madman
Super Moderator
Abstract
While sexual dysfunction is a well-known side effect of taking selective serotonin reuptake inhibitors (SSRIs), in an undetermined number of patients, sexual function does not return to pre-drug baseline after stopping SSRIs. The condition is known as post-SSRI sexual dysfunction (PSSD) and is characterised most commonly by genital numbness, pleasureless or weak orgasm, loss of libido and erectile dysfunction. This article provides a commentary on the incidence and prevalence of PSSD based on a combination of academic literature as well as clinical and research experience. A number of obstacles to quantifying the occurrence of PSSD are outlined including difficulty in designing a suitable study method. Other contextual obstacles include patient embarrassment at raising sexual concerns, the response of healthcare professionals, inability to stop an antidepressant due to withdrawal issues in a proportion o fpatients and patient unawareness that their sexual difficulties are linked to prior medication compounded by variability of online information and a lack of information aimed at public education. A definition of PSSD with diagnostic criteria has been published. A MedDRA code for PSSD has also been introduced, but this is yet to be adopted by regulators.
*Background
*Studies
*Healthcare professionals
*Patients
Conclusion
It is not known how many patients, if any, fully regain their original genital sensation, orgasm intensity, and other domains of sexual functioning after using a serotonin reuptake inhibiting antidepressant. This has never been properly investigated and described, and there is an urgent need to understand the incidence, prevalence and natural history of PSSD, with a focus on informing prevention as well as investigating treatments.
The combination of clinical features and the course of PSSD defeat big data approaches as outlined. There might be some hope if PSSD was a longstanding condition, known about for decades and recognised as such, so that databases could be searched for coding terms or textwords. But it has only been recognised in drug labels since 2019, and has only since then been given a Medical Dictionary for Regulatory Activities (MedDRA) code which at present does not appear to have been adopted by regulators. In an online comment, one of the early authors of the PSSD literature noted a gap in the ability of regulators to recognise enduring medication issues:
*I sent in several case reports of persistent sexual dysfunction to the FDA in the late 90’s however they were recorded as problems during medication and not afterward. It turns out that anything after stopping the drug isn’t considered a side effect. (Shipko, 2017)
There is a general lack of awareness and understanding of the condition among both patients and healthcare professionals. Against this backdrop of under recognition, investigating the number of cases presenting at urology clinics for example, or surveying clinicians about how often they encounter the condition, would also be unlikely to produce meaningful results.
There has been relatively little information aimed at educating the general public about PSSD that would support recognition by patients. From 2010, when attempting to raise the issue with US and UK media, one of the authors (DH) was repeatedly told that we in the media do not want to deter people from taking their antidepressants.
While many cases of PSSD could be relatively straightforward to diagnose in clinical practice where full details of medical history and clinical presentation are available, there are several factors that obscure the visibility of PSSD across a wider population. This presents a significant challenge to epidemiologists and an information gap of substantial importance to patients and clinicians.
While sexual dysfunction is a well-known side effect of taking selective serotonin reuptake inhibitors (SSRIs), in an undetermined number of patients, sexual function does not return to pre-drug baseline after stopping SSRIs. The condition is known as post-SSRI sexual dysfunction (PSSD) and is characterised most commonly by genital numbness, pleasureless or weak orgasm, loss of libido and erectile dysfunction. This article provides a commentary on the incidence and prevalence of PSSD based on a combination of academic literature as well as clinical and research experience. A number of obstacles to quantifying the occurrence of PSSD are outlined including difficulty in designing a suitable study method. Other contextual obstacles include patient embarrassment at raising sexual concerns, the response of healthcare professionals, inability to stop an antidepressant due to withdrawal issues in a proportion o fpatients and patient unawareness that their sexual difficulties are linked to prior medication compounded by variability of online information and a lack of information aimed at public education. A definition of PSSD with diagnostic criteria has been published. A MedDRA code for PSSD has also been introduced, but this is yet to be adopted by regulators.
*Background
*Studies
*Healthcare professionals
*Patients
Conclusion
It is not known how many patients, if any, fully regain their original genital sensation, orgasm intensity, and other domains of sexual functioning after using a serotonin reuptake inhibiting antidepressant. This has never been properly investigated and described, and there is an urgent need to understand the incidence, prevalence and natural history of PSSD, with a focus on informing prevention as well as investigating treatments.
The combination of clinical features and the course of PSSD defeat big data approaches as outlined. There might be some hope if PSSD was a longstanding condition, known about for decades and recognised as such, so that databases could be searched for coding terms or textwords. But it has only been recognised in drug labels since 2019, and has only since then been given a Medical Dictionary for Regulatory Activities (MedDRA) code which at present does not appear to have been adopted by regulators. In an online comment, one of the early authors of the PSSD literature noted a gap in the ability of regulators to recognise enduring medication issues:
*I sent in several case reports of persistent sexual dysfunction to the FDA in the late 90’s however they were recorded as problems during medication and not afterward. It turns out that anything after stopping the drug isn’t considered a side effect. (Shipko, 2017)
There is a general lack of awareness and understanding of the condition among both patients and healthcare professionals. Against this backdrop of under recognition, investigating the number of cases presenting at urology clinics for example, or surveying clinicians about how often they encounter the condition, would also be unlikely to produce meaningful results.
There has been relatively little information aimed at educating the general public about PSSD that would support recognition by patients. From 2010, when attempting to raise the issue with US and UK media, one of the authors (DH) was repeatedly told that we in the media do not want to deter people from taking their antidepressants.
While many cases of PSSD could be relatively straightforward to diagnose in clinical practice where full details of medical history and clinical presentation are available, there are several factors that obscure the visibility of PSSD across a wider population. This presents a significant challenge to epidemiologists and an information gap of substantial importance to patients and clinicians.
