PSSD: What happens when antidepressants kill your sex drive

The day after Chris* stopped taking fluoxetine, he realised something. He couldn’t get hard. The 35-year-old had struggled with erectile dysfunction while he was taking the selective serotonin reuptake inhibitors (SSRIs), but he took it as a sign that the drugs were doing their job if they were affecting his body this potently. But when a whole week passed after coming off the medication and he still couldn’t get it up, Chris started to freak out. “What’s happening?” He remembers thinking. “It’s not coming back.”

Chris is one of a number of people who have experienced post-SSRI sexual dysfunction (PSSD), a condition that occurs when someone experiences sexual problems (like erectile dysfunction, decreased libido, and genital numbness) after stopping taking SSRIs. According to the British Medical Journal, patients have been reporting sexual difficulties after SSRI treatment since 1991. Yet it wasn’t until 2006 that the condition was formally recognised as a syndrome, a delay many find emblematic of the persistent dismissal and denial intrinsic to their experience of PSSD.

Around two months after stopping fluoxetine, Chris was able to get erections again. But he faced a new problem: he’d lost sensitivity in his genitals. “It’s like touching your hand or your elbow and your arm,” he explains. “You still feel it, but it’s not erogenous.” Chris decided to speak to a neurologist about these strange symptoms, but the conversation went nowhere. “That’s not possible,” he remembers the neurologist responding. “It cannot happen. All the effects always go away afterwards […] It’s psychological.”

SSRIs were first developed in the 1970s, beginning with fluoxetine (Prozac), which quickly became one of the most widely prescribed antidepressants after gaining FDA approval in 1987. The drugs revolutionised the treatment of mental health disorders like depression, anxiety and OCD by increasing serotonin levels in the brain without causing as many side effects as earlier antidepressants. But no drug is without potential adverse effects. From the beginning, people taking SSRIs began reporting some form of sexual dysfunction (it’s estimated that over half of SSRI users report problems relating to having sex). But sexual dysfunction experienced after SSRI treatment is less widely acknowledged.

Even among medical professionals who do acknowledge that PSSD is a real condition, research remains limited and there is little consensus within the psychiatric field about what causes it. “You go to doctors because you think they can help you, but in my case they have made my situation much much worse,” says Lola,* a 25-year-old who suffers from PSSD. Lola says she had never wanted to go on sertraline, but when she spoke to the doctor about anxiety, she “insisted” that she should take it. When she began experiencing sexual side effects, she said the doctor assured her that they would go away when she stopped the medication.

But two years since coming off sertraline, Lola says none of her symptoms have gone away. She has no libido, no romantic feelings and her genitals are numb. “It’s taken away all aspects of life that make me feel human and alive,” she says. Watching people around her get into relationships and get married feels particularly painful. “All I ever wanted was to have a partner and my own family but I feel that future has been taken,” she says. “My sense of self as a woman and a sexual being has been stripped away from me.”

My sense of self as a woman and a sexual being has been stripped away from me

In 2018, a psychiatrist named Dr David Healy launched a petition requesting SSRIs and SNRIs to incorporate warnings about PSSD in their labels. Europe and Australia’s medicine regulator has since implemented a safety warning about the condition, but the US Food and Drug Administration (FDA) neither granted or denied it. Then, in May, Dr. Antonei B. Csoka, one of the scientists who signed the petition, sued the FDA for inaction. The FDA has since issued a motion to dismiss.

“It seems just like a lack of concern for the citizens that they’re meant to be looking after,” says Dr Josef Witt-Doerring, a psychiatrist and former FDA officer. “There’s a lack of regulation and a lack of laws that really protect the consumer.” According to Witt-Doerring, while the FDA is good at “knowing the safety of the drug in the first 12 weeks,” when it comes to rarer side effects or those that occur several years later “there’s not a lot of investment there.” (When approached for comment, an FDA press officer said that they would “look into these questions,” but did not come back with a response).

PSSD is still a rare condition. While data is limited, one 2023 study estimated that the risk of developing PSSD in men was 0.46 per cent, and for many, the benefits of SSRIs majorly outweigh the unlikely risk of long term sexual dysfunction. But acknowledging potential adverse effects is paramount to patient safety. Witt-Doerring says that the way forward is weighing up the severity of a patient’s mental health issues and informing them of the potential side effects before handing them out “like candy.”

While some learn to manage PSSD, for others, recovery feels out of reach. For the past two years, Chris has been in a relationship, but he and his girlfriend rarely have sex. When they do, Chris experiences no sexual pleasure and he cannot ejaculate. “Sex is a huge taboo,” he explains. “I feel like I do it for her, and I think that she feels that.” 

Chris feels angry – angry at himself, angry at the medical professionals who persistently told him that his problems were just in his head. It’s worth stressing again that SSRIs can be life-transforming, life-saving drugs for people experiencing mental health challenges, and that PSSD only effects a small minority of people who take SSRIs. But evidently greater transparency around the potential long-term effects of taking SSRIs is urgently needed so that patients can be empowered to make more informed decisions about their health.

*Names have been changed