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Post-SSRI sexual dysfunction

216 points by taxyovio 5y ago

foobarian 5y ago
Selective Serotonin Reuptake Inhibitor (SSRI) https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
ghostbrainalpha 5y ago
People need to know that if you have Post SSRI sexual dysfunction, your body usually learns to work around it. Went I started SSRI's I didn't orgasm for 3 months, but learned how again. Also if you tell your doctor about the sexual dysfunction they will prescribe you Viagra, which I did not need but absolutely love using and overall sex + Viagra is way more fun than before I started SSRI's.
GoHydra 5y ago
Glad to see this finally getting attention. This is not what teenagers have in mind when they ask for "help".
theawesomekhan 5y ago
Seems I'm geo-blocked. My Location is Turkey.
- ainar-g 5y ago
  Same in Russia. Archive: https://web.archive.org/web/20210911150504/https://rxisk.org/post-ssri-sexual-dysfunction-pssd/ https://web.archive.org/web/20210911150504/https://rxisk.org...
- chinathrow 5y ago
  https://archive.md/wip/rG5st https://archive.md/wip/rG5st
cwwc 5y ago
Hmm.. a bum side effect especially since it looks like that SSRI antidepressant might be a treatment for covid.
- deleted 5y ago
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brunoTbear 5y ago
Anecdata: an ex experienced this on SSRIs. Was brutal on her and tough for me. A friend had the same issue. Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.
ljm 5y ago
This was one of the factors that made me think twice about going back on anti-depressants, until I made peace with the fact that my ability to orgasm wasn't going to pull me out of the hole I was in. It's a shitty choice but the desire to not be suicidal forces your hand. It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom. The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be. That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts. And make sure you have a therapist too.
- ivraatiems 5y ago
  Have you considered augmenting with something like Wellbutrin? Some people find it helps with the side effects. I've tried it myself and while I found it was too anxiety-inducing (I felt too keyed up) there's truth to that at least.
  - ljm 5y ago
    No, not personally. I eventually was able to come off the medication. Took a couple of weeks to get back to some semblance of normal but I'm sure there's permanent damage still. That said, it's not easy to walk away from suicidal depression (and attempts to commit suicide) without a decent helping of trauma, and potentially even PTSD. So, of course, there isn't really a 'normal' to go back to once you've got the awareness of that and how far down the rabbit hole you fell. Normal becomes something else.
    - ivraatiems 5y ago
      Wellbutrin has no sexual side effects (the opposite, in fact) and is very effective for depression (but not anxiety). You might want to give it a try if you are still struggling. Of course, it comes with its own tapestry of possible issues. Either way, hope you are doing OK/OK enough.
wayoutthere 5y ago
Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who doesn’t have problems getting / keeping it up. Most of them link back to antidepressant use. What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?
- Tade0 5y ago
  > It hasn’t always been this way, has it? As a man in his 30s growing up I witnessed a shift in attitudes from "just man up" to "seek help", so there's that. If anything I would suggest humanity to give up dating apps. They're essentially making people feel inadequate and pay for the dubious privilege.
  - wayoutthere 5y ago
    Dating apps are awful, but were a lot better once I challenged my standards (and lowered them a bit; I’m not the young hottie I used to be and that was a hard realization).
  - prionassembly 5y ago
    Feeling inadequate is integral to the cherchez-la-femme experience. But it's probably better to be humiliated in night clubs (where eg. women sometimes will pretend not to even see you) than in apps; ego defense mechanisms have less of a chance there. Also: actually kissing tells you a lot that detailed self-reported profiles will never do -- the "chemistry" thing is real, sometimes two people find someone cute and stylish but the kissing doesn't work.
- deleted 5y ago
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- deleted 5y ago
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- ralusek 5y ago
  Trouble in that department is also heavily impacted by men just generally being more sedentary, having poorer diets, and due to those reasons and more, having lower testosterone. Also, consuming pornography in much greater amounts than previously available to people is known to cause serious problems here.
michaelgrafl 5y ago
On the flipside, if you have problems with premature ejaculation, taking one of those might mitigate the issue. Not a doctor, by the way.
- sigotirandolas 5y ago
  Probably. Clomipramine, a TCA, is sometimes used for premature ejaculation.
- jac241 5y ago
  Yes they are indicated for that.
selexin 5y ago
I don’t usually post here, especially on such personal topics, but feel I should. I’ve been on SSRIs and SNRIs for some time now (Pristiq, and now Zolof), and can definitely attest to the some of the changes described in the article. I clearly remember reading the documentation in full that came with both drugs before starting each, and the mentioned side effects were only mentioned in passing, along with possibly every other side effect imaginable, so it was very easy to dismiss - especially when you are in a place you know you need help out of. There was also no real warning of long term side effects from both doctors that have prescribed me. I guess I don’t have any real point, other than if you are considering anti-depressants do more research than I did before taking what you’ve been prescribed - and if in doubt get answers from your doctor, and failing that find a better doctor (if you can).
- haolez 5y ago
  In my case (Pristiq), it was a net positive. My libido decreased (but never desapeared) and I've never had erectile disfuncion so far. Totally worth it for me, with my specific metabolism.
- xattt 5y ago
  Sertraline (Zoloft) often causes more sexual side effects in males than it does in females. I have seen this used at the max dose to control hypersexual behaviour in a patient with dementia.
  - matheusmoreira 5y ago
    It's also used to treat premature ejaculation. Side effects can be really useful in the right context.
  - FilMo 5y ago
    First of all, I need to say I always pay attention to all side effects indicated. I really treat with caution every prescription I get. As for Sertraline, I noticed that the generic one I got from https://www.canadapharmacy.com/ https://www.canadapharmacy.com/ has less sides than the branded one. Don't know why there is the difference, but it still calms me down a bit.
slowmotiony 5y ago
A different anecdotal experience from my own use (10mg Lexapro) - I've always had a problem with premature ejaculation. Was trying all kinds of tricks like doing math problems in my head during sex or trying different breathing techniques - all of that was useless, once I started taking Lexapro it's like it flipped some switch in my head and I can basically go as long as I like now, and finish almost on command. Absolute game changer, it's a fantastic improvement to my quality of life. I also take 5mg of Cialis daily, which definitely helps with erections.
- sizzle 5y ago
  Ummm I’m pretty sure the cialis is keeping the blood engorged where it needs to be. Why not try an experiment, lose the cialis and see if you can “keep it up” so to speak. (This is not medical advice, I’m speaking hypothetically fyi)
  - slowmotiony 5y ago
    No problem - the cialis is not really required, just makes it easier ;)
robbie-c 5y ago
This is interesting. I'm a founder of an app[1] that deals with this ballpark of issue, by providing (among other things) couples with sensate focus therapy, which is a form of sex therapy that has an extremely strong evidence base, and is a pretty standard go-to for libido issues. We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven. [1] https://www.blueheart.io https://www.blueheart.io
chilmers 5y ago
I took SSRIs for a year in my late twenties. They had no effect on my depression, but resulted in permanent sexual dysfunction. My own fault for not properly researching the potential long-term side effects, I suppose, but it certainly wasn't raised as an issue by the prescribing doctor either. I hope someday there will be cure of some kind.
- slowmotiony 5y ago
  Have you tested your hormone profile (blood test)? Testosterone, Free T, Estradiol, Prolactin, Progesterone, SHBG - you could check if all of those are in range because that might be the root cause of your issue. There were studies done where use of SSRIs was causing elevated levels of serum prolactin.
  - chilmers 5y ago
    Interesting, thanks. I did do a basic consumer blood test which reported my testosterone as "normal" (whatever that means), but I should probably do a more in-depth one and check these things.
    - slowmotiony 5y ago
      Yup, I strongly recommend you do at least the ones I mentioned above, it's possible that your issues could be very simple to fix.
    - iammisc 5y ago
      https://www.artofmanliness.com/health-fitness/health/how-to-increase-testosterone-naturally/ https://www.artofmanliness.com/health-fitness/health/how-to-... ^ has information on why 'normal' isn't a good range for everyone.
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      - stimpson_j_cat 5y ago
kayodelycaon 5y ago
I’ve had significant problems with my anti-psychotic before my psychiatrist and I found a proper mix. Given I frequently deal with hypersexuality, there was no way I’d stay on medication long term if that wasn’t fixed. For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.
Jaruzel 5y ago
My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush. So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really. Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;) As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.
- thrownaway561 5y ago
  this... when it comes to sex, we all need to have an understanding partner. you are very lucky to have such a person in your life.
- Perenti 5y ago
  I'm also on venlafaxine, and have been for years. I've recently (4 months) started MMJ for my chronic pain, and it seems to offset the sexual side effects of the Effexor: (1) I have a libido again (2) I always finish now (3) and it feels pretty damn good. The 3rd needs explanation for those who haven't experienced it; one nasty side effect is when you orgasm you ejaculate and feel NOTHING. It messes with the male psyche in a big way in my experience.
- tata71 5y ago
  Is this the only drug/treatment you've attempted to combat the dark well with? This is not medical advice, only anecdotal interest, but, have known many to leave SSRI for well-timed CBD oil. Wonder if issues requiring an SNRI are "similar" enough? Wishing you well!
  - diskzero 5y ago
mmastrac 5y ago
Interesting flip-side: the anti-depressant Tradazone can cause Priapism. I don't think we understand nearly enough about these systems, though I'd argue that anti-depressants are still a big net positive.
kortex 5y ago
PSSD seems to be in part mediated by desensitization of 5HTP1A receptors. Psychedelics are known to modulate 5HTP1A and increase plasticity of serotonin neurons. This would logically be another research avenue for psychedelics. I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success. We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.
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vimy 5y ago
Wellbutrin has the opposite effect. It makes you feel 15 years old again.
- kayodelycaon 5y ago
  That’s because Wellbrutin is an NDRI (norepinephrine–dopamine reuptake inhibitor). It’s a stimulant. It’s actually a third-line medication for ADHD and is sometimes used with other medications to counteract the sexual side-effects of other medications.
- tonyarkles 5y ago
  One thing I find super interesting is how that side effect is pretty inconsistent even in the same person. I’m currently on Wellbutrin/Zyban/Bupropion as a smoking cessation aid and am not having that side effect this time. But last time I was on it for the same reason… oooooohhhhh boy, yeah, it’s a good thing that I had a partner who was good with that!
  - antiterra 5y ago
    It’s possible some of the variation is from the specific manufacturer or manufacturing process. In the case of Wellbutrin XL, generic brands have even been recalled due to not being bioequivalent (https://www.medicinenet.com/script/main/art.asp?articlekey=165718 https://www.medicinenet.com/script/main/art.asp?articlekey=1...) I have been told by a doctor that effects appear inconsistent across brands or places of manufacture, even with non-recalled generics. You should always consult with your own medical professionals about your medication, but you can often ask for a different generic at the pharmacy.
    - tonyarkles 5y ago
      That is super super interesting, thank you!
Madmallard 5y ago
I wonder when we're going to find out better ways to alter the body without causing deleterious entropy. Surely pills and shots are not a solution for everything and are only present because of their easy testability. We need better methods and aggressive creative problem solving and the funding to incentive it.
symlinkk 5y ago
Has anyone taken SSRIs and actually thought it was worth it? I have severe social anxiety and I’m trying to decide if I should try medication or not.
- maxehmookau 5y ago
  Yes. I have been taking sertraline for over a decade and it has literally saved my life. I was able to become the person I always wanted to be without social anxiety overtaking my life at every corner. Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor. Good luck.
- prionassembly 5y ago
  Many many summers and a thousand years ago, I went to a pdoc to complain of anxiety issues. I left (after a good hour+ of talking) with a bipolar 2 diagnosis. The diagnosis was correct: at low doses, lamotrigine/Lamictal behaves like an antidepressant (and you have to taper in slowly to prevent bad reactions) and I flipped the fuck out in euphoric mania. I shortly after went on lithium and never regretted it. I started having dreams that seemed to resolve my deeper "psychoanalytical" issues. It really fixed me up. This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.
- slowmotiony 5y ago
  Yes, 100% worth it for me.
- superflit2 5y ago
  I am not saying it is not for you. But please consider alternatives as CBD or a healthier routine.
  - symlinkk 5y ago
    What makes CBD healthier necessarily? Curious of your viewpoint
jamal-kumar 5y ago
SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work? The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.
- Perenti 5y ago
  SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.
- pyronik19 5y ago
  SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.
  - romwell 5y ago
    I've had a very positive experience with SSRIs as well (Sertraline).
  - ironmagma 5y ago
    There are probably a number of other drugs that could have done that, though.
stefanwlb 5y ago
From another post about COVID treatment. Welcome to world wide sterilization. “If WHO recommends this, you will see it widely taken up,” said study co-author Dr. Edward Mills of McMaster University in Hamilton, Ontario, adding that many poor nations have the drug readily available. “We hope it will lead to a lot of lives saved.” The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck’s experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.
exdsq 5y ago
A big thanks to everyone commenting for helping normalise mens mental health <3
superflit2 5y ago
I will provide some AnecData. I am from a generation that when SSRI became available, it was a marvelous drug. Prescribed to teenagers freely and plentiful. Now on my peers of friends, we have many people who don't have any libido. The hardest-hit group was Women as they go to therapy more[1]. It is so huge we have Forums like "dead bedroom." Once a friend that took SSRI told me how she felt about sex: "I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore." "Brushing my teeth is more useful and fun than sex." I am not talking about sex partners that are not "competent" or good. It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time* The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.) So can we believe the mRNA vacuum is really safe? [1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27
- bongoman37 5y ago
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- iammisc 5y ago
  With women, birth control is the other obvious problem. My wife took birth control for a day or two in her twenties before we married, had the symptom, and threw the pills away. It's very sad. Women's sex drives are as strong as men's, and much stronger when ovulating.
Igelau 5y ago
Takes me a little longer on Zoloft. My psychiatrist and I agreed this is more of a good thing than a bad thing. The crippling anxiety I had without it was much worse for my libido. That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline. Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.
- mehphp 5y ago
  I'm not a doctor, but I'd caution against trying psychedelics at all if you had crippling anxiety before. I didn't realize just how bad my anxiety could get until after I did Psilocybin. It wasn't the root cause of my anxiety, of course, but it sure as hell exacerbated it to the point of being pretty debilitating. I'm now on 25mg of Sertraline, which has all but wiped out my anxiety.
ivraatiems 5y ago
I think this article is a little alarmist. Warnings like these scared me away from SSRIs for a long time despite their likely efficacy in helping treat my symptoms. I sent a number of articles like this one (and several of the medical publications it cites) to my psychiatrist. To her credit, she read them, and her response was that she agreed this kind of permanent change is possible, but it is extremely unlikely. (Anecdotally, she told me, she's treated thousands of people with SSRIs and had never had a report of something like this; she hadn't heard of it happening until I showed her case studies.) I don't think that means my doctor is ignorant - I think that means permanent damage is indeed likely very uncommon. Here is a write up from Lorien Psych (the day job of Scott Alexander at Slate Star Codex) that I think is evenhanded: https://lorienpsych.com/2020/10/25/ssris/ https://lorienpsych.com/2020/10/25/ssris/ Alexander has his issues, but this is an area where he's actually an expert and his approach to the topic helped me a lot. As for me, the benefits of a relatively low dose of an SSRI have really outweighed the risks so far.
- staticman2 5y ago
  Your psychiatrist may have had patients suffering from this that never told her. They would have discontinued the medication, terminated the doctor patient realationship, then waited for things to "go back to normal" when they were off the drug but found it never did. In fact they may have voiced concerns to her and she may have said "it will go back to normal if you discontinue the drug". But they never went off the drugs until they fired her as their doctor, so she would never know about the subsequent problems.
  - ivraatiems 5y ago
    That's possible but it's an awful lot of speculation. She also might have had lots of patients who did so well on SSRIs they stopped seeing her and just had their GP prescribe the medication from then on. Or all her patients might have overdosed on an unrelated drug and died. You can come up with lots of scenarios other than the most likely one. But this: > They would have discontinued the medication, terminated the doctor patient relationship, then waited for things to "go back to normal" when they were off the drug but found it never did. is not the way a good psychiatry practice (like the one I frequent, IMO) is designed to work. You try a lot of different things and you see what works. You're told upfront that this is part of the process and that if you don't like a medication, you don't have to keep taking it, and you should tell the doctor why and what you're open to trying next. I tried buspirone (which I still take), duloxetine (intolerable GI side effects; didn't take for long enough to experience anything sexual), and bupropion (too stimulating, not right for my condition) before I settled on citalopram. I had been specifically avoiding citalopram because I was scared of it, and I feel a little foolish for that now. So I think your scenario is unlikely in my case. I can't speak for other doctors.
agumonkey 5y ago
Anybody knows about the neurology of libido ? not the biomechanical sequence (attractive person -> nerve impulse -> blood flow etc) Talking about the higher representations of the other person's body, why proximity / touch causes all these mental discharges.
hellojesus 5y ago
I want to kill myself every second of every day, and it's been that way for 15ish years now. The only thing, fleeting as it may be, that I find worthy of doing in life is sex, and these ed side effects have kept me from exploring the potential for a world in which I don't to cease to exist or murder in the sake of nihilism. I'd rather destroy the lives of those around me or others' randomly than live without sex. It's just a function of my utility curve. Unfortunately and as counter intuitive as it may seem, I'm very cautious of skin to skin diseases such as hsv and hpv, which has kept me from hiring prostitutes, even though the only thing in life I want is exactly that.
- yosito 5y ago
  I'm sorry you feel that way. It sounds difficult. I believe there are many things that could help you find more pleasure in life and also find more fulfilling sex. I recommend searching for those things, and looking for people who can help you. But I'm actually commenting to point out that sex with a prostitute doesn't have to be risky, despite stereotypes. Most prostitutes are frequently tested for infectious diseases, and most will have no objection if you ask to see a recent clean test. Very very few prostitutes will have unprotected sex. And you could even find a less active prostitute who doesn't have sex with many people. The biggest risk is probably legality, depending on where you're based. But, assuming you have legal access to it, I would recommend seriously considering it. It's a fair exchange of something you have, for something you need that could really help you get what you want out of life. As long as it's between consenting adults, there is no problem with safely exploring this option. One note that I would recommend if you do pursue it is to also pursue personal growth at the same time, because few people find that sex with a prostitute was what they really wanted, and you may find that what you really want in life will take a lot of work to achieve.
  - hellojesus 5y ago
    Thank you for your response. I appreciate it. The problem I have concerning diseases and prostitutes is that, although many get tested often, almost all testing excludes hsv and hpv unless specifically requested. And since ~12% of the population carry hsv-2, which can shed asymptomatically and be contracted from skin-to-skin groinal contact, it seems that it's an eventuality if I pick up prostitution long term, and then it's for life. Condoms help, but they're not perfect. I asked on a forums once if prostitutes would be okay if I wore condom shorts such as the following link, and I was told that (1) the hobby was not for me, (2) the probability of contraction given the use of condoms is low enough not to be a consideration, and (3) the item probably wasn't tested under the same standards as condoms so probably isn't as safe (I figure latex material such as this would be a find physical barrier). https://m.aliexpress.com/item/1005001595057592.html?spm=a2g0n.productlist.0.0.5d617484SiKg6H&browser_id=a57269651b6a4331b7b6d3f243cf9a2a&aff_trace_key=&aff_platform=msite&m_page_id=00117cc83627931571e198c124b250b011a77f3aa1&gclid= https://m.aliexpress.com/item/1005001595057592.html?spm=a2g0... I'm still contemplating it but am having trouble digesting the sti risk. The legal risk doesn't bother me. Edit: auto-correct
n8cpdx 5y ago
As someone dating in their 20s, it is getting hard to find people who aren’t having SSRI-related dysfunction. Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.” They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween. They don’t actually solve the problem long term, you can’t really come off them ever (I know a lot of people who have tried; only one who succeeded and they were on an exceedingly low dose to begin with - it took six months before the frightening neurological symptoms subsided), and they permanently damage ability to have human connection (I don’t understand how that doesn’t worsen depression and anxiety long term). I get that I’m the asshole for suggesting that people take a second look at the side effect profile and consider whether these might be overprescribed. I get that they do make life better overall for some people. I’ve also seen my friends become psychotic and ruin their lives when they try to get off them (because the sexual side effects and weight gain were unbearable). So IDK, it feels urgent enough to raise as a concern. Especially when so many people are taking them. I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs. I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change. Walking 10k steps and CBT are useful interventions that can be easily monitored by physicians with modern technology. I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.
- FFRefresh 5y ago
  I do wonder if there's a culture-wide bug/meme with regards to mental health (and beyond) that makes it hard to push for lifestyle changes at scale. I think one such meme is around agency, with the underlying meme being that humans have no control over their circumstances or mental state. They have anxiety or they have depression. It's part of their identity, and these seem to be thought of as immutable diseases. And it's a social faux pas to suggest to someone with anxiety (particularly someone you are not super close with) that if they altered their behavior and consciously tried to work on their thought patterns, that they could get better. In our culture now, that gets translated as 'blaming the victim', because with a victim mindset, such a suggestion implies that it's the fault of the person. It's an unfortunate state of affairs. It feels like we are increasingly leaning into concepts such as an 'external locus of control' and 'learned helplessness' as a society. I don't know how we can push back on these ideas at scale, but if we don't, it's hard not seeing mental health issues and the externalities of the easy pharmacological solutions expand.
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bostik 5y ago
I must be a weird outlier. While I can agree with the article's opening ("Close to 100% of people who take antidepressants experience some form of sexual side effects") I can't, at least from personal experience, subscribe to the main message. As my wife can attest, when I was on SSRIs, I was hornier than usual.
taxyovio 5y ago
I posted this here in hope more people would be aware of the long term risks involved with SSRI, which are often not discussed from the doctors. These symptoms might only appear after the withdrawal. Some manufacturers and healthcare organisations are being to label this as a potential side effect. You can find a one line warning on NHS website now. People take the drug are usually desperate and at their most vulnerable periods in life. It’s very risky to make life-changing decisions, more so without complete knowledge. Doctors usually won’t even listen to cases of PSSD by simply attributing the SD as remission of depression. But there’re some recent studies on how SSRI could change neutral receptors in a non-reversible way, which could be the potential mechanism.
jonotime 5y ago
I did not realize even the short term affects where that prevalent. Terrified of the long term ones now. It definitely happened to me on citalopram. And now on escitalipram. I have been experimenting with adding DHEA and ginseng from my doc and I think its helping a bit.
a0-prw 5y ago
You shouldn't take any form of medication unless it's necessary to save your life. Period. Doctors are still mostly quacks, except in some exceptional circumstances
- wilsonnb3 5y ago
  This is absolute nonsense, there are literally millions if not billions of people living happier and better lives due to medications that they don't need to save their lives.
lkjfklajsdfpsdf 5y ago
I'm diagnosed with MDD. I was prescribed an SSRI and was not made aware or informed of the sexual side effects. Thankfully after quitting them my libido has restored but to the other extreme where I'm constantly horny.
sterlind 5y ago
Anecdote: I had severe OCD from childhood through my first year in college, triggered by separation from my parents (who never got me therapy despite extremely obvious signs.) I had multiple panic attacks per day resulting in depersonalization/derealization, I was failing my classes etc. Logically I knew that my mom wouldn't die if I didn't stop my room fan at its maximum rotation or if I didn't make the sign of the cross 2^n times. But mental illness is illogical. What "good coping skills" would fix that? Psych put me on Prozac, which numbed every feeling but panic, which it didn't touch. I got relief from a bad trip on 2C-E, in which I had such a severe panic attack that it permanently destroyed that identity and left me with depersonalization. The old me was dead, so over the following months I built a new one. OCD apparently got erased with the rest of me. I successfully went off Prozac by quitting it cold turkey and stayed off SSRIs for a decade. I guess the takeaway is: serious mental illness exists, platitudes about life wouldn't help, SSRIs didn't help either but didn't make me dependent, and psychedelics are a crapshoot.
efields 5y ago
I was prescribed cognitive behavioral therapy (CBT) and Prozac. The CBT did far more for me. I dumped the Prozac after a few months. I have bad days and good days, but I know how to get through the bad ones now. I know what prompts them and even when its hard to think positively I still know that I won't think things are as bad tomorrow. YMMV! A lot! As I get older I feel healthier when I move, touch people, give love and get love. In the US, we _do not prioritize health_, physical nor mental. We're surrounded by shit food. We're "insured" basic baseline function, and improvement often has to come out of our own time, energy, and money. If you're in a relaxed white collar environment, its easy to duck out for an hour of therapy. If you're on the clock, it's almost impossible. This is the bigger issue. Again, some ppl DO need SSRIs or they will harm themselves or others. But always pair with some form of talk therapy and get some daily exercise.
robbiex88 5y ago
In my early 20s (male) I was prescribed (read: pushed) citalopram by my family doctor. I took it for about a year. I'm in my early 30s now and sometimes STILL suffer from the inability to reach orgasm. I stopped taking the medication and when I realized it was in fact the medication interfering with my love life, and unfortunately realized too late. I've read alot about this after the fact and am surprised this reached HN. Nothing really to add to this conversation but its reassuring to know I'm not alone.
mzs 5y ago
I've experienced the sexual side effects. For me they lessened over time (going from mostly not being able to achieve climax to that rarely happening) and taking a lower dose helps. For those that are not at risk of seizures they can take bupropion as well to decrease the dose of the other SSRI further. But honestly sex is mostly in the brain and not finishing every time is only a drag if you think that it is. Personally I find it liberating, sex becomes a fun intimate pass time without an end goal. And certainly the benefits to my depression and anxiety out weigh the negatives for me.
Osiris 5y ago
For someone that suffers from premature ejaculation, these medications are extremely helpful. The trick is to get the right dose that improves your sexual endurance but doesn't prevent orgasm.
anon-guy 5y ago
I wish this article referenced the data used in the sentence where it claims certain facts. Such as the first sentence: “Close to 100% of people who take antidepressants experience some form of sexual side effects.” Says who? There are certain studies referenced but when other claims like the first sentence are made, I’d like to see where they got that conclusion.
marcobarco 5y ago
Can one sue a psychiatrist who prescribed me drugs not telling me about any side effects despite me not having any disease? The psychiatrist just concluded that if I have somatic problems and trouble sleeping I must be mental, turns it wasn't that. No one ever told me about any side effects (it won't hurt your liver I heard, you will remain cured even after stopping the treatment). I repeatedly told him I see no difference, and he interpreted unrelated life changes as results of the drugs. Or perhaps I could sue the company who produced it? More reading: https://en.wikipedia.org/wiki/Anti-psychiatry https://en.wikipedia.org/wiki/Anti-psychiatry https://www.goodreads.com/book/show/6943460-the-emperor-s-new-drugs https://www.goodreads.com/book/show/6943460-the-emperor-s-ne...

216 points by taxyovio 5y ago

Selective Serotonin Reuptake Inhibitor (SSRI) https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...

ghostbrainalpha 5y ago

People need to know that if you have Post SSRI sexual dysfunction, your body usually learns to work around it. Went I started SSRI's I didn't orgasm for 3 months, but learned how again. Also if you tell your doctor about the sexual dysfunction they will prescribe you Viagra, which I did not need but absolutely love using and overall sex + Viagra is way more fun than before I started SSRI's.

GoHydra 5y ago

Glad to see this finally getting attention. This is not what teenagers have in mind when they ask for "help".

theawesomekhan 5y ago

Seems I'm geo-blocked. My Location is Turkey.

ainar-g 5y ago
Same in Russia. Archive: https://web.archive.org/web/20210911150504/https://rxisk.org/post-ssri-sexual-dysfunction-pssd/ https://web.archive.org/web/20210911150504/https://rxisk.org...
chinathrow 5y ago
https://archive.md/wip/rG5st https://archive.md/wip/rG5st

cwwc 5y ago

Hmm.. a bum side effect especially since it looks like that SSRI antidepressant might be a treatment for covid.

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brunoTbear 5y ago

Anecdata: an ex experienced this on SSRIs. Was brutal on her and tough for me. A friend had the same issue. Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.

ljm 5y ago

This was one of the factors that made me think twice about going back on anti-depressants, until I made peace with the fact that my ability to orgasm wasn't going to pull me out of the hole I was in. It's a shitty choice but the desire to not be suicidal forces your hand. It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom. The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be. That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts. And make sure you have a therapist too.

ivraatiems 5y ago
Have you considered augmenting with something like Wellbutrin? Some people find it helps with the side effects. I've tried it myself and while I found it was too anxiety-inducing (I felt too keyed up) there's truth to that at least.
- ljm 5y ago
  No, not personally. I eventually was able to come off the medication. Took a couple of weeks to get back to some semblance of normal but I'm sure there's permanent damage still. That said, it's not easy to walk away from suicidal depression (and attempts to commit suicide) without a decent helping of trauma, and potentially even PTSD. So, of course, there isn't really a 'normal' to go back to once you've got the awareness of that and how far down the rabbit hole you fell. Normal becomes something else.
  - ivraatiems 5y ago
    Wellbutrin has no sexual side effects (the opposite, in fact) and is very effective for depression (but not anxiety). You might want to give it a try if you are still struggling. Of course, it comes with its own tapestry of possible issues. Either way, hope you are doing OK/OK enough.

wayoutthere 5y ago

Ugh. Yes. Not meaning to be crude here and I’m incredibly sympathetic to the men I date, but as a woman in her late 30s it’s hard to find a man my age who doesn’t have problems getting / keeping it up. Most of them link back to antidepressant use. What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?

Tade0 5y ago
> It hasn’t always been this way, has it? As a man in his 30s growing up I witnessed a shift in attitudes from "just man up" to "seek help", so there's that. If anything I would suggest humanity to give up dating apps. They're essentially making people feel inadequate and pay for the dubious privilege.
- wayoutthere 5y ago
  Dating apps are awful, but were a lot better once I challenged my standards (and lowered them a bit; I’m not the young hottie I used to be and that was a hard realization).
- prionassembly 5y ago
  Feeling inadequate is integral to the cherchez-la-femme experience. But it's probably better to be humiliated in night clubs (where eg. women sometimes will pretend not to even see you) than in apps; ego defense mechanisms have less of a chance there. Also: actually kissing tells you a lot that detailed self-reported profiles will never do -- the "chemistry" thing is real, sometimes two people find someone cute and stylish but the kissing doesn't work.
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ralusek 5y ago
Trouble in that department is also heavily impacted by men just generally being more sedentary, having poorer diets, and due to those reasons and more, having lower testosterone. Also, consuming pornography in much greater amounts than previously available to people is known to cause serious problems here.

michaelgrafl 5y ago

On the flipside, if you have problems with premature ejaculation, taking one of those might mitigate the issue. Not a doctor, by the way.

sigotirandolas 5y ago
Probably. Clomipramine, a TCA, is sometimes used for premature ejaculation.
jac241 5y ago
Yes they are indicated for that.

selexin 5y ago

I don’t usually post here, especially on such personal topics, but feel I should. I’ve been on SSRIs and SNRIs for some time now (Pristiq, and now Zolof), and can definitely attest to the some of the changes described in the article. I clearly remember reading the documentation in full that came with both drugs before starting each, and the mentioned side effects were only mentioned in passing, along with possibly every other side effect imaginable, so it was very easy to dismiss - especially when you are in a place you know you need help out of. There was also no real warning of long term side effects from both doctors that have prescribed me. I guess I don’t have any real point, other than if you are considering anti-depressants do more research than I did before taking what you’ve been prescribed - and if in doubt get answers from your doctor, and failing that find a better doctor (if you can).

haolez 5y ago
In my case (Pristiq), it was a net positive. My libido decreased (but never desapeared) and I've never had erectile disfuncion so far. Totally worth it for me, with my specific metabolism.
xattt 5y ago
Sertraline (Zoloft) often causes more sexual side effects in males than it does in females. I have seen this used at the max dose to control hypersexual behaviour in a patient with dementia.
- matheusmoreira 5y ago
  It's also used to treat premature ejaculation. Side effects can be really useful in the right context.
- FilMo 5y ago
  First of all, I need to say I always pay attention to all side effects indicated. I really treat with caution every prescription I get. As for Sertraline, I noticed that the generic one I got from https://www.canadapharmacy.com/ https://www.canadapharmacy.com/ has less sides than the branded one. Don't know why there is the difference, but it still calms me down a bit.

slowmotiony 5y ago

A different anecdotal experience from my own use (10mg Lexapro) - I've always had a problem with premature ejaculation. Was trying all kinds of tricks like doing math problems in my head during sex or trying different breathing techniques - all of that was useless, once I started taking Lexapro it's like it flipped some switch in my head and I can basically go as long as I like now, and finish almost on command. Absolute game changer, it's a fantastic improvement to my quality of life. I also take 5mg of Cialis daily, which definitely helps with erections.

sizzle 5y ago
Ummm I’m pretty sure the cialis is keeping the blood engorged where it needs to be. Why not try an experiment, lose the cialis and see if you can “keep it up” so to speak. (This is not medical advice, I’m speaking hypothetically fyi)
- slowmotiony 5y ago
  No problem - the cialis is not really required, just makes it easier ;)

robbie-c 5y ago

This is interesting. I'm a founder of an app[1] that deals with this ballpark of issue, by providing (among other things) couples with sensate focus therapy, which is a form of sex therapy that has an extremely strong evidence base, and is a pretty standard go-to for libido issues. We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven. [1] https://www.blueheart.io https://www.blueheart.io

chilmers 5y ago

I took SSRIs for a year in my late twenties. They had no effect on my depression, but resulted in permanent sexual dysfunction. My own fault for not properly researching the potential long-term side effects, I suppose, but it certainly wasn't raised as an issue by the prescribing doctor either. I hope someday there will be cure of some kind.

slowmotiony 5y ago
Have you tested your hormone profile (blood test)? Testosterone, Free T, Estradiol, Prolactin, Progesterone, SHBG - you could check if all of those are in range because that might be the root cause of your issue. There were studies done where use of SSRIs was causing elevated levels of serum prolactin.
- chilmers 5y ago
  Interesting, thanks. I did do a basic consumer blood test which reported my testosterone as "normal" (whatever that means), but I should probably do a more in-depth one and check these things.
  - slowmotiony 5y ago
    Yup, I strongly recommend you do at least the ones I mentioned above, it's possible that your issues could be very simple to fix.
  - iammisc 5y ago
    https://www.artofmanliness.com/health-fitness/health/how-to-increase-testosterone-naturally/ https://www.artofmanliness.com/health-fitness/health/how-to-... ^ has information on why 'normal' isn't a good range for everyone.
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    - stimpson_j_cat 5y ago

kayodelycaon 5y ago

I’ve had significant problems with my anti-psychotic before my psychiatrist and I found a proper mix. Given I frequently deal with hypersexuality, there was no way I’d stay on medication long term if that wasn’t fixed. For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.

Jaruzel 5y ago

My personal anecdote: I'm on Venlafaxine which is an SNRI (also cited in the article), and I definitely suffer some of those side-effects. It sucks. At times it makes me want to shy away from sex completely. Other times I think I'm doing OK, only to find out I can't finish, or I finish weakly with no adrenalin rush. So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really. Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;) As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.

thrownaway561 5y ago
this... when it comes to sex, we all need to have an understanding partner. you are very lucky to have such a person in your life.
Perenti 5y ago
I'm also on venlafaxine, and have been for years. I've recently (4 months) started MMJ for my chronic pain, and it seems to offset the sexual side effects of the Effexor: (1) I have a libido again (2) I always finish now (3) and it feels pretty damn good. The 3rd needs explanation for those who haven't experienced it; one nasty side effect is when you orgasm you ejaculate and feel NOTHING. It messes with the male psyche in a big way in my experience.
tata71 5y ago
Is this the only drug/treatment you've attempted to combat the dark well with? This is not medical advice, only anecdotal interest, but, have known many to leave SSRI for well-timed CBD oil. Wonder if issues requiring an SNRI are "similar" enough? Wishing you well!
- diskzero 5y ago

mmastrac 5y ago

Interesting flip-side: the anti-depressant Tradazone can cause Priapism. I don't think we understand nearly enough about these systems, though I'd argue that anti-depressants are still a big net positive.

kortex 5y ago

PSSD seems to be in part mediated by desensitization of 5HTP1A receptors. Psychedelics are known to modulate 5HTP1A and increase plasticity of serotonin neurons. This would logically be another research avenue for psychedelics. I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success. We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.

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vimy 5y ago

Wellbutrin has the opposite effect. It makes you feel 15 years old again.

kayodelycaon 5y ago
That’s because Wellbrutin is an NDRI (norepinephrine–dopamine reuptake inhibitor). It’s a stimulant. It’s actually a third-line medication for ADHD and is sometimes used with other medications to counteract the sexual side-effects of other medications.
tonyarkles 5y ago
One thing I find super interesting is how that side effect is pretty inconsistent even in the same person. I’m currently on Wellbutrin/Zyban/Bupropion as a smoking cessation aid and am not having that side effect this time. But last time I was on it for the same reason… oooooohhhhh boy, yeah, it’s a good thing that I had a partner who was good with that!
- antiterra 5y ago
  It’s possible some of the variation is from the specific manufacturer or manufacturing process. In the case of Wellbutrin XL, generic brands have even been recalled due to not being bioequivalent (https://www.medicinenet.com/script/main/art.asp?articlekey=165718 https://www.medicinenet.com/script/main/art.asp?articlekey=1...) I have been told by a doctor that effects appear inconsistent across brands or places of manufacture, even with non-recalled generics. You should always consult with your own medical professionals about your medication, but you can often ask for a different generic at the pharmacy.
  - tonyarkles 5y ago
    That is super super interesting, thank you!

Madmallard 5y ago

I wonder when we're going to find out better ways to alter the body without causing deleterious entropy. Surely pills and shots are not a solution for everything and are only present because of their easy testability. We need better methods and aggressive creative problem solving and the funding to incentive it.

symlinkk 5y ago

Has anyone taken SSRIs and actually thought it was worth it? I have severe social anxiety and I’m trying to decide if I should try medication or not.

maxehmookau 5y ago
Yes. I have been taking sertraline for over a decade and it has literally saved my life. I was able to become the person I always wanted to be without social anxiety overtaking my life at every corner. Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor. Good luck.
prionassembly 5y ago
Many many summers and a thousand years ago, I went to a pdoc to complain of anxiety issues. I left (after a good hour+ of talking) with a bipolar 2 diagnosis. The diagnosis was correct: at low doses, lamotrigine/Lamictal behaves like an antidepressant (and you have to taper in slowly to prevent bad reactions) and I flipped the fuck out in euphoric mania. I shortly after went on lithium and never regretted it. I started having dreams that seemed to resolve my deeper "psychoanalytical" issues. It really fixed me up. This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.
slowmotiony 5y ago
Yes, 100% worth it for me.
superflit2 5y ago
I am not saying it is not for you. But please consider alternatives as CBD or a healthier routine.
- symlinkk 5y ago
  What makes CBD healthier necessarily? Curious of your viewpoint

jamal-kumar 5y ago

SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work? The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.

Perenti 5y ago
SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.
pyronik19 5y ago
SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.
- romwell 5y ago
  I've had a very positive experience with SSRIs as well (Sertraline).
- ironmagma 5y ago
  There are probably a number of other drugs that could have done that, though.

stefanwlb 5y ago

From another post about COVID treatment. Welcome to world wide sterilization. “If WHO recommends this, you will see it widely taken up,” said study co-author Dr. Edward Mills of McMaster University in Hamilton, Ontario, adding that many poor nations have the drug readily available. “We hope it will lead to a lot of lives saved.” The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck’s experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.

exdsq 5y ago

A big thanks to everyone commenting for helping normalise mens mental health <3

superflit2 5y ago

I will provide some AnecData. I am from a generation that when SSRI became available, it was a marvelous drug. Prescribed to teenagers freely and plentiful. Now on my peers of friends, we have many people who don't have any libido. The hardest-hit group was Women as they go to therapy more[1]. It is so huge we have Forums like "dead bedroom." Once a friend that took SSRI told me how she felt about sex: "I am looking forward to when my husband reaches his 40s, so he does not bother me about sex anymore." "Brushing my teeth is more useful and fun than sex." I am not talking about sex partners that are not "competent" or good. It is like you never felt hungry or willing to eat. But then you *have* to eat, and when you are tasting the food, it is like cardboard * every time* The concerning part is that our PharmaCo does this every ten years. (Thalidomide, SSRIs, etc.) So can we believe the mRNA vacuum is really safe? [1] - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937254/#R27

bongoman37 5y ago
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iammisc 5y ago
With women, birth control is the other obvious problem. My wife took birth control for a day or two in her twenties before we married, had the symptom, and threw the pills away. It's very sad. Women's sex drives are as strong as men's, and much stronger when ovulating.

Igelau 5y ago

Takes me a little longer on Zoloft. My psychiatrist and I agreed this is more of a good thing than a bad thing. The crippling anxiety I had without it was much worse for my libido. That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline. Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.

mehphp 5y ago
I'm not a doctor, but I'd caution against trying psychedelics at all if you had crippling anxiety before. I didn't realize just how bad my anxiety could get until after I did Psilocybin. It wasn't the root cause of my anxiety, of course, but it sure as hell exacerbated it to the point of being pretty debilitating. I'm now on 25mg of Sertraline, which has all but wiped out my anxiety.

ivraatiems 5y ago

I think this article is a little alarmist. Warnings like these scared me away from SSRIs for a long time despite their likely efficacy in helping treat my symptoms. I sent a number of articles like this one (and several of the medical publications it cites) to my psychiatrist. To her credit, she read them, and her response was that she agreed this kind of permanent change is possible, but it is extremely unlikely. (Anecdotally, she told me, she's treated thousands of people with SSRIs and had never had a report of something like this; she hadn't heard of it happening until I showed her case studies.) I don't think that means my doctor is ignorant - I think that means permanent damage is indeed likely very uncommon. Here is a write up from Lorien Psych (the day job of Scott Alexander at Slate Star Codex) that I think is evenhanded: https://lorienpsych.com/2020/10/25/ssris/ https://lorienpsych.com/2020/10/25/ssris/ Alexander has his issues, but this is an area where he's actually an expert and his approach to the topic helped me a lot. As for me, the benefits of a relatively low dose of an SSRI have really outweighed the risks so far.

staticman2 5y ago
Your psychiatrist may have had patients suffering from this that never told her. They would have discontinued the medication, terminated the doctor patient realationship, then waited for things to "go back to normal" when they were off the drug but found it never did. In fact they may have voiced concerns to her and she may have said "it will go back to normal if you discontinue the drug". But they never went off the drugs until they fired her as their doctor, so she would never know about the subsequent problems.
- ivraatiems 5y ago
  That's possible but it's an awful lot of speculation. She also might have had lots of patients who did so well on SSRIs they stopped seeing her and just had their GP prescribe the medication from then on. Or all her patients might have overdosed on an unrelated drug and died. You can come up with lots of scenarios other than the most likely one. But this: > They would have discontinued the medication, terminated the doctor patient relationship, then waited for things to "go back to normal" when they were off the drug but found it never did. is not the way a good psychiatry practice (like the one I frequent, IMO) is designed to work. You try a lot of different things and you see what works. You're told upfront that this is part of the process and that if you don't like a medication, you don't have to keep taking it, and you should tell the doctor why and what you're open to trying next. I tried buspirone (which I still take), duloxetine (intolerable GI side effects; didn't take for long enough to experience anything sexual), and bupropion (too stimulating, not right for my condition) before I settled on citalopram. I had been specifically avoiding citalopram because I was scared of it, and I feel a little foolish for that now. So I think your scenario is unlikely in my case. I can't speak for other doctors.

agumonkey 5y ago

Anybody knows about the neurology of libido ? not the biomechanical sequence (attractive person -> nerve impulse -> blood flow etc) Talking about the higher representations of the other person's body, why proximity / touch causes all these mental discharges.

hellojesus 5y ago

I want to kill myself every second of every day, and it's been that way for 15ish years now. The only thing, fleeting as it may be, that I find worthy of doing in life is sex, and these ed side effects have kept me from exploring the potential for a world in which I don't to cease to exist or murder in the sake of nihilism. I'd rather destroy the lives of those around me or others' randomly than live without sex. It's just a function of my utility curve. Unfortunately and as counter intuitive as it may seem, I'm very cautious of skin to skin diseases such as hsv and hpv, which has kept me from hiring prostitutes, even though the only thing in life I want is exactly that.

yosito 5y ago
I'm sorry you feel that way. It sounds difficult. I believe there are many things that could help you find more pleasure in life and also find more fulfilling sex. I recommend searching for those things, and looking for people who can help you. But I'm actually commenting to point out that sex with a prostitute doesn't have to be risky, despite stereotypes. Most prostitutes are frequently tested for infectious diseases, and most will have no objection if you ask to see a recent clean test. Very very few prostitutes will have unprotected sex. And you could even find a less active prostitute who doesn't have sex with many people. The biggest risk is probably legality, depending on where you're based. But, assuming you have legal access to it, I would recommend seriously considering it. It's a fair exchange of something you have, for something you need that could really help you get what you want out of life. As long as it's between consenting adults, there is no problem with safely exploring this option. One note that I would recommend if you do pursue it is to also pursue personal growth at the same time, because few people find that sex with a prostitute was what they really wanted, and you may find that what you really want in life will take a lot of work to achieve.
- hellojesus 5y ago
  Thank you for your response. I appreciate it. The problem I have concerning diseases and prostitutes is that, although many get tested often, almost all testing excludes hsv and hpv unless specifically requested. And since ~12% of the population carry hsv-2, which can shed asymptomatically and be contracted from skin-to-skin groinal contact, it seems that it's an eventuality if I pick up prostitution long term, and then it's for life. Condoms help, but they're not perfect. I asked on a forums once if prostitutes would be okay if I wore condom shorts such as the following link, and I was told that (1) the hobby was not for me, (2) the probability of contraction given the use of condoms is low enough not to be a consideration, and (3) the item probably wasn't tested under the same standards as condoms so probably isn't as safe (I figure latex material such as this would be a find physical barrier). https://m.aliexpress.com/item/1005001595057592.html?spm=a2g0n.productlist.0.0.5d617484SiKg6H&browser_id=a57269651b6a4331b7b6d3f243cf9a2a&aff_trace_key=&aff_platform=msite&m_page_id=00117cc83627931571e198c124b250b011a77f3aa1&gclid= https://m.aliexpress.com/item/1005001595057592.html?spm=a2g0... I'm still contemplating it but am having trouble digesting the sti risk. The legal risk doesn't bother me. Edit: auto-correct

n8cpdx 5y ago

As someone dating in their 20s, it is getting hard to find people who aren’t having SSRI-related dysfunction. Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.” They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween. They don’t actually solve the problem long term, you can’t really come off them ever (I know a lot of people who have tried; only one who succeeded and they were on an exceedingly low dose to begin with - it took six months before the frightening neurological symptoms subsided), and they permanently damage ability to have human connection (I don’t understand how that doesn’t worsen depression and anxiety long term). I get that I’m the asshole for suggesting that people take a second look at the side effect profile and consider whether these might be overprescribed. I get that they do make life better overall for some people. I’ve also seen my friends become psychotic and ruin their lives when they try to get off them (because the sexual side effects and weight gain were unbearable). So IDK, it feels urgent enough to raise as a concern. Especially when so many people are taking them. I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs. I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change. Walking 10k steps and CBT are useful interventions that can be easily monitored by physicians with modern technology. I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.

FFRefresh 5y ago
I do wonder if there's a culture-wide bug/meme with regards to mental health (and beyond) that makes it hard to push for lifestyle changes at scale. I think one such meme is around agency, with the underlying meme being that humans have no control over their circumstances or mental state. They have anxiety or they have depression. It's part of their identity, and these seem to be thought of as immutable diseases. And it's a social faux pas to suggest to someone with anxiety (particularly someone you are not super close with) that if they altered their behavior and consciously tried to work on their thought patterns, that they could get better. In our culture now, that gets translated as 'blaming the victim', because with a victim mindset, such a suggestion implies that it's the fault of the person. It's an unfortunate state of affairs. It feels like we are increasingly leaning into concepts such as an 'external locus of control' and 'learned helplessness' as a society. I don't know how we can push back on these ideas at scale, but if we don't, it's hard not seeing mental health issues and the externalities of the easy pharmacological solutions expand.

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bostik 5y ago

I must be a weird outlier. While I can agree with the article's opening ("Close to 100% of people who take antidepressants experience some form of sexual side effects") I can't, at least from personal experience, subscribe to the main message. As my wife can attest, when I was on SSRIs, I was hornier than usual.

taxyovio 5y ago

I posted this here in hope more people would be aware of the long term risks involved with SSRI, which are often not discussed from the doctors. These symptoms might only appear after the withdrawal. Some manufacturers and healthcare organisations are being to label this as a potential side effect. You can find a one line warning on NHS website now. People take the drug are usually desperate and at their most vulnerable periods in life. It’s very risky to make life-changing decisions, more so without complete knowledge. Doctors usually won’t even listen to cases of PSSD by simply attributing the SD as remission of depression. But there’re some recent studies on how SSRI could change neutral receptors in a non-reversible way, which could be the potential mechanism.

jonotime 5y ago

I did not realize even the short term affects where that prevalent. Terrified of the long term ones now. It definitely happened to me on citalopram. And now on escitalipram. I have been experimenting with adding DHEA and ginseng from my doc and I think its helping a bit.

a0-prw 5y ago

You shouldn't take any form of medication unless it's necessary to save your life. Period. Doctors are still mostly quacks, except in some exceptional circumstances

wilsonnb3 5y ago
This is absolute nonsense, there are literally millions if not billions of people living happier and better lives due to medications that they don't need to save their lives.

lkjfklajsdfpsdf 5y ago

I'm diagnosed with MDD. I was prescribed an SSRI and was not made aware or informed of the sexual side effects. Thankfully after quitting them my libido has restored but to the other extreme where I'm constantly horny.

sterlind 5y ago

Anecdote: I had severe OCD from childhood through my first year in college, triggered by separation from my parents (who never got me therapy despite extremely obvious signs.) I had multiple panic attacks per day resulting in depersonalization/derealization, I was failing my classes etc. Logically I knew that my mom wouldn't die if I didn't stop my room fan at its maximum rotation or if I didn't make the sign of the cross 2^n times. But mental illness is illogical. What "good coping skills" would fix that? Psych put me on Prozac, which numbed every feeling but panic, which it didn't touch. I got relief from a bad trip on 2C-E, in which I had such a severe panic attack that it permanently destroyed that identity and left me with depersonalization. The old me was dead, so over the following months I built a new one. OCD apparently got erased with the rest of me. I successfully went off Prozac by quitting it cold turkey and stayed off SSRIs for a decade. I guess the takeaway is: serious mental illness exists, platitudes about life wouldn't help, SSRIs didn't help either but didn't make me dependent, and psychedelics are a crapshoot.

efields 5y ago

I was prescribed cognitive behavioral therapy (CBT) and Prozac. The CBT did far more for me. I dumped the Prozac after a few months. I have bad days and good days, but I know how to get through the bad ones now. I know what prompts them and even when its hard to think positively I still know that I won't think things are as bad tomorrow. YMMV! A lot! As I get older I feel healthier when I move, touch people, give love and get love. In the US, we _do not prioritize health_, physical nor mental. We're surrounded by shit food. We're "insured" basic baseline function, and improvement often has to come out of our own time, energy, and money. If you're in a relaxed white collar environment, its easy to duck out for an hour of therapy. If you're on the clock, it's almost impossible. This is the bigger issue. Again, some ppl DO need SSRIs or they will harm themselves or others. But always pair with some form of talk therapy and get some daily exercise.

robbiex88 5y ago

In my early 20s (male) I was prescribed (read: pushed) citalopram by my family doctor. I took it for about a year. I'm in my early 30s now and sometimes STILL suffer from the inability to reach orgasm. I stopped taking the medication and when I realized it was in fact the medication interfering with my love life, and unfortunately realized too late. I've read alot about this after the fact and am surprised this reached HN. Nothing really to add to this conversation but its reassuring to know I'm not alone.

mzs 5y ago

I've experienced the sexual side effects. For me they lessened over time (going from mostly not being able to achieve climax to that rarely happening) and taking a lower dose helps. For those that are not at risk of seizures they can take bupropion as well to decrease the dose of the other SSRI further. But honestly sex is mostly in the brain and not finishing every time is only a drag if you think that it is. Personally I find it liberating, sex becomes a fun intimate pass time without an end goal. And certainly the benefits to my depression and anxiety out weigh the negatives for me.

Osiris 5y ago

For someone that suffers from premature ejaculation, these medications are extremely helpful. The trick is to get the right dose that improves your sexual endurance but doesn't prevent orgasm.

anon-guy 5y ago

I wish this article referenced the data used in the sentence where it claims certain facts. Such as the first sentence: “Close to 100% of people who take antidepressants experience some form of sexual side effects.” Says who? There are certain studies referenced but when other claims like the first sentence are made, I’d like to see where they got that conclusion.

marcobarco 5y ago

Can one sue a psychiatrist who prescribed me drugs not telling me about any side effects despite me not having any disease? The psychiatrist just concluded that if I have somatic problems and trouble sleeping I must be mental, turns it wasn't that. No one ever told me about any side effects (it won't hurt your liver I heard, you will remain cured even after stopping the treatment). I repeatedly told him I see no difference, and he interpreted unrelated life changes as results of the drugs. Or perhaps I could sue the company who produced it? More reading: https://en.wikipedia.org/wiki/Anti-psychiatry https://en.wikipedia.org/wiki/Anti-psychiatry https://www.goodreads.com/book/show/6943460-the-emperor-s-new-drugs https://www.goodreads.com/book/show/6943460-the-emperor-s-ne...