What is post-SSRI Sexual Dysfunction (PSSD) and what do I need to know about it?

What is post-SSRI Sexual Dysfunction (PSSD) and what do I need to know about it?

As I try for the hundredth time to knock one out and inevitably fail miserably, I’m forced to remember that when taking selective serotonin reuptake inhibitors (SSRIs), coming can feel like an Olympic sport. Feeling sticky and ashamed (and somewhat frustrated), I’m left with no other option than to pack away my toys and lubes, roll over and try to get some kip.

According to NHS(Opens in a new tab) data, there are now nearly half a million more adults taking antidepressants than in 2021. So, know you're not alone. For many people prescribed antidepressants, they are a necessary and vital lifeline. They can be life-altering in the best way, but they can also produce side effects that are disheartening. 

Sexual dysfunction and SSRIs can go hand in hand for folks like me. In fact, it's reported that nearly 100(Opens in a new tab) percent of people who take them experience some form of sexual side effects. When I stopped taking them, my enthusiasm and wanking vigour returned quickly, but for others, it can be a vastly different story. One shrouded in unshakeable shame.

What is post-SSRI sexual dysfunction, or PSSD?

Post-SSRI sexual dysfunction, or PSSD, is something felt by people when they come off of antidepressants, (the exact number of those impacted is not known because so little research is done about it, partially due to "inconsistencies" from the medical community about how to diagnose it(Opens in a new tab), but the research that does exist tells us it's prevalent).

While some people experience sexual side effects during taking SSRIs, PSSD is a condition which refers to a long-term condition impacting people who have stopped taking the medication.

Experts like professor of psychology David Healy of Bangor University, and author of the journal Antidepressants and Sexual Dysfunction: A History,(Opens in a new tab) discuss the prevalence of the condition(Opens in a new tab), stating that: "10 percent of people of sexually active years in developed countries are on antidepressants chronically. Nearly 20 percent of the population, therefore, may not be able to make love the way they want." He goes on to explain that in some deprived areas, the figure may be much higher. He also identifies that those who seek to comfort themselves with the thought of post-treatment normality, those prescribed SSRIs might be sorely disappointed, saying that; "...they may be even less able to function."

Per(Opens in a new tab) Healy's paper: "The core features of the condition are genital numbing, loss or muting of orgasm and loss of libido. But many are just as concerned by additional features like emotional numbing or derealisation." PSSD was first reported in medical literature in 2006, despite people with the syndrome reporting(Opens in a new tab) symptoms to regulators since 1999.

In almost all cases, people who suffer from PSSD have experienced some form of sexual dysfunction while taking antidepressant medication in addition to after they stop. "It's very important that people understand what it is, recognise it as soon as possible and understand the complexity of it," Alessio Rizzo, certified psychotherapist, tells Mashable. "SSRI sexual dysfunction is one of the leading reasons people stop taking antidepressant medication which can lead to worsening symptoms alongside withdrawal."

Who is most affected by PSSD?

The truth is, anyone can be affected by PSSD because anyone can be affected by sexual dysfunction.

"We know that it seems to affect every sex, and every age, every ethnicity, so it doesn't seem to be linked to any of the usual parameters that we consider," Rizzo says.

Rizzo explains that people who are more at risk of depression and anxiety, like those in the LGBTQ community, are not destined for mental illness, but may find themselves more likely to develop illnesses like depression and anxiety(Opens in a new tab). "We must be careful not to pathologise dysfunction as an LGBTQ and sexual abuse survivor only problem," he adds, "because it can stop people who do not identify with these two experiences from seeking help."

Around 30-50 percent of people experience mild forms of sexual dysfunction(Opens in a new tab) before taking antidepressants, which means that they could find pre-existing symptoms exacerbated by medication. It could also mean that something else is causing the dysregulation of the sexual response cycle (the connection between desire and arousal, excitement, orgasm and resolution), like pain, sensitivity and past trauma. Collectively, these are known as predispositions. 

This is why approaching a healing process in a holistic nature is important. While medications can help with mood stabilisation, talk therapies like CBT (cognitive behavioural therapy) can help to support healing by modifying thought pathways(Opens in a new tab) (this is called neuroplasticity, and it describes altering chemically embedded behaviours in our brain). Therefore, people with pre-existing symptoms, or who are predisposed to sexual dysfunction, can get to the bottom of what’s disrupting their pleasure response cycle and confront it in a safe environment.

For many people, talking about sex is closely followed by feelings of shame. We also need to remember that there is a cultural stigma surrounding mental health and sex, making it even harder for some to talk about or admit to having a problem. A study conducted by the National Library of Medicine found that young people are especially likely to experience shame(Opens in a new tab) when discussing any form of sexual experience — let alone one that involves problems. 

As such, sexual dysfunction of any kind can be a tremendously isolating experience, leaving people grasping at straws and feeling a lot of internal turmoil. All this is made worse by the cycle of depression and anxiety slowly eating away at any form of self-esteem. 

SSRIs increase serotonin levels in the brain, which has a knock-on effect on the anatomical structures of our reproductive system(Opens in a new tab). Effects of this include being unable to maintain or produce an erection to vaginal dryness, ejaculation, and anorgasmia (absence of orgasm). This is, impart, because SSRIs inhibit nitric oxide production(Opens in a new tab), which greatly affects the way the body relaxes, and actively prevents blood from reaching the genitals.

PSSD is a serious condition and it causes distress. There is currently no treatment for PSSD. The syndrome is not widely understood or agreed upon by researchers as to how it comes about. It is suggested that only future research(Opens in a new tab) holds the answer and that it could lie in those who do not develop PSSD, but only time will tell if this is the case.

UPDATE: Dec. 2, 2022, 9:48 a.m. CET This post has been updated.

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