After Stopping Antidepressants, Sex Problems May Persist

Back in 1993, at age 37, Audrey Bahrick, Ph.D., then a psychologist at the University of Iowa, hit an emotional rough patch and started taking Prozac, one of several selective serotonin uptake inhibitors (SSRIs), the most widely prescribed class of antidepressants. As soon as she started taking it, like more than half of SSRI users, Bahrick began experiencing sexual side effects, including stifled sensation.

Bahrick was well aware that SSRIs cause sexual side effects. That had been widely reported in the research literature and mass media. But like most people who take SSRIs, Bahrick felt the trade-off was worth it. Prozac pulled her out of her emotional tailspin. Its sexual side effects were a drag, but the drug reduced her risk of depression’s potentially fatal result, suicidal thoughts and attempts. She figured her sexuality would return to normal soon after she stopped taking the drug.

After two years on Prozac, Bahrick stopped taking it, but her sexuality did not return to normal. Her sex problems persisted. She had what is now increasingly called post-SSRI sexual dysfunction (PSSD).

Recognition Took Years

Bahrick’s PSSD started in 1995. She thought she was the only one. But she was a psychologist who read the research literature. Every now and then, a similar case report appeared. By 2006, Bahrick had collected a handful of case reports of people who had quit SSRIs but continued to suffer debilitating sexual side effects. She wrote an article that was published in a newsletter of the American Psychological Association. She wrote: “I believe we have barely begun to appreciate the pervasiveness and complexity of these medications' impact on sexuality.”

Many psychologists took issue with her report. They contended that lingering post-SSRI sexual dysfunction reflected not a new syndrome, but rather a recurrence of depression that manifested as the illness often does with a loss of libido, difficulties with arousal, and inability to work up to orgasm. Their prescription—more antidepressants to treat presumptive recurrent depression.

Years passed and Bahrick’s sexuality never returned to her pre-Prozac baseline. Case reports of PSSD continued to find their way into psychological journals. But no studies focused on the issue largely because the Food and Drug Administration does not require pharmaceutical companies to study what happens after people stop taking drugs.

From Anecdotes to Studies and Organizations

The steady trickle of case reports spurred some researchers to coin the label “post-SSRI sexual dysfunction” in 2006, and specify its symptoms, which parallel those that result from taking SSRIs: decreased libido, loss of sensation, loss of lubrication, erectile dysfunction, and difficulty surrounding orgasms. Subsequently, a few researchers investigated the issue. The first article was published in 2017. PSSD is still not an official psychological condition, but sufficient evidence has accumulated for researchers in the field to believe there’s more to PSSD than simply recurrent depression:

• Bahrick’s continuing studies suggest that the prevalence of PSSD may be as high as 10 percent.
• In 2014, investigators in Canada and the UK reported 120 cases of PSSD, the large majority in men who suffered long-term erection inhibition.
• Israeli researchers tracked a large number of men who had stopped taking SSRIs. They were prescribed erection medications at a rate three times that of the general male population, suggesting that after stopping SSRIs. some former users suffer persistent sex problems.
• In 2019, in response to numerous case reports, the European Medicines Agency, a part of the European Union, required SSRI labels to include a warning about possible PSSD. (As I write, the FDA has taken no similar action.)
• In 2022, PSSD sufferers launched an organization based in Australia, the PSSD Network.
• A Reddit forum devoted to post-SSRI sex problems launched in 2019. By 2023, it had 10,000 members.

What To Do

Where do these findings leave people who suspect they may have PSSD? Here are some things to try.

• Discuss your situation with the doctor who prescribed your antidepressant. Not to berate anyone—the drug may have saved your life—but to check in and see what, if anything, your doctor knows about PSSD. Don’t be surprised if you know more. PSSD is not an official condition, so it’s not grist for continuing education programs. Your doctor may well express skepticism. That’s the price of having a still-unofficial condition. Urge your physician to read the references accompanying this post. Try to be patient as your doctor learns about it. Dealing with PSSD is a marathon, not a sprint.
• Live a healthy, sexually optimized lifestyle. A healthy lifestyle is pro-sexual. It minimizes foods that hurt sexuality (junk foods, fast foods, and high-fat items including meats and whole-milk dairy items), while maximizing foods that support optimal health and sexual function (fresh fruits and vegetables).
• Do more of what gives you pleasure. It’s very sad that you’re struggling with with chronic sex problems, but try not to let that define you. As much as possible, enjoy yourself. Explore new ways to do that.