Post SSRI Sexual Dysfunction

SSRI – Selective Serotonin Release Inhibitor medications include Fluoxetine (Prozac), Paroxetine (Seroxat), Citalopram & Escitalopram. 

Sexual difficulties after treatment with SSRIs were first reported in 1991 and formally characterised as a syndrome in 2006. 

In May 2019 , the pharmacovigilance risk assessment committee of the European Medicines Agency  (EMA)concluded that post SSRI sexual dysfunction is a medical condition that can persist after discontinuation of SSRIs as well as SNRIs (Serotonin Norepinephrine reuptake inibtors) like Venlafaxine (Efexor). ]

EMA recommended that product information on all relevant anti -depressants be updated to reflect reports of long term sexual dysfunction after treatment. 

Symptoms:

Post-SSRI sexual dysfunction is under-recognised and has both physical as well as psychological symptoms. It is reported by patients of all ages, both sexes, and from all ethnic groups, may begin after a few doses or after years of exposure. It may persist for decades after treatment is stopped. 

These include genital numbness, decreased sex drive (libido), erectile dysfunction , failure of arousal or orgasm, and premature ejaculation. The feeling of numbness may extended beyond the genital area to a more general dampening of reactivity sometimes termed emotional numbing which impacts on emotional wellbeing. 

The mechanism underlying the sensory changes associated with SSRIs is not well understood. It may be mediated via the action of this group of medication on the cell membrane and antidepressants acting on cell membranes are used to treat neuropathic pain.

There may be spontaneous recover over time for some patients; this may take several years while others may have brief periods of recovery lasting days, This would suggest that there is no permanent damage. 

At present, the risk  of developing  symptoms when starting or taking medication is unknown. There are no clear diagnostic criteria ; the diagnosis relies on symptoms which may vary in severity and can be intermittent rather than persistent. The variable nature is such that symptoms may appear only when treatment is tapered or stopped.

No effective treatment exists.

Various medications including Viagra and other medications in the same group have been tried without reported success. 

There is a similar condition called post-finasteride syndrome which is closely related. This occurs in men taking Finasteride which blocks testosterone conversion  (Proscar or Propecia) to stall hair loss or to treat urinary symptoms caused by prostate enlargement. 

More research is required to quantify the true prevalence of post SSRI, the underlying physiological mechanism and potential treatment.  In the meantime, prescribers should inform patients of the risk when discussing possible treatment options so they can make an informed choice.