Understanding Erectile Dysfunction and PSSD

Erectile dysfunction can cause considerable shame and confusion, especially for younger men. However, more than half of UK men surveyed had experienced some form of erectile dysfunction, and over a quarter of young men,  so it’s not uncommon.(1)

You are more likely to experience erectile dysfunction if you are depressed or if you have been taking certain antidepressants. All antidepressants are not equal, SSRIs (selective serotonin reuptake inhibitors) are most likely to cause sexual side effects, sometimes even after you have stopped taking them.  They are powerful medications for treating depression. But while they may help improve mood, they can have damaging effects on your sexual function. Sometimes those effects can linger for years. 

You may wonder what options you have and how best to treat the condition. Fortunately, help is available. Some medications can help you regain your sexual function and lifestyle changes may help. In this article, we explore a condition called Post SSRI Sexual Dysfunction or PSSD, its causes, symptoms and the options to help you get help.

What is Post SSRI Sexual Dysfunction (PSSD)?

If you have noticed difficulty getting or maintaining an erection after taking antidepressants, you may have post SSRI sexual dysfunction, also known as PSSD. PSSD is a newly described condition where people experience persistent sexual difficulties after taking SSRIs and stopping the medication. 

Previously, we had believed that the sexual side effects of SSRIs would disappear once you stop taking them but research has shown those side effects can linger for years and even decades.(2) The lingering decline in sexual function seen in people who took SSRIs in the past is the main feature of post SSRI sexual dysfunction or PSSD. 

What are SSRIs and how do they work?

SSRIs—selective serotonin reuptake inhibitors—are a class of drugs used to treat depression. They help treat depression by increasing the amount of serotonin in your brain. Serotonin is a chemical substance that helps regulate your mood, sleep, and emotions; higher levels reduce depression symptoms.

Commonly prescribed SSRIs include sertraline (Zoloft, Lustral), fluoxetine (Prozac, Oxactin), and paroxetine (Seroxat). They are also used to treat other conditions such as bulimia, anxiety disorders, obsessive-compulsive disorders (OCD), and premenstrual dysphoric disorder (PMDD).

Sexual side effects of SSRIs

While SSRIs are effective for treating these conditions, they often have unwanted effects on sexual function. About 25% to 73% of people who take these drugs have SSRIs, sexual side effects.(3) These unwanted effects may include:

• Difficulty getting aroused
• Difficulty getting or sustaining an erection (erectile dysfunction)
• Reduced interest in sex (low libido)
• Difficulty achieving orgasm (anorgasmia)
• Delayed orgasm
• Diminished orgasm
• Lack of pleasure or numbness of the genitals (genital anaesthesia)
• Painful ejaculation
• Premature ejaculation

These side effects may persist even after you are no longer taking the SSRIs. Research shows that erectile dysfunction and other sexual problems can continue after you stop taking the medications. In rare cases, these sexual problems can persist for decades, worsening over time.

How is PSSD diagnosed?

PSSD is diagnosed by eliminating other possible causes of sexual problems and establishing that you took SSRIs in the past. PSSD is a new condition that is still being studied by researchers so there is a lot still to learn about the condition.

However, if you are having any symptoms of sexual dysfunction such as loss of sexual interest, difficulty with arousal, erectile dysfunction or problems with orgasms. You may be able to get medications that may help relieve your symptoms.

How do you treat PSSD?

PSSD has not yet been widely recognised as a medical condition. That means it is still under-reported and not much is known about it. It also means there is no definite PSSD treatment or PSSD cure yet. Scientists are still working towards understanding and developing PSSD treatment. (4) In the meantime, your care team can help by giving you treatments for specific symptoms such as erectile dysfunction. And you can make lifestyle changes too.

Can I use Sildenafil or Tadalafil for PSSD?

Yes, you can use Sildenafil (Viagra) or Tadalafil (Cialis) for PSSD. These medications can help alleviate the symptoms of PSSD and help you regain your sexual function.

They may also help even if your erectile dysfunction is due to psychological causes.  The best way to use sildenafil or tadalafil is by starting with the lowest dose and increasing only if the response is inadequate.

If you are not sure what you might be able to use, consult your pharmacist or doctor for medical advice. They may prescribe tadalafil for PSSD or sildenafil for PSSD or something else to help with your symptoms.

Other tips to improve sexual function after PSSD

Along with any drug treatments you are using for erectile dysfunction or other sexual side effects, you may also benefit from changes in lifestyle and psychological approaches.

Diet: A healthy diet can enhance sexual function. Foods rich in antioxidants, vitamins, and minerals can support overall well-being and sexual health. Aim for a diet rich in fresh fruit, vegetables and seafood. Strawberries, avocado, walnuts, pomegranates, spinach, oysters and other seafood, dark chocolate, coffee and tea may help. 

Exercise: Exercise improves heart health and sexual function. Research shows that improved physical activity directly boosts a sex life.(5) Aim for 150-300 minutes of vigorous exercise every week, along with two days of strength training. Walking, cycling and swimming are good places to start. 

Avoiding alcohol, tobacco and other substance use: Little or no alcohol consumption and no smoking can have positive effects on erectile function and overall sexual health. Avoid other substances and hard drugs too. 

Supplements: Some herbal supplements, such as ginseng and ginkgo biloba, are believed to improve sexual function. However, it’s important to consult with a healthcare provider before using these supplements, as they can affect other medications.

Light therapy: Light therapy has been explored as a treatment for sexual dysfunction. While evidence is still limited, some studies suggest it may help improve sexual health by reducing stress and improving blood flow.

Counselling and therapy: Psychological support through counselling or therapy can be beneficial. Cognitive-behavioral therapy (CBT) and sex therapy can help address the mental and emotional aspects of sexual dysfunction.

Mindfulness and relaxation techniques: Mindfulness practices and relaxation techniques can reduce anxiety related to sexual performance and help improve overall sexual health.

What else can I do about my PSSD?

Apart from direct changes to your lifestyle, you can join the PSSD community for extra support. Some things you can do include: 

Patient experiences and support groups: Hearing from others who have experienced PSSD can provide support and insight. Online forums, support groups, and patient stories can offer comfort and practical advice for managing symptoms. You may consider seeking out a PSSD Reddit for instance or a similar group on other social media.

Staying informed: Educating yourself about PSSD and its effects can empower you to make informed decisions about your treatment. Reliable sources include medical journals, trusted health websites, and discussions with healthcare professionals.

Raising awareness: Sharing your experience and knowledge about PSSD can help raise awareness and promote understanding of the condition. This can lead to better support networks and more research into effective treatments.

Open communication with partners: Open and honest communication with your partner about PSSD can support your relationship despite the challenges. Tell your partner about your experiences and concerns, this can foster mutual understanding and support, which can alleviate some of the emotional burden from the PSSD.

Couples therapy: Couples therapy can help with addressing relationship issues related to PSSD. A therapist can help you and your partner navigate the challenges and develop strategies to maintain intimacy and connection.

Erectile dysfunction and PSSD can be challenging and PSSD recovery may not be a clear cut process, but help is available. You may be able to get medication that helps you regain your erectile function and sexual drive. Tadalafil and sildenafil have been used to help people with PSSD and may be helpful for you. Understanding your condition and exploring treatment options with your care team can help improve your sexual health and quality of life. Speak to a healthcare provider if you have concerns about your sexual health.

FAQs

Does erectile dysfunction from antidepressants go away?

Most of the time, erectile dysfunction from taking antidepressants goes away with time. But sometimes the symptoms linger, causing post SSRI sexual dysfunction (PSSD), where people experience sexual problems for years or even decades.

Is PSSD a real thing?

Yes, PSSD is real. Even though the study of the condition is still going on, there is enough evidence to show that some people experience lingering sexual difficulties after they stop taking SSRIs.  

Symptoms of PSSD may include erectile dysfunction, loss of libido, difficulty with orgasms or loss of feeling in the genital area. While PSSD is not yet well understood, you can get treatment for the symptoms you are experiencing. For example, you may be able to take sildenafil or tadalafil for erectile dysfunction caused by PSSD. 

Do all antidepressants cause PSSD? 

All antidepressants do not cause PSSD. So far, research shows that the class of antidepressants most likely to cause PSSD are SSRIs. Other classes of antidepressants such as serotonin/norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, serotonin modulators and tricyclic antidepressants are less likely to cause this effect. 

References

1. 1.Li JZ, Maguire TA, Zou KH, Lee LJ, Donde SS, Taylor DG. Prevalence, Comorbidities, and Risk Factors of Erectile Dysfunction: Results from a Prospective Real-World Study in the United Kingdom. International Journal of Clinical Practice [Internet]. 2022 Mar 20 [cited 2022 Jul 10];2022:e5229702. Available from: https://www.hindawi.com/journals/ijclp/2022/5229702/
2. ‌Csoka A, Bahrick A, Mehtonen OP. Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors. The Journal of Sexual Medicine. 2008 Jan;5(1):227–33.
3. ‌Atmaca M. Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives. Neuropsychiatric Disease and Treatment. 2020 Apr;Volume 16:1043–50.
4. Ben-Sheetrit, J., Hermon, Y., Birkenfeld, S. et al. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry 22, 15 (2023). https://doi.org/10.1186/s12991-023-00447-0
5. 1.Smith L, Grabovac I, Yang L, Veronese N, Koyanagi A, Jackson SE. Participation in Physical Activity is Associated with Sexual Activity in Older English Adults. International Journal of Environmental Research and Public Health. 2019 Feb 8;16(3):489.