From the Guidelines
Post-SSRI Sexual Dysfunction (PSSD) should be managed through a combination of approaches, including consulting with a healthcare provider about potentially switching medications, gradually tapering off SSRIs under medical supervision, or trying medications that might counteract sexual side effects. To deal with PSSD, consider the following options:
- Switching medications: Consult with a healthcare provider about potentially switching to a different medication that may have fewer sexual side effects.
- Gradually tapering off SSRIs: Under medical supervision, gradually tapering off SSRIs may help alleviate PSSD symptoms.
- Trying medications that counteract sexual side effects: Medications such as bupropion (Wellbutrin, 150-300mg daily), sildenafil (Viagra, 25-100mg as needed), or tadalafil (Cialis, 5-20mg as needed) may help counteract sexual side effects 1. Some patients find benefit from supplements like maca root (1500-3000mg daily) or ginkgo biloba (120-240mg daily), though evidence for these is limited 1. Psychological support through sex therapy or counseling can help address the emotional impact of PSSD 1. PSSD is believed to result from prolonged serotonergic activity affecting hormonal balance and neuroplasticity, possibly involving serotonin receptor desensitization, endocrine disruption, and autonomic nervous system changes 1. The condition can persist after discontinuation of SSRIs because these medications may cause lasting changes to neural pathways involved in sexual function 1. Recovery time varies significantly between individuals, from months to years, and some cases may be permanent, highlighting the importance of discussing sexual side effects before starting antidepressant treatment 1.
From the Research
Causes of Post-SSRI Sexual Dysfunction (PSSD)
- The exact cause of PSSD is still unknown, but several theories have been proposed, including epigenetic gene expression, dopamine-serotonin interactions, serotonin neurotoxicity, and hormonal changes 2, 3, 4.
- Previous exposure to certain drugs, genetic predisposition, psychological stress, or chemical stressful reaction to antidepressants, along with pre-existing medical conditions affecting neuroplasticity, may be precipitating factors for PSSD 3.
- The use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) has been linked to the development of PSSD, with symptoms persisting after discontinuation of these medications 2, 5, 3, 4, 6.
Symptoms of PSSD
- Common symptoms of PSSD include genital anesthesia, pleasure-less or weak orgasm, decreased sex drive, erectile dysfunction, and premature ejaculation 5, 3, 4.
- Non-sexual symptoms, such as anhedonia, apathy, and blunted affect, have also been reported in patients with PSSD 3.
- Symptoms can vary in severity and may be persistent, making diagnosis and treatment challenging 2, 5, 3, 4.
Treatment Options for PSSD
- Currently, there is no definitive treatment for PSSD, and various strategies have been suggested, including serotonergic antagonists and dopaminergic agonists 5, 4.
- Some studies have reported promising results with the use of vortioxetine, bupropion, and nutraceuticals in improving symptoms of PSSD 5.
- Low-power laser irradiation and phototherapy have also shown some promising results in treating PSSD 4.
- Further research is needed to investigate the efficacy of these treatment options and to develop effective management strategies for PSSD 2, 5, 3, 4, 6.
Diagnosis and Prevalence of PSSD
- The diagnosis of PSSD is achieved by excluding all other etiologies of sexual dysfunction 3, 4.
- The prevalence of PSSD is unknown due to various obstacles, including difficulty in designing a suitable study method, patient embarrassment, and lack of public education 6.
- A definition of PSSD with diagnostic criteria has been published, and a MedDRA code for PSSD has been introduced, but more research is needed to quantify the incidence and prevalence of PSSD 6.