• Monday July 13,2020

SSRI-related sexual dysfunction

SSRI-related sexual dysfunction (PSSD) is causally associated with the discontinuation of selective serotonin reuptake inhibitors (SSRIs) at the end of treatment. SSRIs, which are among the most prescribed antidepressants, cause an increase in the serotonin concentration in the cerebrospinal fluid in the brain and spinal cord. PSSD manifests itself in a variety of non-specific symptoms, some of which appear contradictory, such as erectile dysfunction and chronic erection (priapism) or delayed ejaculation and premature ejaculation.

What is SSRI-related sexual dysfunction?

SSRI-related sexual dysfunction, commonly referred to as Post-SSRI Sexual Dysfunction (PSSD) in Anglo-Saxon parlance, is likely one of the possible withdrawal syndromes that may occur after discontinuing SSRI antidepressants.

Selective serotonin reuptake inhibitors (SSRIs) belong to a class of commonly prescribed antidepressants that selectively inhibit serotonin transporters and lead to an increase in the serotonin concentration in cerebrospinal fluid (cerebrospinal fluid) in the brain and spinal cord. The causal relationship between taking SSRI or discontinuing the drug and the occurrence of SSRI-related sexual dysfunction requires further scientific research.

There are very different assumptions about the frequency of PSSD, covering a range from rare to common. Because SSRI antidepressants interfere with the serotoninergic metabolism of the body, some symptoms of PSSD with serotonin withdrawal symptoms may be plausibly explained after discontinuation of SSRI medication.


The cause research for the emergence of a PSSD is still ongoing. Three different causal complexes are discussed, which may be considered individually or in their entirety as causative agents of the disease. For example, by taking the SSRI drugs, the hormone balance is changed.

This leads among other things to a reduced testosterone level and has a direct influence on the sexual behavior. However, this does not explain that a PSSD can last for months or years after discontinuing the SSRI, in some cases even for life. Some authors and physicians argue that taking SSRIs is usually a mental illness in the form of depression that could at least contribute to the PSSD symptoms.

The most likely major cause for the development of PSSD is the influence and modification of gene activity via so-called gene silencing. It is believed to result in decreased gene expression because the transfer of the genetic code from the DNA to the mRNA (transcription) is inhibited by, for example, DNA methylation.

The altered gene expression is normally conserved, so that it is also passed on to emerging daughter cells, which also plausibly explains why the PSSD usually lasts so long. Finally, PSSD represents an iatrogenic disease, a disease that is triggered as a side effect of certain medications.

Symptoms, complaints & signs

The main symptoms and complaints of SSRI-related sexual dysfunction or PSSD are due to an increase in serotonin levels in the cerebrospinal fluid in the brain and spinal cord. They are therefore comparable to the serotonin syndrome, which is also triggered by an excessive serotonin level by artificial supply of the neurotransmitter serotonin.

In addition to a number of nonspecific symptoms in the autonomic and central nervous system there are also neuromuscular abnormalities. With regard to specific signs and complaints in the sexual area, the PSSD is characterized by a number of nonspecific and sometimes conflicting symptoms.

In general, there is reduced sensory sensitivity in the genital area, accompanied by diminished sexual excitability and reduced libido. Erectile dysfunction and impotence as well as the inability to orgasm fit well into the overall appearance of the PSSD. Symptoms such as chronic erection (priapism) and premature ejaculation (ejaculatio praecox), which are also observed, are less relevant to the overall picture of PSSD.

Diagnosis & disease course

Serotonin is a biogenic amine that occurs as a tissue hormone and as a neurotransmitter in almost human tissues. Serotonin is involved in many regulatory body processes including blood pressure, blood clotting, intestinal peristalsis, and central nervous system signaling. In addition, serotonin is considered a mood brightener in depressive moods and a kind of happiness hormone with addictive potential.

Serotonin inhibits feelings such as anxiety, aggression and others, so that the positive feelings get stronger weight. If certain events are associated with a reduction in serotonin levels, the body will typically respond with withdrawal symptoms to "put pressure" on the affected person to restore the previous state of increased serotonin levels.

The observed symptoms of PSSD correspond to a subset of the SSRI discontinuation syndrome. Investigation methods that allow a clear diagnosis of PSSD do not exist because no clear parameters are known. Suspicion of PSSD may be confirmed or discarded by reviewing the observed symptoms.

If at least three of the typical symptoms are observed and SSRI medication has been discontinued at the same time, it is very likely that PSSD is present. The disease shows varying degrees of severity and varying degrees of persistence.


In this disease sufferers usually suffer from a significantly reduced sexual desire. For this reason, the complaint may negatively affect the relationship with the partner. Those affected suffer from a limited libido and sometimes also disorders of the erection.

This can lead to psychological problems or depression, especially in men, and severely limit the quality of life. Also, the potency itself is significantly limited by the dysfunction, so it can also come to a demonstrated ejaculation. Those affected continue to suffer from frequent anxiety or depressive episodes. However, the disease does not have a particularly negative impact on health, so the patient's life expectancy is not reduced.

The treatment itself is done with the help of medication. Special complications do not occur. With the help of the treatment, the complaints can usually be restricted relatively well. However, patients may also need psychological treatment. Similarly, sufferers usually need to take the medication throughout their entire life to relieve the symptoms permanently.

When should you go to the doctor?

SSRI-related sexual dysfunction should always be treated by a doctor. It can not be cured by self-help measures. A doctor should be consulted if the patient suffers from significantly reduced sexual desire.

Disorders of potency or erection may also indicate SSRI-related sexual dysfunction and should always be examined by a physician. Some sufferers also suffer from persistent or even premature ejaculation. If these symptoms occur permanently and do not disappear again by themselves, a doctor must be consulted in any case.

SSRI-related sexual dysfunction can be diagnosed by a urologist. In the treatment, however, is usually a visit to a psychologist necessary to treat the disease. However, no direct prognosis of the course can be given.

Treatment & Therapy

A therapy that directly addresses the causes of PSSD is non-existent because ultimately the physiological and biochemical processes leading to the disease are not fully understood. Therapy is usually limited to re-administering the sedated SSRI to the patient when severe symptoms occur.

The withdrawal process of the drug is scheduled over a longer period. So far, there is no drug that could specifically interfere with the hormone balance to reduce or even eliminate the symptoms of PSSD.


The best prevention of SSRI-related sexual dysfunction is to refrain from taking SSRIs or to substitute SSRIs with other drugs if that is a viable alternative. In cases where SSRI drugs are indispensable because of the previous illness, the best prevention is to slow down the medication so that the body can gradually get used to a reduced level of serotonin without "sounding the alarm".


The treatment of SSRI-related sexual dysfunction should be followed by comprehensive follow-up care, as many psychological and physical consequences may result from SSRI-related sexual dysfunction. In particular, the already existing depression may be exacerbated, as the disease also scratched the sexual identity of those affected. Existing psychotherapy must therefore be intensified.

The problems with the resulting from the treatment of sexual disease are considered in the course of follow-up. In particular, a sexual listlessness and a diminished response to sexual stimuli are dealt with thematically. If the condition is very distressing for those affected, close psychiatric surveillance should be used until the sexual function is restored or the psyche stabilized by stopping the antidepressant or switching to another drug.

Because sexual dysfunction can last for years even after the drug has been discontinued, patients need to be prepared for the social and personal consequences that sexual dysfunction may have. It is also important to have an intensive exchange with the partner about the disease in order to prevent a destabilization of the existing relationship. In addition, erectile dysfunction can be treated with special medicines (Viagra), which increase the blood circulation of the penis. For vaginal dryness, the use of special moisturizers and lubricants can be helpful.

You can do that yourself

If there is evidence of SSRI-related sexual dysfunction (PSSD), the patient is suffering from a decreased libido or various forms of potency deficiency. This is particularly distressing when the patient is in an active partnership in which both partners have a desire for sexual union.

In these cases, the doctor will prescribe medications that generally work well and are also well tolerated. If the affected patient and / or his relationship are very stressed, a psychotherapeutic therapy, possibly also a couple therapy is recommended.

In order to reduce the onset of stress that can arise with any PSSD before any sexual activity, different techniques are recommended. Quick to learn and very effective is progressive muscle relaxation according to Jacobson. But also Reiki or yoga with breathing exercises and meditations are good ways to reduce stress.

If the PSSD has not been treated for a long time, the sexual intercourse may be fearful. Here, the knocking acupressure EFT (Emotional Freedom Techniques) has proven to be a good self-help measure against anxiety and / or panic attacks.

According to recent research, even a healthy diet has a positive impact on mental health and can stabilize in the case of PSSD. Patients should be advised of a diet rich in fresh fruits and vegetables, whole grains, and low in sugar and fat.

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