Post-SSRI Sexual Dysfunction
A seldom talked about side effect of SSRIs which changes how people see themselves.
In 2015, I was prescribed antidepressants for the first time. I was 17 years old at the time and wasn’t well-informed on how they work. I had heard some disturbing stories about immeasurable weight gain and drowsiness but I had not paid much attention to them.
In India, there is still a strong stigma attached to the use of. antidepressants to treat any mental disorder. The fear of unforeseen side effects continues to trump any fear of the effects of letting a mental illness go untreated.
Before you read today’s story, I want to make some things clear. I am not against the use of antidepressants. I have been using them for years. The purpose of the story is to inform the readers of a phenomenon that goes unnoticed in mental health care.
I believe an informed practitioner is the best placed to help their clients achieve their best selves.
Sexual Dysfunction & Antidepressants
Antidepressants first became popular in the 1950s. Until then, the treatment for major depressive disorder mostly centered around psychoanalytic psychotherapy.
In such a situation, medicines that offered a biological cure for depression seemed like a game-changer. They quickly gained popularity in the medical community.
Since the 90s, more and more people have been reporting cases of sexual dysfunction either while on antidepressants or after they have been discontinued.
The dysfunction was first known as “genital arousal disorder” but has since been renamed as “Post-SSRI Sexual Dysfunction” (PSSD). Currently, only serotonin-centered antidepressants are believed to cause this dysfunction.
PSSD is marked by a lack of sexual arousal, difficulty in orgasm, or premature ejaculation. Non-sexual symptoms such as anhedonia, apathy, and lack of affect may be present as well.
Unfortunately, there has been reluctance from the psychomedical community to understand the effects of PSSD. This comes from a lack of awareness about the existence of such dysfunction on a large scale.
But for the people experiencing these dysfunctions, it can take quite a toll.
“I have lost the ability to experience romantic feelings. I am a PSSD sufferer.”
“My soul disappeared. I have lost innumerable life opportunities. Most of us suffer in silence”
“My intelligence and ability to love was stolen.”
Awareness of PSSD
While cases of sexual dysfunction post-SSRI intake have been reported since the 90s, it took a long time for professionals to accept that the two may be linked. This is largely due to the shame that is associated with having a sexual dysfunction.
PSSD seems to mostly affect men and we can guess how tough it would be for a man to sit in front of a professional and tell them they’re experiencing sexual dysfunction. The fear of being judged and shamed takes its toll more often than not.
The problem becomes worse when most professionals don’t even know about the existence of such an effect despite being discussed in literature at numerous times.
When talking to their doctors about this issue, patients have reported being avoided, ignored, gaslit, or, at worst, laughed at for being so concerned about their sex life.
“He [the doctor] glibly stated it was all in my head, if I just press on all will be ok.. on saying the latter, he did so with the door opened to usher me out and away faster”
India is not a sex-positive or sex-neutral country as it is. I wonder how many people who have been taking SSRIs experience PSSD but don’t talk out of fear of being judged.
How Prevalent Is It?
It is tough to put an exact estimate on how prevalent PSSD is. The major problem is that sexual dysfunction is a crucial symptom of major depressive disorder as well. If a patient complains of sexual dysfunction during treatment, it cannot be ascertained if it is due to the depression or the SSRIs.
One way to tackle this is to establish a baseline of sexual functionality right from the first meeting but that is not always possible. Some estimates put the occurrence of PSSD at 5% of those who take antidepressants but we cannot know for sure.
Thankfully, with targeted petitions and activist work, PSSD has been gaining acceptance as a side-effect of antidepressants in the US and Europe.
In 2019, the European Medicine Agency made it mandatory to put labels informing patients of possible symptoms of sexual dysfunction on SSRIs and SNRIs.
You can read more individual narratives about the outcomes of PSSD on the PSSD Network. It is an online community for people to share the effects PSSD has had on their lives and how the lack of research in the area has made them invisible to the medical community
Should You Stop Taking Antidepressants?
I am sure some will think this story is against the use of antidepressants. Let me assure you it is not.
Antidepressants help me sleep at night. If it wasn’t for them, I wouldn’t be where I am today.
The point of my story is that MHPs should be open to the experiences of patients even if they are not in the textbooks.
We should be mindful of the cost-benefit ratio before encouraging people to take antidepressants and psychiatrists should be open to their patients about the possible effects of these medicines.
I believe a person should be in charge of their treatment and they should have all the best information available to them before they arrive at a conclusion.
You can read more about the literature around PSSD on this blog by Dr. Awais Aftab, a psychiatrist from the US.
And that is it for this week. PSSD has affected quite a lot of people across the world. Now that I read about it, sometimes I think I have experienced it as well. Have you known of someone in your personal life who was affected by the use of SSRIs? Were they taken seriously by their doctors if they shared it?
I would love to know about their experiences.
Until next time,
Arjun
I wonder how much of the ignorance is truly a lack of awareness. I wouldn't put it past the medical/pharmaceutical industry to purposely sweep these problems under the rug so they can continue to prescribe SSRI's, which must make them a lot of money considering how many people are now on them. Perhaps the ignorance exists because many general practitioners aren't required to perform or read research as part of getting their degree (These are American standards, so I'm not sure if it is different in India).
A lack of affect and notable apathy are common side-effects of SSRI's, so it's really no wonder that they would affect sexual functioning too.
I was only ever on Lexapro for a very short time. In about 3 doses, I felt symptoms of apathy and overall numbness, which definitely inhibited my desire to do the things that normally brought enjoyment like playing/listening to music, college work, etc. I never noticed any sexual issues, but that might have been due to the short time period that I was on the drugs. I stopped very shortly after noticing the apathetic symptoms.
Thank you for bringing this topic up. I'll have to look into the literature you shared to see how prevalent it may be in the U.S.