Why PSSD exists

Does PSSD Exist?

It’s a question that is undoubtedly asked both by those who are in the early stages of suffering from it, and from those who are investigating it from the outside.

It could be argued almost indefinitely that people on an SSRI likely had a psychiatric reason to go on the SSRI, and that it follows that this illness COULD be the cause of psychosomatic delusions that create PSSD.

Becuase of this I feel it is appropriate to begin our investigation of PSSD at an animal level.

I probably would never have believed in PSSD until I got it. A member on my forum made the claim that PSSD is caused by depression. I argue that this is false, becuase PSSD is seen in rat models with un-depressed rats. These rats that are given SSRIs before they are born have decreased sexual behavior when they are mature. Rat’s don’t have bias, and they therefore are incapable of having psychosomatic PSSD. It seems clear to me that at least some cases (and I will agree with skeptics that not all of them are) of claims of PSSD are induced SSRI treatment. Further, I have always said on my forum (to the anger of many members) that SSRIs save more lives than they destroy. Overall they are safe drugs.

The literature

Neonatal Antidepressant Exposure has Lasting Effects on Behavior and Serotonin Circuitry

(Maciag et al., 2013)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118509/

“Here, we show that chronic neonatal (postnatal days 8–21) exposure to citalopram (5 mg/kg, twice daily, s.c.), a potent and highly selective SSRI, results in profound reductions in both the rate-limiting serotonin synthetic enzyme (tryptophan hydroxylase) in dorsal raphe and in serotonin transporter expression in cortex that persist into adulthood. Furthermore, neonatal exposure to citalopram produces selective changes in behavior in adult rats including increased locomotor activity and decreased sexual behavior similar to that previously reported for antidepressants that are nonselective monoamine transport inhibitors.”

Maternal exposure to the antidepressant fluoxetine impairs sexual motivation in adult male mice

(Gouvêa et al., 2004)

https://www.ncbi.nlm.nih.gov/pubmed/18457868

“Global inspection of other cortical areas, such as the hippocampus, also revealed prominent reductions in the SERT-immunoreactive fiber network (data not shown). Moreover, the effects of citalopram on SERT fiber labeling were found to persist into adulthood—PN130 (Figure 7). Similar analysis of clomipramine-treated subjects revealed a nonsignificant effect of drug exposure on cortical SERT innervation; although it should be noted that a trend for decreased immunoreactivity was detected in some individual cases.”

These studies show that treatment with SSRIs cause persistant changes in the expression of SERT in the rodent brain, and that treatment of young rats with SSRIs leads to persistant decreases in sexual activity that carry into adulthood.

But what about in humans? 

This literature exists as well…

Here are a few (of many) peer-reviewed papers on the topic:

1) Persistent Sexual Side Effects after SSRI Discontinuation, Antonei B. Csoka, Stuart Shipko, 2006

2) Genital anaesthesia persisting six years after sertraline discontinuation, Bolton JM, Sareen J, Reiss JP, 2006

3) Post SSRI Sexual Dysfunction, Audrey Bahrick, 2006

4) Prolonged Post-Treatment Genital Anesthesia and Sexual Dysfunction Following Discontinuation of Citalopram and the Atypical Antidepressant Nefazodone, Robert P. Kauffman, Amanda Murdock, 2007

5) Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors, Antonei Csoka, Audrey Bahrick, Olli-Pekka Mehtonen, 2008

6) Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence, Audrey S. Bahrick, 2008

7) Persistent Genital Arousal Disorder in Women: Case Reports of Association with Anti-Depressant Usage and Withdrawal, Sandra R. Leibluma & David Goldmeierb, 2008

8) Persistent sexual dysfunction in genitourinary medicine clinic attendees induced by selective serotonin reuptake inhibitors, Farnsworth KD, Dinsmore WW, 2009

9) The impact of persistent sexual side effects of selective serotonin reuptake inhibitors after discontinuing treatment: a qualitative study, Rebecca Diane Stinson, 2013

10) Does sexual dysfunction persist upon discontinuation of selective serotonin reuptake inhibitors?, G.C. Ekhart, E.P. van Puijenbroek, 2014

11) One hundred and twenty cases of enduring sexual dysfunction following treatment, Hogan C, Le Noury J, Healy D, Mangin D, 2014

12) Penile anesthesia in post SSRI sexual dysfunction (PSSD) responds to low-power laser irradiation: A case study and hypothesis about the role of transient receptor potential (TRP) ion channels, Waldinger MD, van Coevorden RS, Schweitzer DH, Georgiadis J, 2014

13) Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H., 2015

 Doctors on PSSD

Several prominent doctors and researchers acknowledge the existence of PSSD.

Dr. Irwin Goldstein

Dr. Goldstein is the director of San Diego Sexual Medicine and director of sexual medicine at Alvarado Hospital in San Diego. In 2013 CNN did an article about his work.

http://www.cnn.com/2013/05/31/health/lifeswork-sex-medicine/

Dr. David Healy

Dr. Healy has written extensively about PSSD and runs the website www.Rxisk.org. Dr. Healy recieved his training at Cambridge University.

“For over a decade there are reports that describe the link between SSRIs and sexual dysfunction that persist even after discontinuation of treatment. This severe syndrome may be due to a sufferer’s death. And ‘therefore necessary to understand the physiology and study of treatments.”

–  Int J Risk Saf Med. , 2014

He writes more about PSSD here:

http://rxisk.org/post-ssri-sexual-dysfunction-pssd/

Dr. Vincenzo Puppo 

“The disorders of desire, arousal and orgasm are very common side effects of antidepressants, which may persist even after their suspension”

– La stampa, 03/07/2014

Dr. Robert P. Kaufmann

“It ‘s very likely that sexual dysfunction post-treatment, such as genital anesthesia, are not adequately reported. Physicians should be made aware of this unpleasant phenomenon. A formal post-treatment surveillance is absolutely justified.” 

– The Open Womens Healt Journal , 12/2007

“In the recent peer-reviewed literature, three separate case reports have detailed sustained persistence of sexual dysfunction and genital anesthesia well after termination of SSRIs in the absence of residual psychopathology or another identifiable disorder. In each report, the annoying symptoms were absent prior to antidepressant therapy.”

– Primary Psychiatry, 11/25/07

Dr. Carlo Carangard

“SSRIs \ SNRI antidepressants are so effective in creating sexual dysfunction which are sometimes given as a treatment for premature ejaculation. However sometimes these sexual dysfunction can continue even after stopping the drug.” 

–   Psych Central , 05/2016

On a personal note

I was 18 year old with anxiety over going to college. I was in great shape, ate well, and had no previous mental health problems. Sexual health was great. I took an SSRI (Lexapro) for 4 days. In that time, things changed dramatically. They remained changed after I quit, and for quite some time BEFORE I knew that other people had ever recorded this.

Now fast forward 4 years (summer 18′) and little has changed.

I’ve failed to think of another possible explanation for this, and believe me, I’ve thought hard. I’ve just graduated as a Biology and Neuroscience double major, and have studied this stuff in and out of school. I’ve asked doctors and other professionals.

One thing that I have asked many skeptics before, and ask again here, is that I’m looking for a peer-reviewed study that explicitly says that depression/anxiety alone can cause genital numbness. That’s something that I have never found, and seeing that genital numbness is nearly a universal complaint of PSSD sufferers, it’s an important gap in skeptic’s arguments.

I agree with not worrying about a situation that you can’t control, but from interacting with thousands of people who claim these symptoms, I have seen only a handful of them recover on their own.

Want more information, or think that you or a loved one is suffering from PSSD?

Several communities of suffers exist. Most notably:

If you want even more information,

  • Subscribe to the r/PSSD reddit sub. It will keep you updated on research I’m doing, and allow you to give any input you may have.
  • PM me or post on the r/PSSD page if you have any questions.
  • If you are a healthcare professional, please research the dark-side of these drugs before prescribing them…especially to people who haven’t fully developed yet. If you have patients who claim that this has happened to them…fully investigate the situation before throwing their claims under the rug.
  • If you are a researcher/student/ interested in medicine or neuroscience, I’d love your help trying to figure out exactly what has gone wrong, how to research it, and how to treat it.
  • Email me at www.ghostpssd@gmail.com

Thank you, and have a great day,

Ghost

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