Post-SSRI Sexual Dysfunction (PSSD): Healthcare Provider Information Guide
What is PSSD?
PSSD is a condition characterized by irreversible sexual problems that arise during or after the administration of antidepressants and which persist indefinitely even after the medication has been discontinued (Reisman, 2020; Csoka & Shipko, 2006). While most people experience some degree of sexual side effects while taking these drugs, such as low sex drive, PSSD refers to cases where adverse symptoms do not resolve after stopping the medication.
PSSD can occur from the use of all selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and some tricyclic antidepressants (TCAs). Symptoms can vary in severity and for many includes complete loss of all sexual function entirely.
PSSD can occur after just a few doses (Bala et al., 2018, Healy, 2019), after long-term use, or upon stopping the medication (Healy, 2022). More research is required to comprehend the spectrum of responses of antidepressants on human sexuality and the duration of such effects. The longest case in the medical literature is 23 years (Chinchilla et al, 2021). There is currently no known cure or treatment (Reisman, 2020).
For many, PSSD is a disabling condition. Contrary to what the name suggests, the condition often encompasses a much broader constellation of symptoms than simply sexual difficulties, such as cognitive deficits, emotional blunting, loss of sensuality as distinct from actual sexuality, and anhedonia which severely impact a person’s daily functioning and quality of life (Healy et al, 2022; Rice et al, 2025; Peleg et al., 2022).
PSSD can be understood in a similar framework to tardive dyskinesia, as both are iatrogenic conditions (meaning they are caused by medical treatment) that produce persistent and often irreversible symptoms long after discontinuation of the triggering psychiatric medication. In the case of PSSD, the offending agents are antidepressants, while tardive dyskinesia is most commonly associated with prolonged use of antipsychotic drugs.
Symptoms of PSSD
Sexual symptoms (Healy et al, 2022; Bala et al, 2018; Waraich et al, 2020)
• Genital numbness or reduced genital sensation (sometimes described as a persistent anesthesia)
• Pleasureless, muted, or absent orgasm (anorgasmia)
• Decreased vaginal lubrication
• Reduced or absence of sexual desire and response to sexual stimuli
• Reduced sensitivity in other sexually sensitive areas (such as nipples)
• Erectile dysfunction
• Premature or delayed ejaculation
• Absence of morning erections
• Erectile tissue inhomogeneity
Genital numbness, also known as persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of PSSD. Patients often describe this as a sensation similar to that experienced after receiving a local anesthetic, but it fails to resolve after discontinuing the medication that triggered its onset.
Non-sexual symptoms (Healy et al, 2022; Rice et al, 2025; Peleg et al., 2022)
• Emotional numbing
• Blunted affect
• Anhedonia (inability to experience pleasure, joy, motivation, or reward)
• Loss of romantic emotion
• Loss of ability to feel empathy
• Cognitive impairment (memory issues, brain fog, learning difficulties, aphantasia)
• Sensory problems (changes in skin, vision, taste, and smell)
Fluctuating Symptoms: Windows, Crashes, and Stability
While many people with PSS experience a stable set of symptoms that do not fluctuate - some people experience symptom fluctuations, commonly called “windows” and “crashes”.
A “Window” refers to a temporary period when symptoms improve or nearly resolve before returning to their usual state. A “Crash” refers to a sudden and often severe worsening of symptoms, sometimes resulting in a permanent or long-lasting decline in baseline functioning. They occur typically after stopping, reducing, or introducing certain medications or supplements - but can also occur without a known trigger.
How Common is PSSD?
Research suggests that a significant number of people may experience persistent sexual dysfunction after stopping SSRIs or SNRIs. A 2024 study found that around 13% of past antidepressant users reported persistent genital numbness, compared to about 1% of people who used other psychiatric medications (Pirani et al).
Another 2023 study has estimated the risk of PSSD to be 1 in 216 patients that took SSRI/SNRI meds (Ben-Sheetrit et al). This is likely a conservative estimate as this latter study only counted men (women were not part of the study) who actively sought treatment for ED, excluding many sufferers who did not seek medical help for their symptoms.
It’s important not to tell patients this is a “rare” condition - due to a lack of research, we still don’t yet know how common PSSD is. Some research suggests the frequency of PSSD could be 13%.
It is challenging to determine how common PSSD is because many patients are hesitant to discuss sexual problems and may not realize their symptoms are related to past antidepressant use. Other obstacles include lack of awareness amongst healthcare providers, difficulty stopping medication due to withdrawal, and limited public awareness of the condition. As a result, underreporting is likely, driven by stigma, lack of recognition, and misdiagnosis (Healy & Mangin, 2024).
Medical Recognition
Health Canada issued a Summary Safety Review of SSRI/SNRI medications, issued a warning about the long-term risks to sexual functioning despite drug discontinuation, and recommended that doctors warn patients about this risk.
The European Medicines Agency acknowledged PSSD and added persistent sexual dysfunction into their side effect labels in 2019.
The UK Royal College of Psychiatrists acknowledges PSSD on their website.
The fifth edition of the DSM-5 states that “in some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued” (APA, 2013).
Who is at Risk?
PSSD can affect anyone-regardless of age, sex, or ethnicity. It is not dose dependent and can occur after a few doses or after years of use (Bala et al., 2018, Healy, 2018). People who previously tolerated these medications without issues can still develop PSSD.
PSSD is not limited to people who were prescribed antidepressants for mental health conditions; it can occur in anyone who takes the medication. It also occurs in people who took antidepressants for other reasons such as insomnia, PMS, chronic pain, IBS, menopause, etc. There are now many patients prescribed SSRIs for these conditions with no history of mental health problems or sexual dysfunction who suffer PSSD.
Those who took antidepressants before or during adolescence may not recognize symptoms due to a lack of baseline sexual experience (Healy et al, 2021), and may be misidentified as asexual.
Misdiagnosis
PSSD is recognized by health authorities and medical literature, but awareness among healthcare professionals and the general public remains low. This is partly because sexual dysfunction can also be a symptom of depression, and patients or providers may not link persistent symptoms to past antidepressant use (Healy & Mangin, 2024).
Unfortunately, due to an absence of awareness amongst doctors, PSSD is commonly misdiagnosed as depression or another mental health condition. This leads to underreporting, making it seem rare. That perceived rarity may reinforce skepticism, causing more dismissal. However, the main symptoms of PSSD (orgasm difficulties and genital numbness), are not explained by depression and establishes PSSD as a unique condition separate from depression or any mood disorder.
Term “side effects” to describe PSSD can be misleading - as it suggests the symptoms are temporary, rather than a treatment emergent adverse effect that can persist indefinitely. Adjusting the language to “treatment emergent adverse effect” more accurately captures the condition and can also help sufferers to feel more validated in their experience.
Which Medications Can Cause PSSD?
• These medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and some tricyclic antidepressants (TCAs).
• Common SSRIs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), luvoxamine (Luvox), vortioxetine (Trintellix) and escitalopram (Lexapro). Common SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).
• Common tricyclic antidepressants include imipramine, nortriptyline, amitriptyline, and clomipramine.
• Mirtazapine has also resulted in PSSD (Rice, 2025).
Awareness
PSSD has received extensive news coverage:
• BBC
And many more.
Patient lived experience videos:
- Emily Grey from PSSD Canada
- PSSD Network Podcast Episode 1 & Episode 2
- Moral Medicine Youtube Channel showcases many patient testimonials
- Dr Josef Witt-Doerring PSSD Interviews showcases many patient testimonials
Patient Experience and Impact
• The impact of PSSD varies, often depending on the symptom profile and severity - but for many, acquiring PSSD is catastrophic.
• Patients often face disbelief and invalidation from healthcare professionals (Rice et al, 2025), which can worsen distress and isolation. PSSD can profoundly affect identity, relationships, and life goals, and can lead to severe emotional distress, grief, and suicidality. Suffering, hopelessness, and alienation are common experiences (Rice et. al, 2025).
• Many also report a lack of understanding and acceptance from healthcare providers, which compounds distress and leads to mistrust in the medical system and increased self-reliance for symptom management (Rice et. al, 2025).
• The loss of sexual, cognitive, emotional, and physical functioning often eliminates the ability to meet basic needs. Cognitive impairments can severely hinder the capacity to work, study, or function in everyday settings, exposing individuals to job loss, academic failure, financial instability. As a result, many are forced to depend on disability support or family members to survive.
• Emotional blunting and anhedonia symptoms further sever patients from their social world, making it difficult to form or maintain relationships. Those in committed partnerships or with children may experience deep guilt and distress over the loss of emotional connection, which can result in estrangement from loved ones. The inability to engage with life in meaningful ways can deprive individuals of a sense of agency, dignity, and self-worth, often leaving them feeling like a burden to others.
• Profound disconnection from personal, social, and occupational spheres can lead to extreme isolation and mental health decline. Many describe an overwhelming sense of loss - of self, of identity, of the life and future they once imagined. Life goals can be majorly affected – eg family planning.
• Because PSSD is unrecognized, sufferers are often doubted or misunderstood by friends, family, and even doctors - and even when they are believed, there’s no roadmap for support like there is for illnesses with established treatment pathways. Well-meaning supporters often have no idea what to say. The lack of recognition leaves people isolated, without guidance or community, compounding their struggle.
• It’s very common for people to experience disenfranchised grief - loss is not socially validated, others don’t recognize this loss as significant or legitimate, making it difficult to receive support.
• Misdiagnosing PSSD as a psychological or psychosomatic issue compounds suffering deeply and can lead to self-blame. Further traumatization can occur due to deepening feelings of isolation and abandonment misdiagnosis can cause.
• “Many individuals with PSSD-related sexual trauma draw parallels to sexual assault, as developing the condition without informed consent is experienced as a violation of bodily autonomy. The power imbalance, absence of consent, and societal minimization closely mirror the dynamics reported by survivors of sexual assault.” – Healthcare Provider
Treatment Gaps and Risks
• Due to lack of awareness and treatment, many people with PSSD - in an act of desperation - have turned to self experimentation with risky self-treatments (Rice at al, 2025) under the guidance of community-based anecdotes, often leading to a severe irreversible worsening of symptoms. This highlights the urgent need for more research and medical support (PSSD Network President, 2025).
• The lack of professionally run peer support groups highlights a major gap in the healthcare system. Most are not institutionally supported or moderated, and while a few offer valuable support, they’re hard to find. Experiences vary, and some groups can be unsupportive or even harmful.
• Reporting rates of PSSD are likely much lower than the true prevalence, as many people have experiences with clinicians that leave them feeling dismissed or not believed (Rice et al, 2025; Healy et al, 2024). This is dynamic also observed in sexual violence reporting, which can discourage individuals from seeking help or sharing their stories.
Reporting PSSD & Diagnostic Codes
Reporting PSSD symptoms to Health Canada helps identify and monitor long-term adverse effects of antidepressants, leading to improved drug safety information and patient care. It also raises awareness, supports research, and ensures that patient experiences are recognized and addressed by the healthcare system. Adverse event reporting is very important, and can be done online in a short amount of time.
PSSD is has official diagnostic codes. When reporting symptoms to Health Canada make sure to quote these codes in your report:
• SNOMED International Classification: 1340196008
• MedRA: 10086208
• Orphanet: 686475
Additionally the FDA reporting system Medwatch receives reports from other countries.
It is also important to report PSSD to the drug manufacturer (eg Eli Lilly, Lundbeck, Pfeizer, etc).
RxISK collects patient reports to capture drug harms clinical trials and national pharmacovigilance failed to identify. Reports to Rxisk have led to scientific literature on PSSD. Fill out an RxISK report here.
Guide for Practitioners - For All Patients
For All Patients - 4 Steps
1. Create open environment
2. Informed consent
3. Baseline sexual functioning assessment
4. Monitor sexual function regularly
(1) Create Open Environment
Create a safe and supportive environment where patients feel comfortable discussing any concerns about their sexual health. Emphasize that sexual health is an integral part of overall well-being.
(2) Informed Consent
WHO guidelines (2023) prohibit irreversible mental health treatments without free and informed consent. Additionally, the UK’s NICE Guidelines direct the following to prescribers:
“Before starting an antidepressant, discuss: (a) Potential side effects and if they are likely to be temporary or permanent and improve or worsen over time; and (b) all other suitable management options, including non-pharmacological approaches, and ensure that they have been offered.”
As such, clearly inform all patients that SSRIs, SNRIs, and TCAs can cause PSSD. If a patient is concerned about the risk of PSSD, consider alternatives that carry a lower risk of fewer long-term complications. The WHO outlines many interventions that promote and support mental health, and that provide effective treatment without the use of psychotropic drugs (WHO, 2025, p. 91). Included are physical health and lifestyle interventions, psychological interventions, social interventions, and economic interventions.
The WHO recommendation of antidepressant use for moderate-to-severe depression is conditional, as the certainty of the supporting evidence is rated as very low (WHO, 2023, p. 58).
(3) Baseline Sexual Functioning Assessment
Prior to initiating treatment - conduct a thorough baseline assessment of the patient's sexual function. Document any pre-existing sexual difficulties. This is crucial for identifying any changes that occur during or after treatment. Inquire specifically about:
• genital sensation
• orgasm function and pleasure
• libido/desire
• arousal
• ejaculatory function
• erectile function
(4) Monitor Sexual Function Regularly
During treatment, regularly monitor for changes in sexual function during and after treatment. Use open-ended questions to encourage patients to report any changes they may be experiencing (see assessment questions in next section).
Guide for Practitioners - Addressing PSSD:
Addressing PSSD - 6 Steps
1. Epistemic humility
2. Consult diagnostic criteria
3. Validate
4. Refer to mental health support
5. Refer to specialists
6. Report adverse event to Health Canada
Epistemic Humility
By embracing epistemic humility, healthcare providers can more clearly acknowledge the limits of current medical knowledge regarding PSSD, remain open to what is still unknown, and value the insights patients share about their own experiences, all of which strengthen the provider-patient relationship.
Consult PSSD Diagnostic Criteria (Healy et al, 2022)
Necessary
(1) Prior treatment with a serotonin reuptake inhibitor
(2) An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops
Additional
(3) Enduring reduction or loss of sexual desire
(4) Enduring erectile dysfunction (males)
(5) Enduring inability to orgasm or decreased sensation of pleasure during orgasm
(6) The problem is present for ≥3 months after stopping treatment.
There should be
(7) No evidence of pre-drug sexual dysfunction that matches the current profile
(8) No current medical conditions that could account for the symptoms
(9) No current medication or substance misuse that could account for the symptoms
Avoid confusing PSSD with low libido from depression. Remember that Sexual Dysfunction is not a symptom of the other conditions that SSRIs are prescribed for (eg IBS, insomnia, OCD, anxiety, PMS, etc).
Recognition and Validation
Recognition
• PSSD is often misdiagnosed or overlooked. Avoid attributing symptoms to psychosomatic or psychological causes rather than iatrogenic (from the medication).
• Acknowledge the Complexity of PSSD - people with PSSD also often experience cognitive, physical, and emotional symptoms that cause suffering, hopelessness, and alienation (Rice, 2025).
Avoid misattribution
• Misattributing PSSD symptoms to psychogenic or psychosomatic origins can compound suffering and lead to self-blame, mistrust towards medical professionals, and alienation.
Validate and acknowledge patient experiences
• Affirm that Post-SSRI Sexual Dysfunction (PSSD) is real and recognized in the medical literature and by regulatory agencies.
• Validate all emotions - including grief and anger - as normal and understandable responses given the circumstances. Emphasize that this is not the patient’s fault.
• Acknowledge that grief is to be expected and that worsening mental health is very common in this situation.
• Recognize the potential for feelings of self-blame and betrayal, especially since many patients were not warned about the risk of PSSD.
Avoid minimization
• Avoid minimizing or dismissing concerns. Many sufferers have already experienced invalidation, which exacerbates distress.
Manage expectations honestly
• There is currently no treatment for PSSD symptoms (Reisman, 2020). Some people improve, but many do not.
• Encourage coping strategies (see list below).
Refer to Mental Health Support
• To help patient go come to terms with this loss, and to receive adjustment support
• Ensure mental health provider has education and accurate information about PSSD before referring
• If mental health support isn’t an option - encourage patients to seek support from those who will be empathetic and validate their experience
Refer to Specialists
• Referrals to specialists for recognition and medical testing
• Referrals also help to raise awareness in the medical community about PSSD and helps patients to feel like their concerns are being taken seriously
• Refer to: sexual medicine, neurology, rheumatology, urology, and endocrinology
• Due to the multifaceted nature of PSSD, multidisciplinary collaboration can better provide comprehensive support tailored to each patient’s unique needs
Report to Health Canada
• Document and Report PSSD cases to the Canada Vigilance Program to improve understanding and management of antidepressants and PSSD.
• Encourage and support patients to fill out a report as well.
How to Approach Conversations with Patients
Informed Consent
Framing discussions about the possible long-term problems of SSRIs/SNRIs & TCAs requires sensitivity and clarity. A focus on shared decision-making can help patients navigate their treatment options while feeling empowered and informed.
Acknowledge the topic's sensitivity:
• “Sexuality is an important part of health and well-being, but sometimes patients don’t feel comfortable bringing up sexual difficulties with their doctor. So it’s important I share information about some potential adverse effects related to sexuality. “
Present information clearly:
• ”SSRIs can be helpful for some people - however, knowing about all possible outcomes and risks helps you decide the best option for you.”
• “While many people do not have lasting problems, some people develop severe and irreversible adverse sexual problems from these medications that do not resolve when they stop the drug, such as genital numbness and loss of orgasm. We do not know how often PSSD occurs - research suggests the frequency of persistent genital numbness could be 13%".
Explain that long-term problems with sexual function could impact life plans, including relationships, family planning, and quality of life:
• “People with PSSD struggle to sustain romantic relationships and have children… if these may be goals it’s important to consider these risks.”
• “People with PSSD experience the loss of their sexuality to be much more difficult than the original symptoms they were seeking antidepressants for… this is an important consideration for you in your decision-making about trying this medication.”
Discuss alternatives that carry less long term risks, such as counselling, lifestyle changes, exercise, meditation, addressing past trauma, building more healthy relationships, finding meaning, alternative medications:
• “There are alternative pathways to support your health if you're concerned about the risks of these medications.”
Encourage patient autonomy - emphasize that the decision is theirs, and you are there to support them:
• “Your preferences and goals matter. I’m here to provide the information you need to make the best decision for yourself. It’s okay to take some time to decide - this is a big decision”.
Invite Questions:
• “Do you have any questions for me at this point?"
Provide patients with further information about PSSD:
• "It may be helpful to take home some information about PSSD, so you can learn more, reflect, and make this decision with all the facts.”
Monitoring Sexual Function
1) Inquire about general sexual function
• “It’s common for antidepressants to affect sexual function, and sometimes these changes can be subtle. I want to make sure we’re addressing any concerns you might have - so if you’re okay with it, I’m going to ask you some routine questions”
• Have you noticed any changes in your sexual function since starting or stopping your medication?"
2. Genital sensitivity
• “Do you feel any numbness or a lack of sensitivity in the genital area during touch or sexual activity?”
• “Does the genital area feel different compared to before starting the medication?"
3. Arousal and response
• “Are you able to feel physical arousal as you did before starting the medication?”
• “Have you noticed any difficulty becoming physically aroused?”
4. Orgasm
• “Have you noticed any changes in your ability to achieve orgasm, such as reduced intensity or lack of sensation?”
• “Does orgasm feel less satisfying or different than before?”
Assessing for Persistent Symptoms
Inquire and learn about patient’s experience:
• “If you've experienced any changes in sensitivity or function, have these persisted after stopping the medication?”
• “How long have you been noticing these changes? Have they improved, stayed the same, or worsened over time?”
• “How is this impacting your life”?
Discussing Adverse Event Reporting
Explain importance of reporting - discuss procedure:
• “Part of my job is to do Adverse Event reporting - this data on PSSD is very important to collect and report to the Canada Vigilance Program so that Health Canada can get a more accurate estimate of people experiencing this.
Encourage patient to complete a report as well:
• “It’s also valuable for you to complete the report too. How can I best support you with that?”
Managing PSSD
Pharmacological interventions:
• There is currently no treatment for PSSD symptoms (Reisman, 2020).
• Experimentations with other psychoactive substances can risk exacerbating symptoms and emergence of new ones (see treatment gaps and risks).
Coping strategies to manage PSSD-related distress (adapted from the PSSD Network):
• Counselling or psychotherapy for emotional support, grief, and adjustment
• Lifestyle changes such as exercise, healthy routines, engaging with hobbies, building social connection
• Referrals to sexual health specialists, neurologists, rheumatologists, urologists, or endocrinologists can allow for recognition, awareness-raising, and medical testing
• Build daily routines and structure to foster resilience and comfort
• Focus on living day-to-day and accepting the current situation while maintaining hope for the future
• Set boundaries with online research to avoid distress and exhaustion
• Join support groups or online communities for validation and shared experience, but be aware that experiences vary and some groups may not be supportive
• Spend time in nature and with animals for relaxation and companionship
• Engaging in advocacy to channel loss into positive action
• Understandably, many people with PSSD look for support and understanding from others. However, these spaces can sometimes reinforce distress or spread misinformation. On platforms like Reddit, it's important to critically assess information.
• On other forums and in certain groups on Discord people have found - there have been reports of of malicious content such as suicide encouragement, risky treatments, or misleading recovery claims from anonymous users. Encourage patients to engage with caution.
Raising Awareness With Colleagues
• It’s important to help raise awareness with fellow healthcare colleagues so that more people considering these medications can have their rights to informed consent honoured.
• The PSSD info sheet on the BC Centre for Disease Control (BCCDC) website may be a helpful resource share.
Related Syndromes
Related conditions include Post-Finasteride Syndrome (PFS) and Post-Accutane Syndrome (PAS). These syndromes also emerge after discontinuation of particular medications. These iatrogenic conditions all share overlapping symptoms of sexual dysfunction, emotional blunting, and cognitive impairments.
Adjusting the Name of PSSD
Some in the PSSD community suggest renaming PSSD to PSSD/PSS (Post SSRI Sexual Dysfunction/Post-SSRI Syndrome) to reflect the broader range of symptoms beyond sexual dysfunction. By focusing solely on sexual symptoms, the term “Post SSRI Sexual Dysfunction” may contribute to other distressing aspects of the condition being neglected. “Post SSRI Syndrome” acknowledges the ancillary symptoms, and mirrors parallel condition names (PAS & PFS).
Hope
• If you have a patient suffering with PSSD, remind them that they are not alone, and that research and awareness is growing.
• There are reports of PSSD patients experiencing some improvement with time.
• The PSSD Network is a patient-run global advocacy and support organization dedicated to raising awareness, advancing research, and providing resources for people affected by PSSD.
• The Canadian PSSD Society (PSSD Canada) is a patient-run initiative dedicated to doing the same.
What Your Patients Can Do to Take Action
• Report their PSSD to regulatory agencies, such as Health Canada Adverse Event Reporting and FDA Reporting Medwatch
• Report their PSSD to the drug manufacturer (eg Eli Lilly, Lundbeck, Pfizer, etc)
• Share their experience to raise awareness, some options include PSSD Network and Dr Josef-Witt-Doerring Youtube Interviews, and PSSD Canada Patient Stories
• Contribute to research fundraising efforts
Clinical Observations and Reports
Clinicians specializing in PSSD report that patients have provided the following key insights regarding their condition:
• Patients very commonly attribute the following symptoms that arose at the outset of their PSSD, and that they attribute as central to their experience condition: Insomnia, Non-restorative sleep (unrefreshing sleep), Diminished subjective psychoactive response to exogenous substances (e.g., alcohol, caffeine, serotonergic recreational agents), Postural Orthostatic Tachycardia Syndrome (POTS), Tinnitus, Myalgia (muscle pain), Akathisia, Tremors, Distal peripheral hypoesthesia (numbness in hands and feet), Global sensory attenuation (general reduction in sensory perception), Aphantasia (loss of ability to visualize mental imagery), Impaired creativity (reduced capacity for creative thought), Impaired imaginative function, Suppression of oneiric activity (loss of dreaming), Anhedonia specific to aesthetic and artistic stimuli (loss of ability to experience creative or emotional connection to music and art), Social and emotional blunting (reduced ability to experience emotional connection to friends and family).
• Patients have acquired PSSD symptoms from other psychiatric drugs and psychoactive substances such as risperidone, vortioxetine, bupropion, neuroleptics, ashwaganda, mirtazapine, and saint johns wart. PSSD Canada has also received reports from individuals who developed the condition after using these drugs and substances. These cases are not yet in the medical literature, however.
• When patients have reported PSSD, doctors have prescribed bupropion or other SSRI’s to many of them, which has in some cases caused new symptoms that have also remained irreversible.
• In efforts to self-treat, many patients experiment with psilocybin. Unfortunately, psilocybin, including microdoses (e.g., 0.1 g), has been reported by individuals with PSSD to precipitate worsening of the condition, including irreversible total anhedonia and total loss of emotions or "crashes," even after a single use. There are numerous accounts of serious adverse reactions.
Tapering Antidepressants
The World Health Organization and the United Nations have called for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so (2023). When deciding to stop antidepressants, a very gradual tapering called hyperbolic tapering is recommended to minimize withdrawal symptoms and allow the brain to adjust to lower medication levels. Recent clinical guidelines and systematic reviews emphasize that reducing the dose in progressively smaller steps, rather than abrupt or linear reductions, significantly decreases the risk and severity of withdrawal effects (Davies & Read, 2019; Horowitz et al., 2023; National Institute for Health and Care Excellence [NICE], 2022). This approach supports a safer and more comfortable discontinuation process for most patients.
Abrupt or rapid discontinuation of SSRIs significantly increases the risk of withdrawal symptoms, which can be severe, long-lasting, and may result in protracted withdrawal syndromes. Clinical literature and guidelines emphasize that slow, gradual tapering is essential to minimize these risks, as inadequate tapering has been associated with withdrawal symptoms that can persist for months or even years (Horowitz & Taylor, 2019; Hengartner et al., 2020; Royal College of Psychiatrists, 2019). However, there is no indication that tapering reduces the risk of PSSD.
Further Resources
• Research articles on PSSD
• PSSD info sheet on BC Centre for Disease Control website
• Iatrogenic Neuroimune Disease Association (INIDA)
Patient Stories:
https://www.pssdcanada.ca/our-stories
https://www.pssdnetwork.org/patient-spotlight
https://www.pssdnetwork.org/picture-awareness-campaign
https://www.pssd-uk.org/our-stories-uk
https://www.pssd-uk.org/our-stories-international
Further Information About Safer Tapering
• Maudsley Deprescribing Guidelines
• UK’s NICE Guidelines - UK’s health service, which updated its guidance for clinicians to acknowledge withdrawal and recommend regular reviews to discontinue unnecessary medications.
• UK Royal College of Psychiatry Withdrawal Information
• Outro Health with Dr Horowitz and Outro YouTube Taper Playlist
• Therapeutics Initiative UBC Webinars with Dr Horowitz
• The Taper Clinic, the worlds largest clinic dedicating to supporting people de-prescribe from psychiatric medications) for support with medication withdrawal. The Taper Clinic De-prescribing program can be found here for free.
About the Author
Yassie Pirani is a Registered Clinical Counsellor and Registered Social Worker specializing in trauma-informed care. Her clinical practice and research focus on Post-SSRI Sexual Dysfunction (PSSD), and she is committed to supporting those affected by this condition. A contributor to research and advocacy on PSSD, Yassie is dedicated to educating both healthcare professionals and the public about this often-misunderstood condition.
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