As we’ve noted in the past (such as here, here, and most recently here), SSRI antidepressant medications — the most commonly prescribed psychiatric medication today — often have sexual side effects. Inability to orgasm, delayed orgasm, losing sensation in your genitals, and a lack of sex drive are all possible side effects of these common medications.
Despite this being a pretty well-known issue with SSRI antidepressants for at least 10 years and maybe even as long as 20 years, apparently someone over at the Boston Globe just found out. And decided to make it front page news today. Ostensibly the report is noting that some recent studies put the rate of sexual side effects as high as 1 in every 2 patients who take it (which seems about right based upon what I’ve heard from patients over the years). Which is good information to know. (But front page breaking news type of information? I’m not convinced.)
And I just had to laugh when I read this:
But methods for detecting sexual side effects have improved. Researchers have found that asking patients about the sexual effects directly – As in asking, “Have you been having trouble reaching orgasm?” – instead of waiting for spontaneous complaints yields a major increase in reports.
You mean by simply asking patients if they’re experiencing sexual side effects, we’ll have a better idea of whether people are experiencing sexual side effects while taking these medications!?!? Wow. Amazing research there. Seriously, most research I know of that is actually trying to pin down side effects of a medication often provides a checklist to patients, and that’s how you know. So while clinicians may not routinely ask this question (Bad Doctor!), researchers certainly do when researching side effects.
The most news-worthy part of the article is really about 3/5ths of the way through it:
But in a small number of patients, it appears, the symptoms continue after stopping the drugs. Based on recent case reports of persistent effects, an article earlier this year in the Journal of Sexual Medicine said patients should “be told that in an unknown number of cases, the side effects may not resolve with cessation of the medication.”
Such cases are called PSSD, for post-SSRI sexual dysfunction, and if borne out, those effects threaten to make the clinical dilemma around SSRIs sharper.
In the past two or three years, scattered published case reports from around the country have described patients whose sexual symptoms failed to resolve after going off antidepressants.
This is the real news. Some people who are taking SSRI medications apparently are experiencing long-term sexual side effects, even long after they’ve stopped taking the medication. Now that’s news.
There’s very little research into this phenomenon to date, so much of the evidence for it is anecdotal (e.g., there’s a Yahoo Groups support group for it with 1,800 members called SSRIsex). But it’s a start.
SSRI antidepressants, like all medications, have side effects. That’s not a reason not to take them, but something to be aware of if you suddenly notice a change in your sex life after starting a medication regimen. And then talk to your doctor about alternatives (don’t just stop taking them).
Read the full article: Antidepressants may damage more sex lives
11 comments
I’m glad that more is being published about long-term effects. While I am extremely lucky and have not ever experienced any SSRI-related sexual dysfunction, I know many who have.
I have medication that works, finally; but, extremely low sex drive. Are there any medications out there to help woman with the low to nothing sex drive?
Whoa! I had no clue that it would continue long after stopping the SSRI’s. Hmmm. That would explain my chronic inability to be aroused and have an almost nonexistant sex drive. Well, at least, I’ve learned how to manage that over the years along with my husband. The benefits of the SSRI’s far outweigh the sexual side effects because I have chronic major depression that I’ve had for many years. Depression is an insidious illness that needs to be treated and I am grateful to have my illness be manageable. 🙂
Well depression doesn’t do much for sex drive either. I do not like any of the side effects of the SSRI’s, but depression is worse. Hopefully research will continue to develop better medications with less side effects.
When research is sponsored by pharma then of course they don’t want to be asking patients whether they experience this or that symptom (thus finding it much more prevalent than if they just have an allowance for spontaneous report). I’m not sure how much you get in the way of ‘false positive’ where people over-report symptoms that are suggested to them? There are problems with the accuracy of self-report.
People who are depressed often do have sexual problems. It is unclear how much some of those symptoms were problematic prior to the medication vs how much some of those symptoms were problematic because of the medication.
I would think that sexual side effects could indeed be a reason to stop taking medication. Sex tends to be important to people and relationships.
Serotonin Enhancing Psychotropic Pharmaceuticals
In the 1930s, physicians approached the mental illness of depression a bit differently that we do today. While acknowledging a likely cause of depression in one of their patients is often due to some great misfortune, they seemed to focus on what is called a complex. A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior. An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear. And the etiology for this mental disorder was often undefined. People react differently to life stressors in their life, so depression cannot be empirically determined.
In the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy. Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them. Try and be grateful, they would tell their patient, as well as thankful and appreciative for whatever good may be in their life, and normally the depressed patient would eventually recover
Times have changed since then.
Presently, serotonin-enhancing drugs are the therapeutic regimens for those who are suspect of having a depressed state, or perhaps the patient simply asks for these types of drugs due to their perception that they are depressed. Furthermore, and remarkably, various other mood disorders one may have can be treated with these drugs, typically called SSRIs. What is remarkable is that the mood disorders which will be discussed later are subject to debate and have also been brought to the attention to so many others through disease awareness campaigns by the makers of these SSRI drugs. So mental flaws claimed to be relieved by SSRI drugs may not be the case at all.
With depression, the most severe cognitive and behavioral malfunctions are expressed in what is called a major depressive disorder, which is also called clinical depression or major depression. Symptoms of this type of depression, which is the most concerning to health care providers in particular due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, self perceptions of worthiness, guilt, regret, helplessness, and hopeless by the sufferer, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder. The disease has a vexing insistence on staying with the victim for a lengthy period of time- often continuing to progress symptomatically in severity and discomfort. This disease is very disabling, and cannot be lifted by one’s will, so all health care professionals likely agree that depression is a potentially serious condition with their patients. Suicidal ideation and attempts are associated with major depression.
These SSRI drugs mentioned earlier are known by some health care providers as third generation anti-depressants. Such drugs, drugs that affect the mind, are called psychotropic medications. SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI in one capsule, and these drugs are referred to as SNRI medications. The combination of two different drugs has made them the top class of prescriptions for psychological misalignment.
There are several available SSRIs presently, yet it is believed that only two SNRIs are available, which are Cymbalta and Effexor. Some consider these classes of meds, the serotonin enhancers in these medications, have been considered the next generation mood enhancers- after the benzodiazepine hype decades ago, which was followed by what were called trycyclic drugs for depression for some time. Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some, yet not everyone claims relief from these types of drugs.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence. In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.
And the depressive state of a patient certainly can be aggravated by another mood disorder at the same time with some patients. Anxiety usually exists with one who has a major depressive disorder. An objective diagnosis of such a mental condition is rather impossible to assess objectively. Therefore any diagnosis made for a mental abnormality lacks complete accuracy and assurance. Such illnesses can only be assessed conceptually, so the diagnosis or impression concluded by the patient’s health care provider is dependent on subjective criteria expressed by the suspected patient that is not mentally sound. At times, there have been screening programs that have been used for identifying depressed patients have proven to be largely ineffective. A social patient history is uncertain and tricky as well, some have said, yet is obtained often from such patients. There is no objective diagnostic testing for any mental malfunction to validate as to whether or not such a disease is present. A health care provider has to assess as to whether certain non-verbal or vocalized features are present with a patient in order to conclude confidently that one may have in fact some degree or level of depression. To assess a suspected depressed patient is further complicated by the fact that the exact cause of major depression is unknown. Research says that there is a strong genetic component to this illness.
The diagnosis of depression as well as mood disorders that may exist within patients has increased quite a bit over the past few decades. Some have asked themselves, as well as others- actually how many people are really and actually depressed? What is believed is that if one determined to be cognitively impaired from a mental paradigm, then this may be in fact major depression. If this mental disorder is determined by a health care provider, it is possible that pharmacological therapy may be considered reasonable and necessary, as well as psychotherapy either suggested to be performed with or in place of medicinal therapy. Studies show that both therapies working together may be of most benefit for the depressive patient, yet it is not a guaranteed protocol for treatment in this way.
It has been reported that around 10 percent of the U.S. population will at some point be affected by an episode of what may be a major depressive disorder. This is much greater in number than just a few decades ago. Perhaps media sources are to blame, by suggesting to their viewers that they may in fact be depressed. So the diagnosis and medicinal treatment have remarkably increased in a relatively short period of time in the United States. Of course, the expansion of those claimed and determined to be depressed does not sadden the makers of these drugs used to treat this mental disorder one bit, I’m sure.
Some have said that so many more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be possibly intense sadness, perhaps, due to a loss of some sort in their lives. There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions. Sadness is not a medical problem. Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.
In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems. Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons. Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy. However, as illustrated in this situation, they appear to be accepted as a treatment option without reservation.
In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that their manufacturers do is largely unknown to others, such as with screenings performed essentially by front groups, and so forth. However, what is known is that the psychiatry specialty, as they often treats and manages depressed patients, is the one specialty that receives the most monetary funding that is paid to them by these certain pharmaceutical companies for ultimately what they hope will be continued and additional support of the psychotropic meds that they currently promote to these doctors. Needless to say, the desire and the aspect of the pharmaceutical industry clearly is primarily concerned with encouraging as much use out of their products as possible- with both doctors and patients being the route of that increased use they desperately hope will occur.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that are suspected and determined by the health care providers who treat such patients. Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states, moods, or disorders. Patients should be aware of this fact as well as caregivers. And they may not be aware of the options available to them.
For example, tens of millions of prescriptions are written by health care providers for these types of medications for their patients. These drugs are not inexpensive, either, as it is not unusual for a patient to pay greater than one hundred dollars to have their prescription filled for only a month’s worth of these particular drugs.
Presently, there are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.
The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received upon request of their makers to the FDA to have additional indications besides depression for these types of drugs they produce and market, and the indications they have received are for some really questionable conditions , such as social phobia and premenstrual syndrome. Also included with indications that now exist with these types of medications are the quite devastating conditions of what may be mild anxiety and shyness, yet the makers of these drugs consider such patients as having chronic anxiety with severe anxiety disorder, which others have said is rather obsurd. And it gets worse with the indications received for these types of drugs, which now include Obsessive-Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and any form of stress disorders in general. I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals. Likely, they will get the indication for their drugs to treat such creative cognitive states apparently others have in great numbers.
With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or medical problems. Yet with additional indications for particular drugs in these classes of medications, one can be assured that the market for these drugs will continue to grow- as more are prescribed to those patients who are progressively asking for them specifically for relief they anticipate they will receive from taking these drugs. What such patients are not aware of is that studies have shown that this class of medications is only effective in roughly half of those who take them. And some of the indications granted to drugs in these classes of medications may be considered disease mongering tacitly performed by the makers and marketers of these drugs to again grow the market share for particular drugs of this type. This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized more. And as mentioned earlier, such pharmaceutical companies have been known to either create or support front groups to ultimately encourage who may be normal people to get evaluated for the diseases indicated with these medications. Of course, such tactics implemented by such pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and potentially if not actually dangerous to others.
Perhaps of greater concern and danger with these particular psychotropic medications involve the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence- including acts of homicide, and aggression- and this is only to name a few. Such events are devastating and have been demonstrated by those who have or are taking these types of drugs. It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner until forced to do so. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall. Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them as they get older- these children and teenagers who are prescribed these drugs. Others are asking if this is really necessary- and are these drugs doing more harm than good for their children.
For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their self identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist, as demonstrated by others. It is observed in some who take such drugs, but not all who take these drugs. Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994. There are other medications health care providers could prescribe for such patients that have no less benefit for them then the serotonin drugs discussed.
Finally, if SSRIs or SNRIs are discontinued by a patient rapidly, abruptly, and without medical supervision, withdrawals experienced by many of these patients are believed to be quite brutal that follow soon after this drug is not taken anymore by a former patient. This in itself may be a catalyst for one to consider or attempt suicide, others have suggested. Many are aware and understand that discontinuing these SSRIs and SSNIs leaves the brain in a state of neurochemical instability for some great length of time as the neurons need to recalibrate after existing in a brain over-saturated with serotonin and neuron alteration. This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed. And this seems to concern many, yet does not inhibit health care providers for continuing to select such therapy with these drugs for their patients.
SSRIs and SRNIs have been claimed by doctors as well as patients to be extremely beneficial for the patient’s well -being regarding their apparent mental issues that resolve in time. Yet overall, the factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug that can harm themselves and others.
Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants mentioned earlier, in a similar manner some time ago. Considering the lack of efficacy that has been demonstrated objectively with these new serotonin specific psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmacological treatment options should probably be considered, but that is up to the discretion of the prescriber. And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded. Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression. Deficiencies in vitamins B12 and Folate have been suggested as a cause for depression as well. One study showed that a small jog performed by a depressed patient offered similar if not greater relief than a SSRI drug.
It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking. Because at times, a doctor can in fact do harm without intent.
“I use to care, but now I take a pill for that.†— Author unknown*
Dan Abshear
*Addendum to this article based on the following link recently discovered:
http://www.medicalnewstoday.com/articles/132005.php
There are greater than 60 symptoms associated with one who is or may be depressed, and there are different degrees of depression. The number of symptoms expressed by one who suffers from depression determines the severity of their depression.
The characteristics associated with depression are affective, cognitive, and somatic.
For example, affective symptoms are the core symptoms of a depressed mood, and the term that one has a flat affect is an indication that one may be suffering from depression. These symptoms may include sadness, dissatisfaction, crying episodes, irritability, as well as social withdrawal. It should be noted that many events could cause the expression of such symptoms besides depression in itself.
Cognitive symptoms associated with depression may include pessimism, a sense of failure as well as guilt, suicidal ideation, and dislike of self.
Somatic symptoms may include insomnia, fatigue, weight change, and loss of interests, such as sex or other activities engaged in historically with a depressed patient. It should be noted that stress can cause such symptoms as well, in my opinion,
http://www.nimh.nih.gov/health/trials/practical/stard/index.shtml
Dan Abshear
Unfortunately, I was not informed by any of my psychiatrists who prescribed these drugs to me that a) I could have sexual problems and b) that they could last long after I stopped using the medication. Even now, I’ve brought this issue up with my present psychiatrist and he tends not to believe that this problem is caused by these drugs. I am very frustrated with him. Patients should be informed by their doctor period. Instead of waiting for the patient to complain about a problem that disrupts their lives and practically ends what was a wonderful sex life!!!!!! Researching this issue has been devastating to me because I feel I’m left with no hope to ever be able to achieve an orgasm again like I’ve experienced in the past. Shame on any doctor who does not inform their patient of this serious side effect of SSRIs. I have been complaining, but the doctor isn’t in!!!!!
Hi Gail,
I wanted to respond to your post, even though it has been a long time.
I also take a SSRI (Luvox) although I take it for OCD. I am also experiencing a difficulty in achieving orgasm since taking the meds.
I feel for you and what you are experiencing; it is frustrating when you have always functioned more or less normally in the sex department, and then this happens. I guess for me, though, the question is whether the trade-off is worth it. For me, it is. This medication has given back my life and allowed me to think and feel very much the way I used to. When I think back to before I was on the medication, I remember how miserable I felt. When the medication helps the depression, or in my case, the OCD, it is sometimes easy to forget the benefit of it, because you feel normal again. Given the choice between sometimes problematic sex and re-living my OCD, I would take the not-as-good-as-it-used-to-be sex any day!
You may find, as I have, that the orgasm comes at times, sometimes yes and sometimes no. When I’m by myself, it’s usually no, which can be frustrating. When I’m with my wife, it’s usually yes. When it’s still no with my wife, then I try to focus on her pleasure, and stop when the time is right. Often, if we try again later in the day it will work.
Gail, I don’t know if you’ll see this post, but I truly wish you the best of luck and hope that you will be successful in achieving all the things that make life good 🙂
Your article was great! I agree with your point that this was “the most news- worthy” part of the article because so many people are unaware that this could happen.
In response to Kim in one of the comments above regarding a low sex drive, it can be helped by taking testosterone prescribed by your physician only. Good luck Kim.
I have been off zoloft for at least 1 year. I am still having problems. The doctors never told me that this would happen. At this point I am very angry. The doctor told me this problem does not exist. How could a problem get this bad. They need to do the research to find out a way to cure this. Some days I feel like I do not want to carry on anymore. I trusted doctors for most of my life and now I do not trust them period. No one believes me. Yet, all over the internet you hear about PSSD. I tried Cialis but that did nothing really. The doctors only seem to treat Erectile Dysfunction which is really sad. My life has been torn apart by this. I can never have the same sex life again that I used to have. I trusted the doctors and they do not seem to care. What you are saying is definitely news but the doctors do not hear it. There is no warning on these drugs stating the long term negative effects. My depression is now worse than ever. And for this condition there seems to be no hope for a cure. I had blood work done to test my hormone levels but I have not been to the doctor yet for the results. But hopefully I can get a solution. I am fed up with this and I just want this problem to be behind me. I just want to be heard. That’s why I decided to comment on this.
If doctor stop their pretentious view of things, they will probably find other things to link with SSRI. For example, I know I guy who have had depersonnalization since the second day of SSRI. 2 years after it haven’t resolved, and really probably will never.
For myself, it’s depersonalization itself wich have motivated me to take SSRI. This haven’t do nothing, so I tapered off. In the second week of the taper I was throw in a manic phase. 1 month after, when it stopped, I was left with strong aphaty, no motivation, inhability to concentrate, and my emotionnal system is simply dead. 1,5 years after nothing changed. I’m currently talking with someone on the waking life forum for wich EXACTLY the same things hapenned. I mean EXACTLY, he was have dp, taked SSRI, gone manic when tapered off, and left dead/not human anymore.