As I try for the hundredth time to knock one out and inevitably fail miserably, I’m forced to remember that when taking selective serotonin reuptake inhibitors (SSRIs), coming can feel like an Olympic sport. Feeling sticky and ashamed (and somewhat frustrated), I’m left with no other option than to pack away my toys and lubes, roll over and try to get some kip.
According to NHS data, there are now nearly half a million more adults taking antidepressants than in 2021. So, know you’re not alone. For many people prescribed antidepressants, they are a necessary and vital lifeline. They can be life-altering in the best way, but they can also produce side effects that are disheartening.
Sexual dysfunction and SSRIs can go hand in hand for folks like me. In fact, it’s reported that nearly 100 percent of people who take them experience some form of sexual side effects. When I stopped taking them, my enthusiasm and wanking vigour returned quickly, but for others, it can be a vastly different story. One shrouded in unshakeable shame.
What is post-SSRI sexual dysfunction, or PSSD?
Post-SSRI sexual dysfunction, or PSSD, is something felt by people when they come off of antidepressants, (the exact number of those impacted is not known because so little research is done about it, partially due to “inconsistencies” from the medical community about how to diagnose it, but the research that does exist tells us it’s prevalent). The condition was only recognised by regulators in 2006, despite reports emerging in 1999.
Experts like professor of psychology David Healy of Bangor University, and author of Antidepressants and Sexual Dysfunction: A History, are discussing the prevalence of the side effect, stating that: “10 percent of people of sexually active years in developed countries are on antidepressants chronically. Nearly 20 percent of the population, therefore, may not be able to make love the way they want.” He goes on to explain that in some deprived areas, the figure may be much higher.
In almost all cases, people who suffer from PSSD have experienced some form of sexual dysfunction while taking antidepressant medication in addition to after they stop. “It’s very important that people understand what it is, recognise it as soon as possible and understand the complexity of it,” Alessio Rizzo, certified psychotherapist, tells Mashable. “SSRI sexual dysfunction is one of the leading reasons people stop taking antidepressant medication which can lead to worsening symptoms alongside withdrawal.”
Rizzo explains that PSSD is complex, with multiple factors pulling psychological and physical strings. There are also environmental factors to consider, like exposure to stress, relationships, work, and money. And, while it can feel inherently comforting to feel like a problem is an easy fix, it also limits the routes for intervention and understanding — two things overcoming PSSD requires by the bucket load.
“A lot can be achieved just by attending to the human side of what’s happening in someone who is affected by PSSD,” Rizzo says. “I always recommend that people explore all options, from the medications to talk therapy.”
Who is most affected by PSSD?
The truth is, anyone can be affected by PSSD because anyone can be affected by sexual dysfunction.
“We know that it seems to affect every sex, and every age, every ethnicity, so it doesn’t seem to be linked to any of the usual parameters that we consider,” Rizzo says. “However, it’s different if someone has a pre-existing vulnerability to sexuality, and this spectrum is huge, we can go from a victim of sexual abuse to people who are members of the LGBTQ community.”
Rizzo explains that people who are more at risk of depression and anxiety, like those in the LGBTQ community, are not destined for mental illness, but may find themselves more likely to develop illnesses like depression and anxiety. “We must be careful not to pathologise dysfunction as an LGBTQ and sexual abuse survivor only problem,” he adds, “because it can stop people who do not identify with these two experiences from seeking help.”
Around 30-50 percent of people experience mild forms of sexual dysfunction before taking antidepressants, which means that they could find pre-existing symptoms exacerbated by medication. It could also mean that something else is causing the dysregulation of the sexual response cycle (the connection between desire and arousal, excitement, orgasm and resolution), like pain, sensitivity and past trauma. Collectively, these are known as predispositions.
Sexual dysfunction of any kind can be a tremendously isolating experience.
This is why approaching a healing process in a holistic nature is important. While medications can help with mood stabilisation, talk therapies like CBT (cognitive behavioural therapy) can help to support healing by modifying thought pathways (this is called neuroplasticity, and it describes altering chemically embedded behaviours in our brain). Therefore, people with pre-existing symptoms, or who are predisposed to sexual dysfunction, can get to the bottom of what’s disrupting their pleasure response cycle and confront it in a safe environment.
How do we move past PSSD shame?
For many people, talking about sex is closely followed by feelings of shame. We also need to remember that there is a cultural stigma surrounding mental health and sex, making it even harder for some to talk about or admit to having a problem. A study conducted by the National Library of Medicine found that young people are especially likely to experience shame when discussing any form of sexual experience — let alone one that involves problems.
As such, sexual dysfunction of any kind can be a tremendously isolating experience, leaving people grasping at straws and feeling a lot of internal turmoil. All this is made worse by the cycle of depression and anxiety slowly eating away at any form of self-esteem.
SSRIs increase serotonin levels in the brain, which has a knock-on effect on the anatomical structures of our reproductive system. Effects of this include being unable to maintain or produce an erection to vaginal dryness, ejaculation, and anorgasmia (absence of orgasm). This is, impart, because SSRIs inhibit nitric oxide production, which greatly affects the way the body relaxes, and actively prevents blood from reaching the genitals.
Not one single part of this experience is because there is something wrong with you or your body.
Remember that none of this is within your control when you’re taking SSRIs. No matter how horny you may or may not feel, not one single part of this experience is because there is something wrong with you or your body. The same can be said for PSSD. Though it is not widely understood or agreed upon by researchers as to how it comes about, there is hope. It is suggested that only future research holds the answer and that it could lie in those who do not develop PSSD, but only time will tell if this is the case.
Create a space for healing
Mental illness can feel pretty relentless. Recurring dances with depression and fluctuating anxiety can feel like a Sisyphean struggle.
We should not discredit SSRIs’ ability to save us from the edge. And, while I know (trust me) that losing sexual function for a while can feel like the final straw, it isn’t and stopping medication abruptly isn’t the answer. Any proposed changes to your intake of medication should be discussed with a doctor as SSRI withdrawal causes side effects that you should be made aware of. That doesn’t mean that if you’re worried about PSSD you can’t make some changes to the antidepressants you already take. “The most important point of intervention is to seek information beforehand, and monitor not just sexual dysfunctions, but any other side effects, from gaining weight and losing creativity — all that stuff,” explains Rizzo.
A study conducted in 2016 suggests avoiding the SSRI Paroxetine, as it has the greatest incidence of causing sexual dysfunction. But, if you’re advised to take an SSRI, Sertraline and Fluoxetine are recommended as having the lowest impact on your sex life. If the symptoms persist, ask to be moved onto an alternative antidepressant, or add an adjunctive (think supplement) antidepressant. However, always consult your doctor before taking or changing medications. Stopping, chopping and changing without a doctor’s approval is a one-way hellish ticket to some earth-shattering withdrawal (take it from me), with highly unpleasant neurological symptoms
However, Rizzo recognises that self-advocacy isn’t always an easy task for someone experiencing mental ill-health. “People might not feel entitled enough to ask for something different, especially if they’re depressed. They cannot assert themselves to go back to the GP and have the courage to say this isn’t working for me, the side effects are very bad.”
If you have already come off of your antidepressants and you’re experiencing PSSD, Rizzo suggests exploring which external stressors could be adding to your dysregulation. “I would call it a gentle approach: acknowledge and accept that what was available to you earlier is not temporarily available, and it’s OK,” says Rizzo.
“If you can start from that mindset,” he continues, “you can begin to think about other pleasures that might still be available to you.” There are other things you can do too, like talking to your partner.
Rizzo explains that you need to build your pleasure responses from the bottom up, slowly, with limited expectations. Things like sensual touching, familiarising yourself with your anatomy with no expectations of orgasm or complete arousal. This way you can begin to allow your body to exit the sympathetic state and enter a parasympathetic state, where you are more likely to relax and enjoy pleasurable stimuli. If you come away from medication and you’re still bombarded with job stresses, running around, and money worries, then the body won’t be able to exit that anxious space.
Recovery isn’t linear. Take the time to fully rest and recalibrate. And, if in doubt, press your GP for more options like talking therapies or alternative medications. As Rizzo says, “Remember that there is choice, the choice is your right.”
