Treatment with commonly prescribed antidepressants may cause a small proportion of patients to develop persistent sexual side effects that continue even after stopping the medication.
This condition is known as post-SSRI sexual dysfunction (PSSD).
- The study found 0.46% of patients developed erectile dysfunction that continued after stopping antidepressants. This suggests the risk of PSSD is around 1 in 200 patients.
- PSSD was identified in 4 out of 866 patients treated with antidepressants, giving an estimated prevalence of 4.3 cases per 100,000 males aged 21-49 years.
- Antidepressant use raised the odds of needing erectile dysfunction treatment by over 3 times even after adjusting for potential confounding factors.
- PSSD symptoms lasted from 3.6 to 14.8 months after antidepressant discontinuation in identified cases.
Source: Annals of General Psychiatry (2023)
Link Between SSRIs & Permanent Sexual Dysfunction (Study)
PSSD refers to sexual side effects like decreased desire, arousal issues, and erectile dysfunction that arise during antidepressant treatment but persist even after the medication is stopped.
The condition has been documented since the early 2000s but the actual prevalence remains unclear.
This new retrospective cohort study aimed to estimate the risk and prevalence of PSSD in young males treated with serotonergic antidepressants like SSRIs and SNRIs.
Researchers utilized a large medical database from an Israeli health organization to compare antidepressant users to non-users.
Rigorous exclusion criteria were applied to minimize confounding causes of erectile dysfunction.
Antidepressant-treated patients who subsequently took erectile dysfunction medications like Viagra were identified as having probable PSSD if dysfunction continued after stopping antidepressants.
The study found antidepressant users had over 3 times higher odds of needing erectile dysfunction treatment, even after adjusting for factors like age and BMI.
And 0.46% of antidepressant users appeared to have PSSD that lasted months after stopping treatment.
Overall this research provides one of the first systematic evaluations of PSSD prevalence and risk, suggesting it is a real but uncommon condition affecting around 1 in 200 patients.
Persistent Post-SSRI Sexual Dysfunction (PSSD) Details
PSSD encompasses a range of persistent sexual side effects associated with serotonergic antidepressants like SSRIs and SNRIs.
It was first characterized in online forums and case reports in the early 2000s.
Symptoms vary but frequently include genital anesthesia, decreased arousal and libido, erectile dysfunction, and difficulty orgasming.
For unclear reasons the condition does not always resolve when the medication is stopped.
Animal studies also indicate certain antidepressants can cause irreversible effects on sexual function if given during critical developmental periods.
The biological mechanisms behind PSSD remain poorly understood.
For many years PSSD was not officially recognized as a potential side effect.
But in 2019 the European Medicines Agency stated it can occur with SSRIs and SNRIs.
However current knowledge about prevalence relies largely on anecdotal reports.
Better prevalence estimates are needed to accurately communicate PSSD risks during informed consent conversations.
This study aimed to provide more systematic data on how frequently PSSD occurs.
Researching PSSD from Antidepressants (Methods)
This retrospective cohort study utilized the medical records database of Clalit Health Services, a large Israeli health organization.
Researchers identified males aged 21-49 years old who were prescribed serotonergic antidepressants like SSRIs during the study timeframe.
866 antidepressant users formed the study group.
A control group of 11,436 males who did not use antidepressants was matched based on rigorous exclusion criteria.
Participants with disorders or medications associated with erectile dysfunction were excluded.
The study group and controls were compared based on how many received erectile dysfunction medications like sildenafil.
These prescriptions served as an objective measure of sexual dysfunction.
PSSD cases were identified as those who continued erectile dysfunction treatment for over 3 months after stopping antidepressants, in the absence of depression.
Statistical analyses calculated the prevalence of PSSD and the odds ratio for erectile dysfunction with antidepressants versus controls.
PSSD Risk from SSRIs & Antidepressants (Analysis)
Antidepressant users had 3.6 times higher crude odds of receiving erectile dysfunction medications compared to non-users.
The adjusted odds ratio remained significant at 3.2 after accounting for demographic variables.
Out of 866 antidepressant users, 4 patients met criteria for PSSD based on persistent erectile dysfunction after drug discontinuation.
This equates to 0.46% of those treated.
Applying this rate to the population sampled gives an estimated PSSD prevalence of 4.3 cases per 100,000 males aged 21-49 years.
In PSSD cases, erectile dysfunction lasted from 3.6 to 14.8 months after stopping antidepressants.
The duration of prior treatment ranged from 4-8 months.
These results indicate PSSD is a real but uncommon condition, occurring in approximately 1 out of every 200 young males who take antidepressants.
Informed Consent & Monitoring Antidepressant Users
This study represents an important step in quantifying the prevalence and risk of PSSD associated with widely prescribed antidepressants.
The findings suggest clinicians should specifically discuss the small chance of persistent sexual side effects when obtaining informed consent for antidepressant treatment.
Patients should be educated that PSSD is rare but can occur in around 0.5% of those treated.
And dysfunction may not resolve quickly after stopping medication.
Clinicians should also actively monitor for sexual side effects both during and after discontinuing antidepressants.
Genital anesthesia in particular may be an early warning sign of PSSD.
However, conclusions are limited by the retrospective design and measurement of only erectile dysfunction.
Further prospective research is warranted to validate the prevalence and mechanisms of PSSD.
In the meantime, the small but documented risk reinforces the importance of judicious antidepressant prescribing and vigilant monitoring for sexual side effects.
- Paper: Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants (2023)
- Authors: Joseph Ben-Sheetrit et al.