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Contested evidence

Post-SSRI sexual dysfunction (PSSD)

Persistent syndrome·Medication side-effects
⚠ Critical

Recognized by the European Medicines Agency's Pharmacovigilance Risk Assessment Committee (2019): sexual dysfunction can be long-lasting in some patients even after treatment stops. Prevalence is unknown due to underreporting.

Effect across the cycle

DesireInhibitory: Persistent loss of libido after discontinuation.
ArousalInhibitory: Persistent impaired arousal and genital anesthesia.
PerformanceInhibitory: Persistent erectile dysfunction reported.
ClimaxInhibitory: Orgasmic and ejaculatory anhedonia.
ExperienceInhibitory: Emotional blunting may persist alongside sexual symptoms.
MemoryInsufficient: Not a defining feature.

Mechanism

Iatrogenic syndrome in which genital anesthesia, erectile/orgasmic dysfunction and loss of libido persist after SSRIs/SNRIs are stopped. Proposed mechanisms include epigenetic gene-expression changes, dopamine–serotonin dysregulation, 5-HT1A downregulation and altered neuroplasticity.

Pharmacokinetics
Can follow even brief exposure; duration unknown, sometimes long-lasting.
Reversibility
By definition persistent; poorly understood, no established treatment.

Sex differences & notes

Affects both sexes.

Key sources

  • EMA PRAC recognition, 11 June 2019
  • PubMed 34627736 (biological plausibility)