Decades after sexual dysfunction caused by antidepressants was first reported to persist after patients stopped taking the drugs, how many people experience continuing sexual problems is still not known.  Citizens Commission on Human Rights calls on the FDA to address the issue without further delay. 

Researchers active in investigating the adverse effects of psychiatric drugs have expressed concern over the lack of scientific data on the prevalence of antidepressant-caused sexual problems that persist after patients stop taking the drugs.  The condition has caused marriages to break up, and people are known to have committed suicide as a result of it.  Because the antidepressants most at issue are selective serotonin reuptake inhibitors (SSRIs), the condition is called post-SSRI sexual dysfunction (PSSD).

Research indicates that while taking antidepressants, 25%-80% of patients encounter sexual difficulties they had not experienced before taking the drugs.  Patients report that the sexual dysfunction strained their relationships, deepened their depression, lowered their self-esteem, and brought on feelings of failure.

In a recent article in Epidemiology and Psychiatric Sciences, psychiatrist and psychopharmacologist David Healy, M.D., and Dee Mangin, M.D., both professors at McMaster University in Canada, report that “while sexual dysfunction is a well-known side effect of taking selective serotonin reuptake inhibitors (SSRIs), in an undetermined number of patients, sexual function does not return to pre-drug baseline after stopping SSRIs.”

PSSD can comprise a range of sexual symptoms experienced while taking antidepressants that continue after the drugs are no longer used, including a lack of sexual drive, lack of sexual sensation, and problems with sexual performance that were not experienced before starting on the drugs.  In addition to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) and some older tricyclic antidepressants are also known to cause PSSD.

According to Healy and Mangin, the problem of PSSD has been known for decades, with the condition first reported to the drug regulatory agency in the UK in 1991 and first reported in the medical literature in 2006.  However, there are still no known treatments for the condition.

PSSD can have a devastating impact on patients’ lives.  The researchers write that “PSSD can lead to marriage break-up and job loss.”  Professor Healy reveals that he is “aware of at least 20 cases of people who have committed suicide as a result of the condition.”

“This has never been properly investigated and described, and there is an urgent need to understand the incidence, prevalence and natural history of PSSD, with a focus on informing prevention as well as investigating treatments,” the researchers wrote. 

In 2018, Healy and Mangin were among 22 signers of a citizen petition delivered to the U.S. Food and Drug Administration (FDA), calling on the agency to strengthen the warning on antidepressants’ labeling to adequately convey the serious risk of persistent, even permanent sexual side effects after the use of antidepressants has stopped.  The petition also called for the FDA to require SSRI and SNRI manufacturers to send a “Dear Health Care Provider Letter” to inform psychiatrists, family doctors and other prescribers about the risk, placing an obligation on them to fully inform their patients of the risks.

After similar petitions were filed in 2018 with drug regulatory agencies in Europe and Canada, warnings were updated by the European Medicines Agency in 2019 and by Health Canada in 2021 to reflect the risk.  However, the FDA has yet to take final action.

Recently, a lawsuit was filed in the U.S. District Court for the District of Columbia by one of the petition signers, claiming the FDA has failed to take final action on the petition and seeking a court order requiring the FDA to act. 

The lawsuit states that antidepressant labeling warns of sexual problems that may be experienced while taking antidepressants, but “current labeling in the United States does not adequately convey the risk of broad, severe, and potentially permanent post-treatment changes to sexual function.” 

“The devastating sexual side effects from antidepressants, harming the sex lives of an untold number of the 45 million Americans taking these psychiatric drugs – side effects that can persist and even become permanent – should have been addressed years ago by the FDA,” said Anne Goedeke, president of the National Affairs Office of the Citizens Commission on Human Rights.  “The FDA needs to act now, without further delay.”

A key rationale for prescribing antidepressants in the first place – to fix a chemical imbalance in the brain – was found to be without scientific merit.  A 2022 comprehensive review of research into whether a lack of the brain chemical serotonin causes depression concluded there was no convincing evidence to support the theory.  This calls into question the prescribing of SSRI and SNRI antidepressants that make more serotonin available in the brain, if no known chemical deficiency exists.

WARNING: Anyone wishing to discontinue or change the dose of an antidepressant or other psychiatric drug is cautioned to do so only under the supervision of a physician because of potentially dangerous withdrawal symptoms.