What is PSSD?

The following is from the RXISK website by Dr David Healy. Further information can be found here: https://rxisk.org/post-ssri-sexual-dysfunction-pssd/

"Post-SSRI sexual dysfunction (PSSD) is an iatrogenic condition which can arise following antidepressant use, in which sexual function does not completely return to normal after the discontinuation of SSRIs, SNRIs and some tricyclic antidepressants." (Bahrick AS, 2006, 2008).

Some people develop sexual side effects on antidepressants which either remain in full, or don’t resolve completely, when the drug is stopped. For others, the condition only appears when they actually stop the medication, or begin to reduce the dosage.

PSSD affects both men and women. It can happen after only a few days exposure to an antidepressant and can persist for months, years, or indefinitely. There is no known cure.

Symptoms of PSSD can include:

  • Reduced genital sensation / genital anesthesia

  • Erectile dysfunction / decreased vaginal lubrication

  • Delayed or inability to orgasm (anorgasmia)

  • Pleasureless, weak or “muted” orgasms

  • Decreased libido

  • Reduced response to sexual stimuli

  • Decreased or lack of nocturnal erections

  • Premature ejaculation

  • Reduced nipple sensitivity

  • Soft glans

Some sufferers experience a noticeable reduction in tactile sensation – describing their genitals as feeling less sensitive or numb, as if exposed to an anesthetic. Others perceive little or no change in tactile sensation, but notice a reduction in sexual sensation. These problems can also be accompanied by reduced nipple sensitivity.

Orgasm is typically experienced with a decreased or loss of pleasurable feeling, often referred to as a pleasureless or muted orgasm. There can also be noticeably weaker muscle contractions. Although men and women with PSSD often have more difficulty in achieving orgasm, premature ejaculation can also develop after stopping an SSRI (Adson DDE, Kotlyar M 2003).
Although less commonly reported, some male sufferers develop an issue in which the shaft of the penis becomes erect but the glans remains flaccid. "

The Term ‘PSSD’ is misleading, as symptoms experienced by sufferers are not limited to the aforementioned sexual symptoms. Many people also suffer with:

  • Persistent anhedonia (the inability to feel pleasure)

  • emotional blunting

  • sleep problems

  • akathisia (a movement disorder that makes it difficult to sit still)

  • involuntary muscle movements

  • muscle wastage

  • Loss of drive/motivation

  • memory problems and other cognitive problems

  • shrinkage of genitals and testes.

    There are reports of people suffering for 10, 15, 20 years with no relief in sight.

    Unfortunately, the fact that sexual dysfunction can apparently be a symptom of depression has led to the frequent assumption that patients reporting the above symptoms must be suffering from depression or anxiety rather than there being any physiological changes in brain and body having occurred during their treatment and withdrawal from antidepressants.

    There has been little in the way of medical research to attempt to explore the issue further.