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Cited by 167Sexual function and dysfunction studiesSexuality, Behavior, and TechnologySchizophrenia research and treatment

Post-SSRI Sexual Dysfunction: A Literature Review

Bala, Areeg, Nguyen, Hoang Minh Tue, Hellstrom, Wayne J.G.·2018·Sexual Medicine Reviews
DOI 10.1016/j.sxmr.2017.07.002
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Abstract

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of drug. Post-SSRI sexual dysfunction (PSSD) is a condition in which patients continue to have sexual side effects after discontinuation of SSRI use. The prevalence of persistent sexual side effects after discontinuing SSRIs is unknown. The recognition and study of PSSD will increase our knowledge base of this underreported and distressing condition. AIM: To provide coverage of the current literature on PSSD, update information on the pathophysiology of PSSD, and discuss potential management options. METHODS: Comprehensive review of literature pertaining to PSSD. MAIN OUTCOME MEASURES: The symptoms, classification, pathophysiology, diagnostic considerations, and management of PSSD were reviewed. RESULTS: Common PSSD symptoms include genital anesthesia, pleasure-less or weak orgasm, decreased sex drive, erectile dysfunction, and premature ejaculation. Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression theory, cytochrome actions, dopamine-serotonin interactions, proopiomelanocortin and melanocortin effects, serotonin neurotoxicity, downregulation of 5-hydroxytryptamine receptor 1A, and hormonal changes in the central and peripheral nervous systems. The diagnosis of PSSD is achieved by excluding all other etiologies of sexual dysfunction. Treating PSSD is challenging, and many strategies have been suggested and tried, including serotonergic antagonists and dopaminergic agonists. There is still no definitive treatment for PSSD. Low-power laser irradiation and phototherapy have shown some promising results. CONCLUSION: PSSD is a debilitating condition that adversely affects quality of life. Further studies are warranted to investigate the prevalence, pathophysiology, and treatment of PSSD. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev 2018;6:29-34.

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  • New withdrawal symptoms may occur with any type of SSRI, but paroxetine is the most likely to be associated with new symptoms, while fluoxetine is the least associated.

    “A bulk of literature, derived from controlled trials [18, 110, 111], case reports [19], and patients' online reports [112], showed that new withdrawal symptoms may occur with any type of SSRI, but paroxetine is the most likely to be associated with new symptoms, while fluoxetine being the least associated.”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [112]

  • After SSRIs long-term use, persistent post-withdrawal disorders have been described.

    “After SSRIs long-term use, persistent post-withdrawal disorders have been described [10, 13, 18, 19, 112, 117, 118].”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [112]

  • Belaise et al. analyzed online reports and found the most frequent persistent post-withdrawal disorders after SSRI discontinuation were disturbed mood, depression, emotional liability, mood swings, irritability, anxiety, insomnia, impaired concentration, and impaired memory.

    “Belaise et al. [112] analyzed online reports from individuals who described persistent post-withdrawal disorders after SSRI discontinuation; the most frequent disorders were: disturbed mood, depression, emotional liability, mood swings, irritability, anxiety, insomnia, impaired concentration, impaired memory.”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [112]

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Authors
Bala, A., Nguyen, H. M. T., & Hellstrom, W. J. G.
Affiliations
Tulane University (US)
Corresponding author
Hellstrom, Wayne J.G.
ORCID
Hellstrom, Wayne J.G.
Venue
Sexual Medicine Reviews
Publisher
Oxford University Press (OUP)
Published
2018-01
Volume
6
Issue
1
Pages
29-34
ISSN
  • 2050-0513 (ISSN-L)
  • 2050-0521
DOI
10.1016/j.sxmr.2017.07.002
OpenAlex
W2741573634
Cited by
167
References
34
Citations by year
2026: 18 · 2025: 19 · 2024: 18 · 2023: 20 · 2022: 37 · 2021: 17 · 2020: 13 · 2019: 15 · 2018: 8 · 2017: 1 · 2016: 1
FWCI
1.54
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Sexual Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
  • Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
selective serotonin reuptake inhibitors, sexual side effects, erectile dysfunction, premature ejaculation, pathophysiology, serotonin neurotoxicity, serotonin-dopamine interaction, proopiomelanocortin, serotonergic antagonists, dopamine agonists, low-level laser therapy, phototherapy, antipsychotic adverse effects
MeSH terms
Adrenergic alpha-Antagonists, Depression, Humans, Sexual Behavior, Sexual Dysfunction, Physiological, Cognitive Behavioral Therapy, Selective Serotonin Reuptake Inhibitors

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