SSRI-related sexual dysfunction (PSSD) is causally related to discontinuation of selective serotonin reuptake inhibitors (SSRI) after the end of therapy. SSRIs, which are among the most commonly prescribed antidepressants, work by increasing levels of serotonin in the cerebrospinal fluid in the brain and spinal cord. PSSD manifests itself in a variety of non-specific symptoms, some of which appear contradictory, such as erectile dysfunction and permanent erection (priapism) or delayed ejaculation and premature ejaculation.
What is SSRI-related sexual dysfunction?
SSRI-related sexual dysfunction, known in English as Post-SSRI Sexual Dysfunction (PSSD), is very likely one of the possible withdrawal syndromes that can occur after stopping SSRI antidepressants. See wholevehicles for What are the Meanings of Hypoproteinemia.
SSRIs (Selective Serotonin Reuptake Inhibitors) belong to a class of commonly prescribed antidepressants that selectively inhibit serotonin transporters and lead to an increase in the concentration of serotonin in the cerebrospinal fluid (cerebrospinal fluid) in the brain and spinal cord. The causal complex between taking SSRIs or stopping the drug and the occurrence of SSRI-related sexual dysfunction still requires further scientific research.
There are very different assumptions about the frequency of PSSD, covering a range from rare to frequent. Because SSRI antidepressants interfere with the body’s serotoninergic metabolism, some symptoms of PSSD can be plausibly explained by serotonin withdrawal symptoms after stopping the SSRI drugs.
Research into the causes of PSSD is not yet complete. Three different causal complexes are discussed, which individually or in their entirety are possible causes of the disease. For example, the hormone balance is changed by taking the SSRI drugs.
This leads, among other things, to a reduced testosterone level and has a direct impact on sexual behavior. However, this does not explain why PSSD can persist for months or years after stopping SSRIs, and in some cases for life. Some authors and physicians state that when SSRIs are taken, a mental illness in the form of depression is usually present, which could at least contribute to PSSD symptoms.
The most likely main cause for the development of PSSD is an influencing and change in gene activity via so-called gene silencing. It is believed to lead to reduced gene expression because the transfer of the genetic code from DNA to mRNA (transcription) is inhibited by, for example, DNA methylation.
The altered gene expression is usually preserved so that it is also passed on to developing daughter cells, which also plausibly explains why PSSD usually lasts so long. Ultimately, PSSD embodies an iatrogenic disease, a disease that is triggered as a side effect of certain medications.
Symptoms, Ailments & Signs
The main symptoms and signs of SSRI-related sexual dysfunction or PSSD are due to increases in serotonin levels in the cerebrospinal fluid in the brain and spinal cord. They are therefore comparable to the serotonin syndrome, which is also triggered by an excessively high serotonin level caused by an artificial supply of the neurotransmitter serotonin.
In addition to a series of unspecific symptoms in the vegetative and central nervous areas, there are also neuromuscular abnormalities. With regard to specific signs and symptoms in the sexual area, the PSSD is characterized by a number of non-specific and sometimes contradictory symptoms.
In general, there is reduced sensory sensitivity in the genital area, accompanied by decreased sexual arousal and decreased libido. Erectile dysfunction and impotence as well as the inability to have an orgasm fit well into the overall picture of PSSD. Symptoms such as permanent erection (priapism) and premature ejaculation (ejaculatio praecox), which are also observed, do not fit the overall picture of PSSD.
Diagnosis & course of disease
Serotonin is a biogenic amine found as a tissue hormone and neurotransmitter in almost all human tissues. Serotonin is involved in many regulatory body processes such as blood pressure, blood clotting, intestinal peristalsis and signal transmission in the central nervous system. In addition, serotonin is considered a mood enhancer for depressive moods and a kind of happiness hormone with potential for addiction.
Serotonin inhibits feelings such as fear, aggression and others so that the positive feelings are given more weight. When certain processes are associated with a reduction in serotonin levels, the body usually reacts with withdrawal symptoms in order to put “pressure” on the person concerned to restore the previous state of increased serotonin levels.
The observed symptoms of PSSD correspond to a sub-complex of the SSRI withdrawal syndrome. Examination methods that allow a clear diagnosis of PSSD do not exist because no clear parameters are known. The suspicion of PSSD can be confirmed or rejected by checking the observed symptoms.
If at least three of the typical symptoms are observed and SSRI drugs have been discontinued at the same time, there is a high probability of PSSD. The course of the disease varies in severity and duration.
Those affected with this disease usually suffer from a significantly reduced sexual desire. Because of this, the complaint can negatively affect the relationship with the partner. Those affected suffer from a limited libido and sometimes also from erectile dysfunction.
This can lead to psychological problems or depression, especially in men, and significantly reduce their quality of life. The potency itself is also significantly restricted by the dysfunction, so that ejaculation can also occur. Those affected continue to suffer from frequent states of anxiety or depressive phases. However, the disease does not have a particularly negative effect on health, so it does not reduce the patient’s life expectancy.
The treatment itself is carried out with the help of drugs. There are no particular complications. With the help of treatment, the symptoms can usually be limited relatively well. However, patients may also need psychological treatment. Likewise, those affected usually have to take the medication for their entire life in order to permanently relieve the symptoms.
When should you go to the doctor?
SSRI-related sexual dysfunction should always be treated by a doctor. It cannot be cured by self-help measures. A doctor should be consulted if the patient suffers from significantly reduced sexual desire.
Potency or erection disorders can also indicate SSRI-related sexual dysfunction and should always be examined by a doctor. Some of those affected also suffer from permanent potency or even premature ejaculation. If these symptoms persist and do not go away on their own, a doctor must be consulted in any case.
SSRI-related sexual dysfunction can be diagnosed by a urologist . During treatment, however, a visit to a psychologist is usually necessary to treat the disease. However, no direct prognosis of the course can be given.
Treatment & Therapy
A therapy that directly targets the causes of PSSD does not exist because ultimately the physiological and biochemical processes that lead to the disease are not yet fully understood. Therapy is usually limited to re-administering the discontinued SSRI to the patient if severe symptoms occur.
The withdrawal process of the drug is scheduled over a longer period of time. So far, there is no drug that could specifically intervene in the hormonal balance in order to reduce or even eliminate the symptoms of PSSD.
The best way to prevent SSRI-related sexual dysfunction is to not take SSRIs or to substitute SSRIs with medications with other active ingredients if this is a practicable alternative. In cases where SSRI drugs are essential due to the pre-existing condition, the best prevention is to taper off the drugs very slowly so that the body can gradually get used to reduced serotonin levels without “sounding the alarm”.
The treatment of SSRI-related sexual dysfunction should be followed by comprehensive follow-up care, as numerous psychological and physical consequences can result from SSRI-related sexual dysfunction. In particular, the depression that is already present can intensify, since the disease also scratches the sexual identity of those affected. Existing psychotherapy must therefore be intensified.
The problems with the sexual disease resulting from the treatment are taken into account in the course of the follow-up care. In particular, a lack of sexual desire and a reduced reaction to sexual stimuli are dealt with thematically. If the disease is very stressful for those affected, close psychiatric monitoring should be carried out until sexual function is restored by stopping the antidepressant or switching to another drug or until the psyche is stabilized again.
Because sexual dysfunction can persist for years after drug discontinuation, patients need to be prepared early for the social and personal consequences that sexual dysfunction can have. It is also important to have an intensive exchange with your partner about the illness in order to prevent the existing relationship from destabilizing. Erectile dysfunction can also be treated with special medication (Viagra) that increases blood flow to the penis. The use of special moisturizing creams and lubricants can be helpful against vaginal dryness.
You can do that yourself
If there is evidence of SSRI-related sexual dysfunction (PSSD), the patient suffers from a decreasing libido or from various forms of erectile dysfunction. This is particularly distressing if the patient is in an active partnership in which both partners desire sexual union.
In these cases, the doctor will prescribe drugs that generally work well and are also well tolerated. If the affected patient and/or his/her relationship is under great strain, psychotherapeutic therapy is recommended, possibly also couple therapy.
Various techniques are recommended to relieve the stress that can arise with PSSD before any sexual activity. Jacobson ‘s progressive muscle relaxation is easy to learn and very effective. But Reiki or yoga with breathing exercises and meditations are also good ways to reduce stress.
If the PSSD has not been treated for a long time, the sexual act may now be anxious. EFT (Emotional Freedom Techniques) tapping has proven to be a good self-help measure against anxiety and/or panic attacks.
According to the latest research, even a healthy diet has a positive influence on mental health and can also stabilize in the case of PSSD. Patients are advised to eat a diet high in fresh fruit and vegetables, whole grain products, and low in sugar and fat.