If it feels like talk of antidepressants has been increasingly dominating conversations over the last few years, it’s probably because it has — thanks, mostly, to the fact that a record number of people are now taking them. In the U.K, prescription of selective serotonin reuptake inhibitors (SSRIs) has skyrocketed, with more than six million people in England receiving antidepressants in just three months in 2020 — the highest figure on record. This trend is echoed around the world, with researchers confirming a direct link between the coronavirus pandemic and the consumption of SSRIs.
Naturally, then, as people learn to feel more comfortable discussing their mental health struggles and experiences with medication, they’re also becoming progressively confident talking about one particular side effect of SSRIs: sexual dysfunction. Around 70 percent of people taking SSRIs report adverse sexual side effects, including delayed ejaculation, absent or delayed orgasm, low libido and vaginal dryness. It’s believed to happen specifically with both SSRIs and SNRIs (selective norepinephrine reuptake inhibitors) because by increasing serotonin levels, other hormones and neurotransmitters like testosterone and dopamine could be affected. While a change in testosterone may impact sexual arousal, dopamine plays a role in achieving an orgasm.
In fact, SSRI-induced sexual dysfunction is so common that it’s generally considered to be the begrudging trade-off for improved mental health — and when you potentially feel well enough to stop taking your antidepressants, most people see their sex life gradually return to normal.
However, for the unlucky few, even when they come off SSRIs, the negative sexual side effects continue. This is known as Post-SSRI Sexual Dysfunction, or PSSD. The condition — which can affect all genders — can either see already-present sexual side effects remain, or it can even induce sexual dysfunction after the person stops taking SSRIs. A 2018 literature review called it a “debilitating,” “underreported” and “distressing” condition that can cause genital numbness, pleasureless or weak orgasms, decreased sex drive, erectile dysfunction and premature ejaculation.
PSSD is a relatively newly reported condition, first investigated by medical researchers in 2006, but only formally recognized by the European Medicines Agency (EMA) in June 2019 — this might explain why a Reddit group dedicated to it has just 4,700 members. Still, despite the lack of research into it, anyone can suffer from PSSD, whether they’ve been on antidepressants for years, months or days, and it can persist indefinitely. Worse, as there’s no known cure or treatment, sufferers just have to hope that their symptoms will eventually improve.
One of these sufferers is 39-year-old Frank (not his real name) from Florida, whose PSSD symptoms did improve — not once, but three times. Frank first started taking SSRIs in 2009 and was on them until 2017, when he switched to antipsychotics. It wasn’t until 2019, however, when he began using Prozac that he started feeling the symptoms of PSSD. After dealing with the condition for six months, Frank says it “healed 100 percent.” But soon, he had two more bouts of it, this time from taking other medications that alter serotonin levels (aripiprazole and hydroxyzine). He tells me that his main symptoms were “mute orgasm, no sensation, cold genitals, erectile dysfunction, pain down there and weak ejaculation.”
“My opinion is that some medications are spiked to cause this PSSD,” he theorizes. “I have taken Abilify before with no PSSD issues, and I’ve taken hydroxyzine for many years with no problems sexually. Yet I took one dose [of the latter] recently and got PSSD symptoms, followed by a deep depression and [a tendency to become] more easily angered — the PSSD definitely triggered all that much harder.” Frank says antidepressants also made him “lack emotions” and fail to “connect with people close to me,” adding that he felt “disconnected and couldn’t cry… like the world was a fake movie or something.” This is another common symptom of SSRIs.
Still, Frank has been fortunate that his PSSD symptoms have always seemed to gradually improve. Others in the r/PSSD subreddit haven’t been so lucky. One person shared their tormenting experience of the condition, which they acquired after taking Prozac and sertraline “at different times for just over a year.” They wrote, “I remember thinking having a girlfriend/sex would be the best thing ever. I remember the feeling of falling in love. The best, most magical feeling ever. Now I’m barely attracted to the opposite sex, let alone have a hint of a sex drive. Having all this snatched away from you whilst you’re so young is agonizing. I would never wish this upon anyone.”
Some even describe the lack of pre-warning by doctors as “a crime.” Another person said that when they mentioned PSSD to their doctor, they were told, “There’s no such thing as PSSD. Get your head out of your phone; don’t search for symptoms and don’t self-diagnose yourself. You’re fine.” In response, the person wrote: “The amount of denial and [lack of] empathy shown is crazy. I’m already going through enough mental trauma and this just adds to it.”
In light of the EMA’s 2019 ruling — followed by Health Canada’s January 2021 decision to “inform patients abut the potential risk of long-lasting sexual dysfunction despite discontinuation of SSRIs or SNRIs” — those suffering from PSSD can remain hopeful that the tide is turning on recognition of the condition. This is, in part, thanks to the work of drug safety website RxISK, which launched a petition in 2018 to put pressure on global medical agencies to warn patients about the possible long-term sexual side effects of SSRIs. The Food and Drug Administration (FDA), however, has yet to respond.
Despite RxISK’s work to get PSSD recognized, Mark Silvert, one of the psychiatrists at London’s Blue Tree Clinic, says doctors still know “very little” about it. “We don’t know why it affects some people and not others,” he explains. “And there’s no data on [its commonality] yet.” He adds that while a few doctors will inform patients about the risk of PSSD before prescribing them SSRIs, he admits that “most will not, as it’s relatively new.” When I ask if there’s any treatments recommended for someone suffering with PSSD, Silvert responds, “There’s no recognized effective treatments, but patients should remain optimistic that, with time, things will resolve, so supportive therapy may be useful.”
So, until the condition is better validated by doctors and patients are properly informed ahead of being prescribed SSRIs — like they are with short-term sexual side effects — sufferers mostly just have one another to rely on. “Talk to your family and your friends about this insane story of ours,” one person recently pleaded, “not only to spread awareness and limit the damage these drugs can do, but also to break down the wall of silence and embarrassment that inevitably arises from PSSD.”