PSSD: The Devastating Sexual and Emotional Side Effect of Antidepressants
The BBC’s recent documentary Our Silent Emergency rightly drew plaudits for its openness about male mental health, with some of the biggest praise reserved for the moment presenter Roman Kemp was shown taking Sertraline (also know by its brand name, Zoloft). Filmed as part of his daily routine, he explained how he’d been on the SSRI antidepressant for 12 years to help combat his depression. Just a few weeks prior, Olly Alexander — singer and star of breakout TV hit “It’s A Sin” — spoke to The Guardian about the same drug, enthusing “I was worried about long-term use and the doctor said ‘well, the latest research shows it can promote neurogenesis’ and I was like, that’s the coolest thing. I’ll keep taking them forever.”
If the opponent is shame, then the decades-long battle for antidepressants would (and should) appear close to being won. A new generation of young men being open about their experience is a positive thing and — initially at least — it feels like another step towards improved mental health for all. But what if, in the rush to end the stigma around using antidepressants in the first place, the very real risks of taking them — and perhaps more importantly stopping them — are being overlooked?
Most people will probably have a very vague notion that sex drive can be affected by antidepressants, but historically the impact has been played down, couched in soft terms like “reduced libido”. Others will consider any problems of that nature to be limited to time spent on the drug. The correlation between sexual dysfunction and human emotions is not widely acknowledged to be strong. However, the emergence of a devastating condition called PSSD blows away all of these preconceptions.
PSSD (Post-SSRI-Sexual-Dysfunction) is an iatrogenic condition that until very recently has existed in the margins, yet sexual difficulties during and after treatment with SSRIs (the group of antidepressant that includes Sertraline) were first reported as far back as 1991. By 2006 these symptoms had acquired their acronym and in May 2019 the condition was at last formally recognised by the European Medicines Agency.
As often with little-known conditions the name is unhelpful. Firstly it suggests that SSRIs are the only cause, when another group of antidepressants — SNRIs — are also culpable. Secondly, the implication is that it “only” causes sexual problems (although symptoms that can range from genital anaesthesia to the inability to orgasm would be enough for most people to contend with) and fails to represent properly the other life-changing havoc wreaked in the form of anhedonia (the inability to feel pleasure), emotional blunting, apathy, akathisia (a movement disorder that makes it difficult to sit still), plus memory and cognitive problems.
Not everyone is affected, either on or coming off the drug (a 2001 survey, however, found that 40% of patients even after ending treatment had broadly intolerable sexual side effects) but it’s this latter part of the process that is perhaps most misunderstood. Up until October 2019 the NICE guidelines still stated that withdrawal symptoms from antidepressants were mild and self-resolving within 7–14 days, something which — if they could still laugh — would’ve been met with howls of derision from those suffering from what is known as PWS (Protracted Withdrawal Syndrome), most of whom were tapered off these drugs far too fast by their doctors resulting in severe long-term symptoms.
In a study entitled ‘Protracted Withdrawal Syndrome after stopping taking antidepressants’ released earlier this year it was found that antidepressants “of all types may incur protracted withdrawal potentially lasting months to many years” and that PWS represents a “severe and debilitating condition, which can lead even to suicide”. One case told of a woman who repeatedly “expressed distress about her ongoing sexual dysfunction” (PSSD) which had persisted for 38 months. Her final post via an online support forum came in October 2019, “‘To be honest, now I’m in absolute hell. I don’t see much hope in this situation any more. It’s been 3 + years and I’m still in pretty much the same situation. I don’t know how much longer I’ll be here honestly.’ The following day she killed herself. She had recently turned 21 years-old.”
As well as being one of the most debilitating symptoms of withdrawal, PSSD is also one of the most lengthy (there are reports of people suffering for 10, 15, 20 years without respite). There is no known cure for it. Although there are accounts of people recovering quicker, for others the picture is bleak, with one sufferer telling Psychology Today, “I am a 30-year-old woman with PSSD for over 4 years after citalopram suspension. There was nothing more traumatic in my life than losing the sexuality that had always grown with me. I can no longer feel excitement or pleasure. I did not receive honest information on the harms or informed consent. My original illness was nothing compared to all the new symptoms brought on by antidepressants and withdrawal. SNRI and SSRI medications have left me feeling permanently chemically lobotomised and castrated.”
More than six million people in England received antidepressants in the three months leading up to September last year. So what can be done to avoid an epidemic? While NICE have now changed their guidelines on antidepressant withdrawal to “Severe and lengthy” they still do not recognise PSSD as a medical condition (neither do the Department of Health and the NHS) and this needs to change. Educating mainstream media is equally important. While Kemp and Alexander’s openness is welcome, the latter’s concern over long-term use is just one myth that needs busting — PSSD can be contracted after only a few days exposure to an antidepressant. The former’s documentary, brilliant as it was, at times spoke in cliches such as “Men don’t talk” and “There’s a solution to every problem” which simply raises more questions. What if you ask for help and there’s no solution? And what if — to coin a phrase — it’s the help that kills you?
