Prescribers know that they are supposed to inform patients about common side effects and potentially serious adverse reactions. When this is done correctly and the patient decides to take the medicine it is called “informed consent.” But there is one complication prescribers hate to talk about. It turns out that sexual side effects are quite common, especially when it comes to antidepressant medication. Doctors do not always mention this complication. The idea that this adverse reaction might last after the drug is discontinued is even more disconcerting.
Antidepressants are Popular but Sexual Side Effects Are A Secret:
Antidepressant medications remain among the most commonly prescribed products in the pharmacy. Our back of the envelope calculations suggest that nearly 50 million people are taking drugs like sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac) and duloxetine (Cymbalta). SSRIs (selective serotonin reuptake inhibitors and SNRIs (serotonin and norepinephrine reuptake inhibitors) modify these neurotransmitters in the brain.
If all those individuals are experiencing relief from depression, that’s wonderful. Sadly, that is an unlikely outcome. Most clinicians would be surprised to learn how effective the antidepressants they prescribe so casually actually are when it comes to relieving depression. You can learn about the true benefits and risks of antidepressants at this link.
Despite the fact that such drugs are surprisingly ineffective for many patients, they do have side effects. That includes sexual problems that are rarely mentioned when a prescription is offered. Sometimes the sexual side effects are long lasting. In other words, they continue after the antidepressant is stopped.
The Scandal of Persistent Sexual Side Effects:
Dr. Antonei Csoka alerted the medical community to “persistent sexual side effects after SSRI discontinuation” 18 years ago (Psychotherapy and Psychosomatics, April, 2006). He and his co-author reported on three cases of sexual dysfunction that did not disappear even months after an SSRI antidepressant was discontinued. That was not a message most clinicians wanted to hear.
Two years later, Dr. Csoka and colleagues reported additional cases of persistent loss of libido, erectile dysfunction, “genital anesthesia” and inability to experience orgasms (Journal of Sexual Medicine, Jan. 2008).
In 2018, 21 other scientists joined Dr. Csoka in filing a citizen petition with the FDA. They urged the agency to put more precise language about persistent sexual side effects into the official prescribing information for both SSRI and SNRI antidepressants.
Current labeling for drugs like sertraline or escitalopram mention sexual dysfunction including ejaculatory delay or failure, decreased libido, erectile dysfunction and delayed or absent orgasm. But there is little mention of persistent sexual complications once the antidepressants are discontinued.
FDA Sued Over PSSD (Post-SSRI Sexual Dysfunction) Inaction:
Public Citizen announced on May 20, 2024:
“Public Citizen today filed a lawsuit against the U.S. Food and Drug Administration (FDA) for its inaction on a petition requesting that the FDA require the revision of product labels for selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The requested revision seeks to warn of the drugs’ risk of serious sexual side effects, which may persist after stopping SSRI or SNRI treatment, and may even be permanent. Although the petition was filed six years ago, the FDA has neither granted nor denied it.”
Public Citizen represents Dr. Antonei Csoka and colleagues. Their complaint states in part that:
“The FDA has unreasonably delayed issuing a decision in light of the nature and extent of the public health interests addressed in the petition,” and that “The FDA’s failure to act on the citizen petition constitutes agency action unlawfully withheld or unreasonably delayed.”
The People’s Pharmacy Has Also Been Reporting Sexual Side Effects Are Common and Persistent:
Readers of this newspaper column would likely agree with Dr. Csoka and Public Citizen. They have reported their own experiences with sexual side effects after stopping antidepressants.
One woman wrote:
“I am a 23-year-old female. I was on a normal dose of Prozac for less than two months before I decided it wasn’t helping me and I got off it.
“It’s been about three years now and my libido has not been the same since. I fear I may never again have the libido I had before this medicine. It has also caused a high degree of genital anesthesia. Orgasms are difficult to reach and my sensitivity is depressingly low. I would rather be depressed than have these side effects.”
Are Patients Warned About Chemical Castration?
Women are not the only ones to suffer. Another reader wrote:
“I’m 50, male, and was on Prozac for a year. I have had lingering side effects in terms of low/no sexual interest and difficulty reaching orgasm. It’s been almost two years since I’ve gone off the drug and I’m thinking the effects are going to be permanent. I’m working on accepting that and trying to figure out how to have a relationship. My marriage was lost in the meantime.”
It is past time for pharmaceutical manufacturers and the Food and Drug Administration to acknowledge that sexual side effects can persist in some cases long after antidepressants have been discontinued. Prescribers and dispensers should also warn patients about this potential problem.
When Sexual Side Effects Are Dismissed:
Q. I am taking fluoxetine for depression and something unsettling is happening. After years of a satisfying sex life, I am now unable to achieve orgasm.
I asked my doctor if this could be a side effect of the medicine but he was not very forthcoming. He offered to prescribe a different antidepressant but he wasn’t very reassuring that it would be substantially better.
I still can’t believe that this could be a complete coincidence. Are there any antidepressants that don’t screw up your sex life? I have to take an antidepressant or I fall off a cliff psychologically.
A. The vast majority of antidepressants can, according to the FDA, affect “sexual desire, sexual performance and sexual satisfaction.” Many make it difficult to achieve orgasm.
That is especially true for SSRI (selective serotonin reuptake inhibitors) antidepressants like fluoxetine, paroxetine and sertraline. Newer antidepressants such as Celexa, Cymbalta, Lexapro and venlafaxine are also capable of interfering with a satisfying sex life.
You may want to ask your doctor about bupropion (Wellbutrin). This antidepressant works differently from all other antidepressants. It affects dopamine receptors rather than interacting primarily with the neurochemical serotonin the way SSRI-type antidepressants do. Bupropion does not appear to lower libido or interfere with orgasm.
In one study it was actually found to restore sexual function. Subjects with low libidos were recruited and split into two groups. Half were given a sugar pill and half received bupropion. Within two weeks those on bupropion began to report more interest in sex. After three months, over half of them were making love more often. One of the researchers reported that “the effects we saw in several women who’d had trouble having orgasms were stunning.”
Another scientist, Helen Kaplan, who was director of the human sexuality program at Cornell Medical Center in New York City at the time, noted that “Wellbutrin is really the first sensible sexual stimulant we’ve ever had.”
Another study of people with type 2 diabetes and depression concluded that:
“Bupropion treatment of major depressive disorder had few sexual side effects and was associated with significant improvements in sexual functioning.”
Bupropion is not without side effects. Learn more about them here. Many visitors to this website have reported problems with some generic formulations of bupropion. You can read their stories by clicking on this link.
Long Lasting Sexual Side Effects Are Surprising:
Most prescribers believe that when a drug is discontinued any adverse reactions will gradually fade away. That may not always be true with sexual complications. This reader shares her story:
Q. I have been taking escitalopram for eight years. Within four years on this antidepressant, I started having sexual side effects, especially delayed low-intensity orgasms and low sex drive.
Now that I’m engaged, I am trying to wean off escitalopram so I will like having sex more. I’ve gone from 20 mg to 5 mg. My desire is higher, but my orgasms are becoming even less intense and more delayed. There’s just no sexual pleasure any more.
What a puzzle! I thought this situation would get better. Instead, it has gotten worse: higher sex drive, less orgasm.
A. Sexual side effects are common with the type of antidepressant you are taking (SSRI, or selective serotonin reuptake inhibitor). They include lower libido, erectile dysfunction, genital anesthesia, delayed ejaculation or orgasm or inability to achieve orgasm. Most people expect such symptoms to disappear once they stop taking the medication, but that doesn’t always happen.
Your experience has a name. Researchers call it post SSRI sexual dysfunction (PSSD). Sadly, there is not much information about this condition.
A review published in the journal Expert Opinion on Drug Safety (April, 2022) concludes:
“Little is known about the mechanisms underlying PSSD and no effective treatment exists. It is necessary to increase recognition of PSSD among prescribers and improve its management at the clinical level.”
It’s Not Just Antidepressants!
Several years ago we started hearing from readers of our syndicated newspaper column that some prostate pills were also causing libido problems. More worrisome, though, were reports that sexual side effects might be long lasting.
The drugs in question include dutasteride and finasteride. They are prescribed for men with enlarged prostate glands. When sexual side effects are persistent, even after the drugs are discontinued, it can be disheartening. Here is a link that will provide more insight into this problem.
There is even a name for this condition: “post-finasteride syndrome” or (PFS). You can read more about in this article published in the journal International Journal of Risk & Safety In Medicine (Feb. 22, 2022). It is described this way:
“Finasteride, dutasteride and saw palmetto are 5 alpha-reductase inhibitors that can trigger an enduring sexual dysfunction with a very similar profile to PSSD [post-SSRI sexual dysfunction]. As the name suggests, PFS is most commonly associated with finasteride which was licensed for the treatment of male pattern baldness in 1997. In 2011, a warning for erectile dysfunction that persisted after stopping treatment was added to the US product label for the finasteride products, Propecia and Proscar. This was updated in 2012 to include libido disorders, ejaculation disorders and orgasm disorders that continued after discontinuation of Propecia, and decreased libido that continued after discontinuation of Proscar.”
If you would like more information about how drugs can affect human sexuality, you can download our FREE guides on this topic.
Please share your own experience with sexual side effects in the comment section below. If you have managed to overcome this problem, please let other readers know how you accomplished it. Thank you for supporting our work.
