My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush.<p>So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.<p>Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)<p>As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.
As someone dating in their 20s, it is getting hard to find people who aren’t having SSRI-related dysfunction. Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.” They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween.<p>They don’t actually solve the problem long term, you can’t really come off them ever (I know a lot of people who have tried; only one who succeeded and they were on an exceedingly low dose to begin with - it took six months before the frightening neurological symptoms subsided), and they permanently damage ability to have human connection (I don’t understand how that doesn’t worsen depression and anxiety long term).<p>I get that I’m the asshole for suggesting that people take a second look at the side effect profile and consider whether these might be overprescribed. I get that they do make life better overall for some people. I’ve also seen my friends become psychotic and ruin their lives when they try to get off them (because the sexual side effects and weight gain were unbearable). So IDK, it feels urgent enough to raise as a concern. Especially when so many people are taking them.<p>I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs.<p>I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change. Walking 10k steps and CBT are useful interventions that can be easily monitored by physicians with modern technology.<p>I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.
This was one of the factors that made me think twice about going back on anti-depressants, until I made peace with the fact that my ability to orgasm wasn't going to pull me out of the hole I was in. It's a shitty choice but the desire to not be suicidal forces your hand.<p>It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom.<p>The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be.<p>That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts.<p>And make sure you have a therapist too.
I don’t usually post here, especially on such personal topics, but feel I should. I’ve been on SSRIs and SNRIs for some time now (Pristiq, and now Zolof), and can definitely attest to the some of the changes described in the article. I clearly remember reading the documentation in full that came with both drugs before starting each, and the mentioned side effects were only mentioned in passing, along with possibly every other side effect imaginable, so it was very easy to dismiss - especially when you are in a place you know you need help out of. There was also no real warning of long term side effects from both doctors that have prescribed me.
I guess I don’t have any real point, other than if you are considering anti-depressants do more research than I did before taking what you’ve been prescribed - and if in doubt get answers from your doctor, and failing that find a better doctor (if you can).
Anecdote: I had severe OCD from childhood through my first year in college, triggered by separation from my parents (who never got me therapy despite extremely obvious signs.) I had multiple panic attacks per day resulting in depersonalization/derealization, I was failing my classes etc.<p>Logically I knew that my mom wouldn't die if I didn't stop my room fan at its maximum rotation or if I didn't make the sign of the cross 2^n times. But mental illness is illogical. What "good coping skills" would fix that?<p>Psych put me on Prozac, which numbed every feeling but panic, which it didn't touch. I got relief from a bad trip on 2C-E, in which I had such a severe panic attack that it permanently destroyed that identity and left me with depersonalization. The old me was dead, so over the following months I built a new one. OCD apparently got erased with the rest of me. I successfully went off Prozac by quitting it cold turkey and stayed off SSRIs for a decade.<p>I guess the takeaway is: serious mental illness exists, platitudes about life wouldn't help, SSRIs didn't help either but didn't make me dependent, and psychedelics are a crapshoot.
I took SSRIs for a year in my late twenties. They had no effect on my depression, but resulted in permanent sexual dysfunction. My own fault for not properly researching the potential long-term side effects, I suppose, but it certainly wasn't raised as an issue by the prescribing doctor either. I hope someday there will be cure of some kind.
A different anecdotal experience from my own use (10mg Lexapro) - I've always had a problem with premature ejaculation. Was trying all kinds of tricks like doing math problems in my head during sex or trying different breathing techniques - all of that was useless, once I started taking Lexapro it's like it flipped some switch in my head and I can basically go as long as I like now, and finish almost on command. Absolute game changer, it's a fantastic improvement to my quality of life. I also take 5mg of Cialis daily, which definitely helps with erections.
SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work?<p>The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.
I think this article is a little alarmist. Warnings like these scared me away from SSRIs for a long time despite their likely efficacy in helping treat my symptoms.<p>I sent a number of articles like this one (and several of the medical publications it cites) to my psychiatrist. To her credit, she read them, and her response was that she agreed this kind of permanent change is possible, but it is extremely unlikely. (Anecdotally, she told me, she's treated thousands of people with SSRIs and had never had a report of something like this; she hadn't heard of it happening until I showed her case studies.)<p>I don't think that means my doctor is ignorant - I think that means permanent damage is indeed likely very uncommon.<p>Here is a write up from Lorien Psych (the day job of Scott Alexander at Slate Star Codex) that I think is evenhanded: <a href="https://lorienpsych.com/2020/10/25/ssris/" rel="nofollow">https://lorienpsych.com/2020/10/25/ssris/</a><p>Alexander has his issues, but this is an area where he's actually an expert and his approach to the topic helped me a lot.<p>As for me, the benefits of a relatively low dose of an SSRI have really outweighed the risks so far.
I want to kill myself every second of every day, and it's been that way for 15ish years now.<p>The only thing, fleeting as it may be, that I find worthy of doing in life is sex, and these ed side effects have kept me from exploring the potential for a world in which I don't to cease to exist or murder in the sake of nihilism.<p>I'd rather destroy the lives of those around me or others' randomly than live without sex. It's just a function of my utility curve.<p>Unfortunately and as counter intuitive as it may seem, I'm very cautious of skin to skin diseases such as hsv and hpv, which has kept me from hiring prostitutes, even though the only thing in life I want is exactly that.
PSSD seems to be in part mediated by desensitization of 5HTP1A receptors. Psychedelics are known to modulate 5HTP1A and increase plasticity of serotonin neurons. This would logically be another research avenue for psychedelics.<p>I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success.<p>We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.
I posted this here in hope more people would be aware of the long term risks involved with SSRI, which are often not discussed from the doctors. These symptoms might only appear after the withdrawal.<p>Some manufacturers and healthcare organisations are being to label this as a potential side effect. You can find a one line warning on NHS website now.<p>People take the drug are usually desperate and at their most vulnerable periods in life. It’s very risky to make life-changing decisions, more so without complete knowledge.<p>Doctors usually won’t even listen to cases of PSSD by simply attributing the SD as remission of depression. But there’re some recent studies on how SSRI could change neutral receptors in a non-reversible way, which could be the potential mechanism.
Anecdata: an ex experienced this on SSRIs. Was brutal on her and tough for me. A friend had the same issue.<p>Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.
I’ve had significant problems with my anti-psychotic before my psychiatrist and I found a proper mix. Given I frequently deal with hypersexuality, there was no way I’d stay on medication long term if that wasn’t fixed.<p>For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
I've experienced the sexual side effects. For me they lessened over time (going from mostly not being able to achieve climax to that rarely happening) and taking a lower dose helps. For those that are not at risk of seizures they can take bupropion as well to decrease the dose of the other SSRI further.<p>But honestly sex is mostly in the brain and not finishing every time is only a drag if you think that it is. Personally I find it liberating, sex becomes a fun intimate pass time without an end goal. And certainly the benefits to my depression and anxiety out weigh the negatives for me.
In my early 20s (male) I was prescribed (read: pushed) citalopram by my family doctor. I took it for about a year. I'm in my early 30s now and sometimes STILL suffer from the inability to reach orgasm. I stopped taking the medication and when I realized it was in fact the medication interfering with my love life, and unfortunately realized too late. I've read alot about this after the fact and am surprised this reached HN. Nothing really to add to this conversation but its reassuring to know I'm not alone.
Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who <i>doesn’t</i> have problems getting / keeping it up. Most of them link back to antidepressant use.<p>What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t <i>always</i> been this way, has it?
I was prescribed cognitive behavioral therapy (CBT) and Prozac. The CBT did far more for me. I dumped the Prozac after a few months. I have bad days and good days, but I know how to get through the bad ones now. I know what prompts them and even when its hard to think positively I still know that I won't think things are as bad tomorrow.<p>YMMV! A lot!<p>As I get older I feel healthier when I move, touch people, give love and get love.<p>In the US, we _do not prioritize health_, physical nor mental. We're surrounded by shit food. We're "insured" basic baseline function, and improvement often has to come out of our own time, energy, and money. If you're in a relaxed white collar environment, its easy to duck out for an hour of therapy. If you're on the clock, it's almost impossible. This is the bigger issue.<p>Again, some ppl DO need SSRIs or they will harm themselves or others. But always pair with some form of talk therapy and get some daily exercise.
Takes me a little longer on Zoloft. My psychiatrist and I agreed this is more of a good thing than a bad thing. The crippling anxiety I had without it was much worse for my libido.<p>That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline.<p>Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.
This is interesting. I'm a founder of an app[1] that deals with this ballpark of issue, by providing (among other things) couples with sensate focus therapy, which is a form of sex therapy that has an extremely strong evidence base, and is a pretty standard go-to for libido issues.<p>We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques <i>are</i> proven.<p>[1] <a href="https://www.blueheart.io" rel="nofollow">https://www.blueheart.io</a>
Can one sue a psychiatrist who prescribed me drugs not telling me about any side effects despite me not having any disease? The psychiatrist just concluded that if I have somatic problems and trouble sleeping I must be mental, turns it wasn't that. No one ever told me about any side effects (it won't hurt your liver I heard, you will remain cured even after stopping the treatment). I repeatedly told him I see no difference, and he interpreted unrelated life changes as results of the drugs. Or perhaps I could sue the company who produced it?<p>More reading:
<a href="https://en.wikipedia.org/wiki/Anti-psychiatry" rel="nofollow">https://en.wikipedia.org/wiki/Anti-psychiatry</a>
<a href="https://www.goodreads.com/book/show/6943460-the-emperor-s-new-drugs" rel="nofollow">https://www.goodreads.com/book/show/6943460-the-emperor-s-ne...</a>
I wonder when we're going to find out better ways to alter the body without causing deleterious entropy. Surely pills and shots are not a solution for everything and are only present because of their easy testability. We need better methods and aggressive creative problem solving and the funding to incentive it.
I did not realize even the short term affects where that prevalent. Terrified of the long term ones now. It definitely happened to me on citalopram. And now on escitalipram. I have been experimenting with adding DHEA and ginseng from my doc and I think its helping a bit.
Interesting flip-side: the anti-depressant Tradazone can cause Priapism.<p>I don't think we understand nearly enough about these systems, though I'd argue that anti-depressants are still a big net positive.
You shouldn't take <i>any</i> form of medication unless it's necessary to save your life. Period. Doctors are still mostly quacks, except in some exceptional circumstances
People need to know that if you have Post SSRI sexual dysfunction, your body usually learns to work around it.<p>Went I started SSRI's I didn't orgasm for 3 months, but learned how again. Also if you tell your doctor about the sexual dysfunction they will prescribe you Viagra, which I did not need but absolutely love using and overall sex + Viagra is way more fun than before I started SSRI's.
I must be a weird outlier. While I can agree with the article's opening ("Close to 100% of people who take antidepressants experience some form of sexual side effects") I can't, at least from personal experience, subscribe to the main message.<p>As my wife can attest, when I was on SSRIs, I was hornier than usual.
I wish this article referenced the data used in the sentence where it claims certain facts.<p>Such as the first sentence:
“Close to 100% of people who take antidepressants experience some form of sexual side effects.”<p>Says who?<p>There are certain studies referenced but when other claims like the first sentence are made, I’d like to see where they got that conclusion.
Anybody knows about the neurology of libido ? not the biomechanical sequence (attractive person -> nerve impulse -> blood flow etc)<p>Talking about the higher representations of the other person's body, why proximity / touch causes all these mental discharges.
I'm diagnosed with MDD. I was prescribed an SSRI and was not made aware or informed of the sexual side effects. Thankfully after quitting them my libido has restored but to the other extreme where I'm constantly horny.
For someone that suffers from premature ejaculation, these medications are extremely helpful. The trick is to get the right dose that improves your sexual endurance but doesn't prevent orgasm.
I will provide some AnecData.<p>I am from a generation that when SSRI became available, it was a marvelous drug.<p>Prescribed to teenagers freely and plentiful.<p>Now on my peers of friends, we have many people who don't have any libido.<p>The hardest-hit group was Women as they go to therapy more[1].<p>It is so huge we have Forums like "dead bedroom."<p>Once a friend that took SSRI told me how she felt about sex:<p>"I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore."<p>"Brushing my teeth is more useful and fun than sex."<p>I am not talking about sex partners that are not "competent" or good.
It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time*<p>The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.)
So can we believe the mRNA vacuum is really safe?<p>[1] - <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27" rel="nofollow">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27</a>