Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence

Summary & key facts

Post-SSRI sexual dysfunction (PSSD) is a condition where sexual problems start with SSRIs or related antidepressants and keep going after the medicine is stopped. Common symptoms are genital numbness, weak or pleasureless orgasms, low libido, and erectile problems. Researchers say we do not know how common PSSD is because studies are few, methods vary, and there are many barriers to measuring it reliably.

Key facts:

• PSSD stands for post-SSRI sexual dysfunction and means sexual side effects that continue after stopping serotonin reuptake inhibiting antidepressants (SSRIs, some SNRIs and some tricyclics).
• Typical symptoms reported for PSSD include genital numbness, pleasureless or weak orgasm, loss of libido, and erectile dysfunction.
• PSSD has been reported across all ages, both sexes, and all ethnic groups in the literature.
• Diagnostic criteria for PSSD were published in 2022, and a MedDRA code for PSSD exists but has not been widely adopted by regulators.
• Regulatory recognition has grown over time: fluoxetine product information was changed in 2011, DSM-5 mentioned persistent sexual effects in 2013, EMA and Health Canada recommended label changes in 2019, and Australia’s TGA issued a 2024 sa
• Some studies report lasting effects: one study found 55% of patients switched from an SSRI to amineptine still had sexual dysfunction after 6 months.
• A placebo-controlled study of sertraline reported that 34% of participants kept the drug’s ejaculation-delaying effect 6 months after stopping.
• A small healthy-volunteer study of paroxetine found that 9% reported more than mild erectile or ejaculatory dysfunction four weeks after stopping.
• A 2019 survey of 76 former antidepressant users found 52.6% (40/76) had persisting sexual dysfunction and 26.3% (20/76) had genital anesthesia and/or nipple insensitivity, but the study had possible selection bias and other limits.
• A 19-year retrospective study using records of prescriptions for erectile dysfunction drugs after serotonergic antidepressants estimated a 0.46% risk of irreversible sexual dysfunction, but it excluded women, focused only on erectile proble

Abstract

While sexual dysfunction is a well-known side effect of taking selective serotonin reuptake inhibitors (SSRIs), in an undetermined number of patients, sexual function does not return to pre-drug baseline after stopping SSRIs. The condition is known as post-SSRI sexual dysfunction (PSSD) and is characterised most commonly by genital numbness, pleasureless or weak orgasm, loss of libido and erectile dysfunction. This article provides a commentary on the incidence and prevalence of PSSD based on a combination of academic literature as well as clinical and research experience. A number of obstacles to quantifying the occurrence of PSSD are outlined including difficulty in designing a suitable study method. Other contextual obstacles include patient embarrassment at raising sexual concerns, the response of healthcare professionals, inability to stop an antidepressant due to withdrawal issues in a proportion of patients and patient unawareness that their sexual difficulties are linked to prior medication compounded by variability of online information and a lack of information aimed at public education. A definition of PSSD with diagnostic criteria has been published. A MedDRA code for PSSD has also been introduced, but this is yet to be adopted by regulators.

Topics

Hormonal and reproductive studies Menopause: Health Impacts and Treatments Sexual function and dysfunction studies

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Clinical psychology Embarrassment Erectile dysfunction Internal medicine Libido Medicine Orgasm Psychiatry Psychology Psychotherapist Sexual dysfunction Sexual function