How to Manage Post-SSRI Antidepressant Sexual Dysfunction (PSSD)

[madman]

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This ISSM Webinar is on Post SSRI Sexual Dysfunction.

The webinar will be opened by Annamaria Giraldi, ISSM President (Denmark). The webinar will be moderated by Alan Shindel (USA) and Marco Gonçalves (Portugal). Topics:

Post-SSRI Sexual Dysfunction (PSSD): history and relevance – David Healy (Republic of Ireland) Explanatory Processes and Diagnosis of PSSD: what do we still need to know? – Yacov Reisman (the Netherlands)

Q&A Session led by the moderator

 

[madman]

Managing Post-SSRI Antidepressant Sexual Dysfunction (PSSD): An Overview

Post-SSRI Sexual Dysfunction (PSSD) is a condition that affects some individuals after they stop taking selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant. PSSD can manifest as persistent sexual dysfunction, including decreased libido, erectile dysfunction, and genital numbness, even after discontinuing the medication. This condition has been the subject of increasing attention in the medical community, with efforts to understand its causes and develop effective management strategies.

 

[madman]

 

[madman]

Understanding PSSD​

PSSD is not fully understood and is still being researched. The condition's history and relevance were discussed by David Healy during an ISSM webinar, highlighting the need for more comprehensive studies on its prevalence and impact on patients12. Yacov Reisman also contributed to the discussion by exploring the explanatory processes and diagnosis of PSSD, emphasizing the gaps in current knowledge12.

 

[madman]

Management Strategies​

While there is no universally effective treatment for PSSD, several strategies are being explored:

1. Alternative Medications: Some patients may benefit from switching to different antidepressants or using medications that do not affect serotonin levels as significantly.
2. Lifestyle Changes: Improving overall health through diet, exercise, and stress management can help alleviate symptoms.
3. Counseling and Therapy: Psychological support is crucial for managing the emotional impact of PSSD.
4. Research and Clinical Trials: Ongoing research aims to identify more effective treatments and understand the underlying mechanisms of PSSD.

ISSM Webinar on PSSD​

The International Society for the Study of Women's Sexual Health (ISSM) hosted a webinar on PSSD, moderated by Alan Shindel (USA) and Marco Gonçalves (Portugal). The webinar featured discussions on the history and relevance of PSSD by David Healy and the diagnostic challenges by Yacov Reisman12. This event highlights the growing interest in addressing PSSD and the need for collaborative efforts to improve patient outcomes.

​

 

[Nelson Vergel]

Wow! This is amazing. Thank you @madman

 

[Nelson Vergel]

Post-SSRI Sexual Dysfunction (PSSD)

www.excelmale.com

 

[madman]

 

[madman]

 

[madman]

Wow! This is amazing. Thank you @madman

Long overdue!

Great webinar

 

[Nelson Vergel]

I did not know that this drug could be a possible treatment: Ganisetron (Kytril,) Injectable

Antiemetic
It can prevent nausea and vomiting caused by cancer treatments such as radiation and chemotherapy, including cisplatin. It can also treat and prevent nausea and vomiting after surgery.

It did not seem to work well in this study:

A Placebo-Controlled, Crossover Trial of Granisetron in SRI-Induced Sexual Dysfunction
July 2001The Journal of Clinical Psychiatry 62(6):469-73


Abstract
Sexual side effects are commonly associated with serotonin reuptake inhibitor (SRI) therapy. The mechanism underlying SRI-induced sexual dysfunction has been hypothesized to be mediated by direct serotonergic effects. Evidence from open-label reports suggests that cyproheptadine, nefazodone, mirtazapine, and mianserin, which block one or more serotonin receptors, may reverse sexual side effects. The current study was a prospective, randomized, crossover trial comparing granisetron, a serotonin-3 antagonist, with placebo in outpatients who developed sexual dysfunction during SRI treatment. Thirty-one outpatients who were currently experiencing sexual dysfunction associated with SRIs were randomly assigned to double-blind treatment with granisetron (1-1.5 mg) or placebo for use 1 to 2 hours prior to sexual activity. Patients rated sexual symptoms after each trial using the Sexual Side Effect Scale (SSES). After 4 trials of the medication, patients crossed over to the other treatment for 4 more trials. Twenty patients received at least 1 dose of placebo and granisetron. Analysis by repeated-measures analysis of variance showed no significant effects of granisetron relative to placebo. Significant improvement between baseline and treatment-phase SSES scores was observed for both granisetron (p = .0004) and placebo (p = .0081). The study medication was generally well tolerated. The results of this study do not support the efficacy of granisetron (1-2 mg) in the treatment of SRI-associated sexual side effects. A significant placebo response may be associated with the treatment of SRI-induced sexual dysfunction.

 

[Nelson Vergel]

Sexual side effects are common with antidepressants in both men and women, so your concern is understandable. Effects on sexual function can include:

A change in your desire for sex
Erectile problems
Orgasm problems
Problems with arousal, comfort and satisfaction
The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem.

Antidepressants with the lowest rate of sexual side effects include:

Bupropion (Wellbutrin XL, Wellbutrin SR)
Mirtazapine (Remeron)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)

Antidepressants most likely to cause sexual side effects include:

Selective serotonin reuptake inhibitors (SSRIs), which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).

Tricyclic and tetracyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and clomipramine (Anafranil).

Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). However, selegiline (Emsam), an MAOI that you stick on your skin as a patch, has a low risk of sexual side effects.
If you're taking an antidepressant that causes sexual side effects, your doctor may recommend one or more of these strategies:

Waiting several weeks to see whether sexual side effects get better.
Adjusting the dose of your antidepressant to reduce the risk of sexual side effects. But always talk with your doctor before changing your dose.

Switching to another antidepressant that may be less likely to cause sexual side effects.
Adding a second antidepressant or another type of medication to counter sexual side effects. For example, the addition of the antidepressant bupropion may ease sexual side effects caused by another antidepressant.

Adding a medication to improve sexual function, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra, Staxyn). These medications are approved by the Food and Drug Administration only to treat sexual problems in men. Limited research suggests that sildenafil may improve sexual problems caused by antidepressants in some women, but more information is needed on its effectiveness and safety in women.

Antidepressants: Which cause the fewest sexual side effects?

Sexual side effects are common with antidepressants in both men and women, but there are options to prevent or reduce such side effects.

www.mayoclinic.org

 

[Nelson Vergel]

PT - 141 (Bremelanotide) for Improved Sex Drive (Libido) and Erections

• Bremelanotide (PT 141) is a synthetic melanocortin compound • It is a ‘melanocortin receptor agonist’- activates melanocortin receptors in the body • ‘Melanocortins’ refer to a group of peptide hormones derived in the pituitary gland • Several melanocortins have been identified...

www.excelmale.com

 

[Nelson Vergel]

Medications that Cause Sexual Dysfunction

www.excelmale.com

 

[gabrielbm67]

Los efectos secundarios sexuales son comunes con los antidepresivos tanto en hombres como en mujeres, por lo que su preocupación es comprensible. Los efectos sobre la función sexual pueden incluir:

Un cambio en tu deseo sexual.
Problemas de erección
problemas de orgasmo
Problemas con la excitación, la comodidad y la satisfacción.
La gravedad de los efectos secundarios sexuales depende del individuo y del tipo específico y la dosis de antidepresivo. Para algunas personas, los efectos secundarios sexuales son menores o pueden disminuir a medida que sus cuerpos se adaptan al medicamento. Para otros, los efectos secundarios sexuales continúan siendo un problema.

Los antidepresivos con la tasa más baja de efectos secundarios sexuales incluyen:

Bupropión (Wellbutrin XL, Wellbutrin SR)
Mirtazapina (Remeron)
Vilazodona (Viibryd)
Vortioxetina (Trintellix)

Los antidepresivos con mayor probabilidad de causar efectos secundarios sexuales incluyen:

Inhibidores selectivos de la recaptación de serotonina (ISRS), que incluyen citalopram (Celexa), escitalopram (Lexapro), fluoxetina (Prozac), paroxetina (Paxil, Pexeva) y sertralina (Zoloft).
Inhibidores de la recaptación de serotonina y norepinefrina (IRSN), que incluyen venlafaxina (Effexor XR), desvenlafaxina (Pristiq) y duloxetina (Cymbalta).

Antidepresivos tricíclicos y tetracíclicos, como amitriptilina, nortriptilina (Pamelor) y clomipramina (Anafranil).

Inhibidores de la monoaminooxidasa (IMAO), como isocarboxazida (Marplan), fenelzina (Nardil) y tranilcipromina (Parnate). Sin embargo, la selegilina (Emsam), un IMAO que se pega en la piel como un parche, tiene un bajo riesgo de efectos secundarios sexuales.
Si está tomando un antidepresivo que causa efectos secundarios sexuales, su médico puede recomendarle una o más de estas estrategias:

Esperar varias semanas para ver si los efectos secundarios sexuales mejoran.
Ajustar la dosis de su antidepresivo para reducir el riesgo de efectos secundarios sexuales. Pero siempre hable con su médico antes de cambiar su dosis.

Cambiar a otro antidepresivo que tenga menos probabilidades de causar efectos secundarios sexuales.
Agregar un segundo antidepresivo u otro tipo de medicamento para contrarrestar los efectos secundarios sexuales. Por ejemplo, la adición del antidepresivo bupropión puede aliviar los efectos secundarios sexuales causados por otro antidepresivo.

Agregar un medicamento para mejorar la función sexual, como sildenafil (Viagra), tadalafil (Cialis) o vardenafil (Levitra, Staxyn). Estos medicamentos están aprobados por la Administración de Alimentos y Medicamentos solo para tratar problemas sexuales en hombres. La investigación limitada sugiere que el sildenafilo puede mejorar los problemas sexuales causados por los antidepresivos en algunas mujeres, pero se necesita más información sobre su eficacia y seguridad en las mujeres.

Antidepressants: Which cause the fewest sexual side effects?

Sexual side effects are common with antidepressants in both men and women, but there are options to prevent or reduce such side effects.

www.mayoclinic.org

Tanks a lot. Nelson, Have you had experience with Vortioxetine and bupropion??? Wich one was better??

 

[Nelson Vergel]

Bupropion made me grind my teeth. Trintellix gave me tachycardia. Fortunately, I no longer use any of them.

 

[Nelson Vergel]

post-SSRI sexual dysfunction

Persistent sexual dysfunction after SSRI withdrawal: a scoping review and presentation of 86 cases from the Netherlands (2021) Katherine Chinchilla Alfaro, Florence van Hunsel & Corine Ekhart Abstract Background: Sexual dysfunction is highly prevalent worldwide. A specific form is persistent...

www.excelmale.com

 

[Nelson Vergel]

Sexual Dysfunction Associated with Psychiatric Illness and Treatment

Primary Sexual Dysfunctions and Sexual Dysfunction Associated with Psychiatric Illness and Treatment Introduction to the Session Welcome, My name is Joe Ceremelli, and I oversee Grand Rounds for the Department of Psychiatry and Behavioral Sciences. Thank you for joining today’s presentation...

www.excelmale.com

 

[sammmy]

It's sad how the SSRI clinical trials report only 5% sexual dysfunction, while the postmarketing studies all report above 50% ejaculatory dysfunction while taking SSRI. Pure example of "clinical trial honesty" when it is sponsored by manufacturer. The sexual side effects are the FIRST thing one notices, they were the reason I dropped antidepressants back in 2010. It is beyond me, how they "didn't notice them" in the "clinical trials".

Unfortunately the anti-depressants with no such effects do not work very well for depression.

I personally stopped antidepressants in 2010 due to delayed orgasm but then had a normal sex life after that and got delayed orgasm problem due to getting AIDS in 2013 - most probably the HIV virus attacking the nervous system. In my personal case I do not believe I have post SSRI sexual disfunction because there was a period of several years between the SSRI usage and AIDS in which my sexual function was normal.

While viagra works for ED, most of the "treatments" listed for orgasmic dysfunction had no effect on me. The studies of such treatments must have a placebo control and must separate erectile dysfunction from orgasmic dysfunction - these require different treatments so just lumping them as "sexual dysfunction" means they have no clue what they are attempting to treat.

 

[Nelson Vergel]

Everything You Need To Know About Post-SSRI Sexual Dysfunction

www.excelmale.com