly affected if sexual issues are not addressed. Each time you spot those challenges, your mood may drop, or you may even experience some fears, and it will then become harder for you to keep up with optimistic thoughts about yourself and the future.

Should You Be Worried About PSSD?

Yes, PSSD is something one should have in mind. PSSD is not a common condition but can occur; the sex-related problems caused by SSRIs can aggravate if they have been bothering you previously. Keep an eye on any sexual changes when starting or stopping SSRIs.

If you experience any of these, be sure to contact your doctor. He or she can help you weigh the good with the bad in your medication and give you alternative therapies if necessary. Do not get alarmed but do stay informed and take an active role in your health.

Antidepressants Least Likely to Cause ED

Some antidepressants can treat depression while avoiding erectile dysfunction. [9] Here’s a look at a few options:

  • NDRIs (Norepinephrine and Dopamine Reuptake Inhibitors): Wellbutrin (bupropion) raises dopamine and norepinephrine levels and is less likely to cause sexual issues compared to other antidepressants. [10] It may even improve sexual function and can be used alongside SSRIs to counteract their side effects.
  • Viibryd (vilazodone): This SSRI also acts as a serotonin receptor agonist. [11] It targets depression, more specifically, resulting in fewer sexual side effects.
  • Remeron (mirtazapine): Remeron, which works like a tetracyclic antidepressant, has a lower chance of causing sexual dysfunction. [12]

Diagnosis and Treatment

Diagnosing PSSD involves ruling out other causes of sexual issues. Clinicians need to recognize signs like genital numbness that set PSSD apart from other sexual problems. [13]

Treating it is challenging, and there’s no guaranteed solution yet. Doctors may try medications like serotonergic antagonists or dopaminergic agonists. Low-power laser therapy and phototherapy show potential, but they’re not guaranteed fixes.

The duration of PSSD varies. [14] Some studies found SSRI-related sexual dysfunction lasted up to 6 months after stopping the drug. Other case studies showed that PSSD could last for years without any improvement. [15]

For those experiencing premature ejaculation, Dapoxetine (Priligy) is a selective serotonin reuptake inhibitor designed to treat that specific issue.

Summing Up!

SSRIs treat depression and other mental health issues but often cause sexual side effects like erectile dysfunction and low libido. Sometimes, these effects are even persistent after the discontinuation of medicines, which is called PSSD. Talk with your doctor about which antidepressant may be the best one for you with the fewest sexual side effects.

If you notice sexual side effects, talk to your doctor about regulating your dose or trying different meds.

References

  1. Ben-Sheetrit, Joseph, et al. Estimating the Risk of Irreversible Post-SSRI Sexual Dysfunction (PSSD) due to Serotonergic Antidepressants. Vol. 22, no. 1, 21 Apr. 2023, https://doi.org/10.1186/s12991-023-00447-0.  Accessed 22 May 2023.
  2. Dorwart. Laura . “Is Erectile Dysfunction Caused by Antidepressants Permanent?” Verywell Health, www.verywellhealth.com/post-ssri-erectile-dysfunction-5218272.
  3. Atmaca, Murad. “Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives.” Neuropsychiatric Disease and Treatment, vol. Volume 16, Apr. 2020, pp. 1043–1050, https://doi.org/10.2147/ndt.s185757.
  4. Bala, Areeg, et al. “Post-SSRI Sexual Dysfunction: A Literature Review.” Sexual Medicine Reviews, vol. 6, no. 1, Jan. 2018, pp. 29–34, https://doi.org/10.1016/j.sxmr.2017.07.002.
  5. Peleg, Liran C., et al. “Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors.” Sexual Medicine Reviews, Oct. 2021, https://doi.org/10.1016/j.sxmr.2021.07.001.  Accessed 22 Nov. 2021.
  6. Healy, David. “Antidepressants and Sexual Dysfunction: A History.” Journal of the Royal Society of Medicine, vol. 113, no. 4, 23 Jan. 2020, pp. 133–135, https://doi.org/10.1177/0141076819899299.
  7. Ben-Sheetrit, Joseph, et al. Estimating the Risk of Irreversible Post-SSRI Sexual Dysfunction (PSSD) due to Serotonergic Antidepressants. Vol. 22, no. 1, 21 Apr. 2023, https://doi.org/10.1186/s12991-023-00447-0.
  8. Bala, Areeg . Post-SSRI Sexual Dysfunction: A Literature Review. www.sciencedirect.com/science/article/pii/S2050052117300720.
  9. Smucny, John, and Michael S. Park. “Which Antidepressant Is Best to Avoid Sexual Dysfunction?” American Family Physician, vol. 69, no. 10, 15 May 2004, pp. 2419–2420, www.aafp.org/pubs/afp/issues/2004/0515/p2419.html.
  10. “Norepinephrine-Dopamine Reuptake Inhibitors.” Hypersomnia Foundation, www.hypersomniafoundation.org/glossary/norepinephrine-dopamine-reuptake-inhibitors/.
  11. “Viibryd.com.” Www.viibryd.com, www.viibryd.com/.  Accessed 14 Apr. 2024.
  12. AlBreiki, Mohammed, et al. “Prevalence of Antidepressant-Induced Sexual Dysfunction among Psychiatric Outpatients Attending a Tertiary Care Hospital.” Neurosciences, vol. 25, no. 1, 1 Jan. 2020, pp. 55–60, https://doi.org/10.17712/nsj.2020.1.20190058.
  13. Healy, David. “Post-SSRI Sexual Dysfunction & Other Enduring Sexual Dysfunctions.” Epidemiology and Psychiatric Sciences, vol. 29, 23 Sept. 2019, https://doi.org/10.1017/s2045796019000519.
  14. Safarinejad, M R, and S Y Hosseini. “Safety and Efficacy of Citalopram in the Treatment of Premature Ejaculation: A Double-Blind Placebo-Controlled, Fixed Dose, Randomized Study.” International Journal of Impotence Research, vol. 18, no. 2, 18 Aug. 2005, pp. 164–169, https://doi.org/10.1038/sj.ijir.3901384.  Accessed 17 Dec. 2020.
  15. Ben-Sheetrit, Joseph, et al. Estimating the Risk of Irreversible Post-SSRI Sexual Dysfunction (PSSD) due to Serotonergic Antidepressants. Vol. 22, no. 1, 21 Apr. 2023, https://doi.org/10.1186/s12991-023-00447-0.

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