A new study reveals that widely prescribed antidepressants may cause persistent erectile dysfunction in a small but significant number of male patients.
Key Facts:
- The study found that serotonergic antidepressants like SSRIs and SNRIs triple the risk of erectile dysfunction (ED) compared to non-users.
- After stopping the antidepressants, 0.46% of patients (1 out of every 216) were found to have irreversible ED, a condition called post-SSRI sexual dysfunction (PSSD).
- PSSD is characterized by genital anesthesia, lack of libido, and inability to orgasm. It can last for months or years after stopping antidepressants.
- The prevalence of PSSD was estimated at 4.3 cases per 100,000 males aged 21-49 years old.
- PSSD is not routinely warned about when prescribing common antidepressants like Prozac, Zoloft and Lexapro.
Source: Annals of General Psychiatry (2023; 22: 15)
The Dangers of Overprescribing Antidepressants
Antidepressants are among the most commonly prescribed medications in the US.
Over 10% of all Americans over the age of 12 have taken antidepressants in the past month.
Selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft and Lexapro make up over 80% of all antidepressant prescriptions.
While these drugs provide relief for many with depression and anxiety, they also come with side effects that are not always properly communicated to patients.
Sexual dysfunction is the most common side effect of SSRIs – occurring in over 70% of patients.
Decreased libido, difficulty getting aroused, and inability to orgasm often pushes people to stop taking their medication.
Doctors have assumed this sexual dysfunction is temporary and will resolve after stopping treatment.
But a new study in a major psychiatric journal challenges this assumption.
Researchers Find Irreversible ED in 1 out of 216 Antidepressant Users
The study looked at over 12,000 healthy Israeli men aged 21-49 who had no pre-existing conditions that could cause ED.
It defined erectile dysfunction (ED) by whether the men had received prescriptions for ED medications like Viagra and Cialis.
8% of the men who had taken SSRIs or other serotonergic antidepressants had received ED prescriptions, compared to only 2.5% of non-users.
After adjusting for factors like age, BMI, socioeconomic status, anxiety and depression, antidepressant users had triple the risk of ED.
More concerning was that 0.46% of the antidepressant users were found to have post-SSRI sexual dysfunction (PSSD) – irreversible ED persisting after stopping the medication.
This means 1 out of every 216 patients who take serotonergic antidepressants may develop lifelong sexual side effects.
Characterizing Post-SSRI Sexual Dysfunction
PSSD is an under-recognized condition that leaves patients with sexual symptoms long after stopping antidepressant treatment:
- Decreased genital sensitivity or outright genital anesthesia
- Loss of libido
- Erectile dysfunction
- Inability to orgasm or pleasureless/weakened orgasms
- Decreased arousal and responsiveness
These symptoms reflect changes to the sexual pleasure centers of the brain.
PSSD can last for months or years after discontinuing antidepressants, even when depression and anxiety symptoms have resolved.
There are currently no effective treatments for PSSD. Prevention by carefully considering alternative therapies is the only reliable solution at this time.
The first cases of PSSD were documented in 2006. However, it has been challenging to study due to relying on patient self-reports and the stigma around sexual dysfunction.
By using anonymous medical records to identify ED treatment, this study provides an important first estimate of the prevalence of persistent antidepressant-induced sexual dysfunction.
Reassessing Risk vs. Benefit for SSRI Therapy
Antidepressants provide life-changing relief from depression and anxiety disorders for millions of people. However, this study highlights the need for doctors to carefully weigh risks vs benefits when prescribing.
PSSD is not routinely warned about when starting or stopping common antidepressants. Yet it represents a long-term and potentially severe adverse effect on quality of life.
As a newly characterized phenomenon, many physicians are still unaware of PSSD. But patients have a right to informed consent around lifelong sexual dysfunction – however small the risk.
There are many psychosocial treatments and non-antidepressant medications that can be tried first for depression and anxiety. The study authors recommend openly discussing PSSD and alternative options as part of the consent process before prescribing antidepressants.
While the risk is low, 1 in 216 is highly significant for a life-altering condition like PSSD.
Further studies are urgently needed to confirm the prevalence and provide patients and doctors with a clearer understanding of the long-term effects of psychiatric medications.
References
- Study: Estimating the risk of irreversible post‑SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants
- Authors: Joseph Ben-Sheetrit et al. (2023)
