What Is the Risk of Permanent Sexual Dysfunction from Antidepressants?

Sexual dysfunction is a common and debilitating adverse effect of SSRI drugs, with up to 73% of antidepressant users experiencing it. Researchers have linked sexual dysfunction to the drugs’ numbing effect on emotions and proposed a biological pathway that may cause it.

In many cases, this problem resolves once people stop taking antidepressants. However, in some cases, people are left with long-term sexual dysfunction even after stopping the drug. This has been termed “post-SSRI sexual dysfunction” (PSSD) and can be permanent.

Because the risk of PSSD has only been recognized more recently, researchers are still attempting to discover how commonly this harmful effect of the drug appears. In a new study in the Annals of General Psychiatry, researchers attempted to quantify the risk.

However, they were only able to estimate the risk for one very specific part of the PSSD community—males¹ experiencing erectile dysfunction (ED). And they could only estimate this based on prescriptions for phosphodiesterase-5 inhibitors. Thus, their study did not include PSSD occurring in women, erectile dysfunction for which men didn’t receive a prescription drug, and all other PSSD, including reduced libido, arousal, and lubrication; genital numbness; inability to orgasm; and more.

The researchers found that 1 out of every 216 males prescribed an SSRI (from an extremely healthy subset, as described below) filled a prescription for phosphodiesterase-5 inhibitors within 12 months of stopping SSRI use (0.46%). The prevalence of ED in males in the general population was 0.0043%, so the males taking the drug were about 100 times more likely to have ED.

After adjusting for age, socioeconomic status, BMI, depression, and anxiety, those who took an antidepressant were still more than three times as likely to develop ED than the general population (odds ratio 3.2).

However, this only includes one very specific type of PSSD and only includes men who actually sought and were prescribed drugs to treat their ED. Thus, the risk of PSSD for women, men who didn’t seek drug treatment, and all other kinds of PSSD remains unknown. A 2020 study reported a much higher PSSD prevalence rate in males.

The researchers used data from Tel Aviv’s Clalit Health Services database and included only males between the ages of 21 and 49 with a BMI less than 25. Participants were also excluded if they had a psychiatric diagnosis (including depression and anxiety), had basically any other health conditions, including such things as hypertension and celiac disease, had taken any of dozens of other classes of drugs associated with sexual side effects, had ever had alcohol or drug abuse diagnoses, or were current or past smokers—meaning that this is an extremely specific subset of ridiculously healthy patients on SSRIs who did not even have depression or anxiety diagnoses.

The study included 12,302 males, 866 (7.0%) of whom had taken serotonergic antidepressants (including SSRIs, SNRIs, and TCAs). Four of them received a prescription for an ED drug.

The researchers write that doctors must tell their patients about this risk so that patients can make an informed decision about whether to use antidepressants.

The study was led by Joseph Ben‑Sheetrit and Paz Toren at Tel‑Aviv Brüll Community Mental Health Center, Israel.

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Ben‑Sheetrit, J., Hermon, Y., Birkenfeld, S., Gutman, Y., Csoka, A. B., & Toren, P. (2023). Estimating the risk of irreversible post‑SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Annals of General Psychiatry, 22(15). https://doi.org/10.1186/s12991-023-00447-0 (Link)