Fact Sheet: Post-SSRI/SNRI Sexual Dysfunction (PSSD)
This page contains all the essential information about PSSD. This information can be printed out and presented to your doctor to provide them with what they need to know.
Sexual Dysfunction, including lowered libido and erection and orgasm issues, are common side-effects of many types of antidepressants (Higgins et al, 2010) Most people report that these side effects go away either immediately or gradually after they stop taking the medication. However, some people report persistent or worsened sexual dysfunction after stopping their antidepressant (Reisman, 2020.)
Though similar symptoms have been reported for a variety of antidepressants and other psychiatric medications, most of the reports are from people who have taken Selective Serotonin Reuptake Inhibitors (SSRIs) (Bala et al, 2018) or Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). When these symptoms persist for more than a few months after taking the last dose of the medication, it is called Post-SSRI Sexual Dysfunction or Post-SSRI/SNRI Sexual Dysfunction (PSSD).
What you should know:
•Though it is estimated to be rare, it remains unknown what percentage of people who take antidepressants will develop PSSD (Bahrick, 2008)
•PSSD can begin during or soon after stopping antidepressant treatment and may persist for months, years, or indefinitely after stopping the medication (Waraich et al, 2020)
•There is currently no reliable treatment or cure for PSSD (Reisman, 2020)
•Symptoms of PSSD may include:
-Reduced genital sensation / genital anesthesia
-Erectile dysfunction / decreased vaginal lubrication
-Delayed or inability to orgasm (anorgasmia)
-Pleasureless, weak, or “muted” orgasms
-Decreased or absent libido
-Reduced response to sexual stimuli
-Decreased or lack of nocturnal erections
-Premature or delayed ejaculation
-Reduced nipple sensitivity
-Soft glans
-Loss of penile/clitoral size
-Irregular menstruation (Bala et al, 2018)
•Other symptoms sometimes reported alongside PSSD include:
-Reduced intensity of emotions (particularly romantic love)
-Anhedonia (inability to feel any form of pleasure in life)
-Compromised memory
-Poor sleep quality
-Depersonalization
-Loss of drive/motivation/hope
-Loss of creativity
-Loss of focus
All of the above symptoms have been shown to accompany antidepressant use (Opbroek et al, 2002) and have been anecdotally reported to persist post-treatment.
•PSSD can be highly emotionally distressing. It can cause strain on personal relationships, diminish quality of life, and contribute to thoughts of suicide (Healy, 2018)
•In January 2021, Health Canada released a Summary Safety Review of SSRI and SNRI medications. In it, they stated they were unable to officially confirm or rule out a causal link between SSRI and SNRI medication and reports of ongoing sexual dysfunction because there had not been sufficient research designed to assess this. However, they recommended that Canadian doctors warn patients of the potential long-lasting sexual dysfunction after cessation of treatment with these classes of antidepressants. They also stated that sexual dysfunction associated with antidepressant use was likely underreported due to lack of information and stigma. (Health Canada, 2021)
•PSSD remains understudied and underreported. Public awareness and research is greatly needed. (Reisman, 2017)
•When presented with PSSD symptoms, it is common for doctors to conclude that they are the result of depression or other forms of mental illness. (Healy et al, 2019) If you believe you are suffering from PSSD, it may be helpful to bring medical literature on PSSD to show your doctor. Various sources can be found here: https://www.pssd.info/resources
•For more information or to connect with the PSSD community in Canada, please visit www.pssdcanada.ca
References
Bala A, Nguyen HMT, Hellstrom WJG. (2018) Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev 6:29–34. Retrieved from: https://www.sciencedirect.com/science/article/pii/S2050052117300720?via%3Dihub
Bahrick, Audrey; Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence; (June 2008) The Open Psychology Journal 1(1):42-50 DOI:10.2174/1874350100801010042 Retrieved from: https://www.researchgate.net/publication/228667893_Persistence_of_Sexual_Dysfunction_Side_Effects_after_Discontinuation_of_Antidepressant_Medications_Emerging_Evidence
Health Canada; Summary Safety Review - Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-norepinephrine Reuptake Inhibitors (SNRIs) - Assessing the Potential Risk of Sexual Dysfunction despite Treatment Discontinuation (2021) https://hpr-rps.hres.ca/reg-content/summary-safety-review-detail.php?lang=en&linkID=SSR00254
Healy D, Le Noury J, Mangin D. (2019) Post-SSRI sexual dysfunction: Patient experiences of engagement with healthcare professionals. Int J Risk Saf Med. ;30(3):167-178. doi: 10.3233/JRS-191005. PMID: 31450514. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31450514/
Healy, D. Citizen petition: Sexual side effects of SSRIs and SNRIs (2018) International Journal of Risk and Safety in Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004927/
Higgins, Agnes; Nash, Michael, Lynch, Aileen M; Antidepressant-associated sexual dysfunction: impact, effects, and treatment (2010) Drug Health Patient Saf. 2: 141–150. Published online 2010 Sep 9. doi: 10.2147/DHPS.S7634 Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/
Opbroek, Adam; Pedro L Delgado, Cindi Laukes, Cindy McGahuey, Joanna Katsanis, Francisco A Moreno, Rachel Manber; Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs inhibit emotional responses? (2002) International Journal of Neuropsychopharmacology; Retrieved from: https://pubmed.ncbi.nlm.nih.gov/12135539/
Reisman Yacov; Post-SSRI sexual dysfunction, BMJ (2020) 368 :m754 doi:10.1136/bmj.m754 Retrieved from: https://www.bmj.com/content/368/bmj.m754.full
Reisman, Yacov; Sexual Consequences of Post-SSRI Syndrome; Sexual Medicine Reviews (2017) Volume 5, Issue 4; Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S205005211730046X
Waraich, Ahad *; Clemons, Channing; Ramirez, Roma; Yih, Jessica; Goldstein, Sue; Goldstein, Irwin; Post-SSRI Sexual Dysfunction (PSSD): Ten Year Retrospective Chart Review; Journal of Urology (2020) doi.org/10.1097/JU.0000000000000964.015; Retrieved from https://www.auajournals.org/doi/abs/10.1097/JU.0000000000000964.015