From the Guidelines
Sexual side effects from SSRIs typically resolve within a few weeks to several months after discontinuing the medication, though the timeline varies significantly between individuals. Most people notice improvement within 1-3 weeks after stopping medications like fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), or paroxetine (Paxil) 1. However, some individuals may experience persistent sexual dysfunction lasting 6 months or longer, a condition sometimes called Post-SSRI Sexual Dysfunction (PSSD). The resolution time depends on several factors including the specific medication, duration of treatment, dosage, and individual physiology. It's essential to note that a discontinuation syndrome characterized by various symptoms, including dizziness, fatigue, and anxiety, has been reported following missed doses or acute discontinuation of shorter-acting SSRIs, notably paroxetine but also (to a lesser extent) fluvoxamine and sertraline 1. Therefore, it's crucial to discontinue SSRIs only under medical supervision to avoid withdrawal symptoms, and to taper off gradually rather than stopping abruptly. If sexual side effects persist beyond 3 months after discontinuation, consult your healthcare provider, as this may indicate PSSD or another underlying condition requiring evaluation. These side effects occur because SSRIs increase serotonin levels, which can inhibit dopamine and norepinephrine pathways involved in sexual function and arousal. Some key points to consider when discontinuing SSRIs include:
- Starting with a subtherapeutic dose as a “test” dose to assess initial adverse effects, such as anxiety or agitation 1
- Systematic assessment of treatment response using standardized symptom rating scales to monitor progress and adjust treatment as needed 1
- Parental oversight of medication regimens is of paramount importance in children and adolescents 1.
From the Research
Sexual Side Effects of SSRIs
- Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are common in patients taking selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4, 5, 6.
- These side effects may persist after discontinuation of the medication and can last indefinitely in some individuals 2, 3.
Duration of Sexual Side Effects
- There is evidence to suggest that sexual side effects from SSRIs can persist for a long time after stopping the medication, with some cases reported to be permanent 2.
- The duration of these side effects can vary from person to person, and some individuals may experience a reversal of symptoms over time 2, 3.
Management of Sexual Side Effects
- Management of SSRI-induced sexual dysfunction can be complex and challenging 4.
- Various strategies have been reported to manage these side effects, including waiting for tolerance to develop, dosage reduction, drug holidays, substitution of another antidepressant drug, and augmentation strategies with other medications 5, 6.
- Some studies suggest that certain medications, such as bupropion, mirtazapine, and vilazodone, may be effective alternatives to SSRIs with fewer sexual side effects 6.