Post-SSRI sexual dysfunction

Antidepressants are one of the most commonly prescribed drugs from the British National Formulary. 

In 2022/2023 antidepressants remained the BNF section that had the largest number of patients and items prescribed.

86 million antidepressants to an estimated 8.6 million people in the UK in 2022/2023. 

One poorly recognised potential adverse effect of antidepressants relates to persistent sexual dysfunction, also known as PSSD. 

This is thankfully thought to be an uncommon occurrence with SSRIs or SNRIs, but can have life-altering consequences in the event that it does occur. 

Research studies vary but estimate that the rates range from 0.7% of SSRI-users up to 5% of SSRI-users. 

Symptoms can include emotional numbing as well as reduced libido, genital numbness, and erectile dysfunction.

For some people these symptoms and signs start following cessation of the antidepressant and for others they experience them whilst taking the antidepressant. 

This article noted that sexual dysfunction can persist indefinitely after stopping an SSRI and may not be reversible. 

Having said that Dr. Rachel knows of individuals who have managed to reverse their symptoms using approaches to support mitochondrial function. 

This article presented case studies of people who had experienced persistent sexual dysfunction for months or years after stopping SSRIs. 

This study talks about the rates of apathy caused by antidepressants. In the study the rates of apathy associated with antidepressants varied from 5.8% of people to 50% of people and for SSRIs in particular, the rates varied from 20% to 92% of people. 

It is now recognised that antidepressants are associated with a withdrawal syndrome if not tapered correctly when attempting to discontinue the medication. 

The Maudsley Institute published deprescribing guidelines for antidepressants in 2024 and hyperbolic tapering appears to be more successful at allowing people to successfully discontinue medication. 

Generally the longer you have been on an antidepressant and the higher the dose, the greater the risk of withdrawal symptoms when attempting to taper. 

This paper showed that the use of tapering strips has allowed greater success in the Netherlands for people to be able to come off the medications. 

Withdrawal symptoms can include symptoms of anxiety and depression that can be mistaken for relapse, rather than withdrawal. Therefore it is always wise to work with a knowledgeable prescriber skilled in tapering when trying to come off these medications. 

Dr. Rachel does not prescribe medications in this practice.