In April 2022, we were able to publish a German-language article on PSSD in the "Fortbildungstelegramm Pharmazie", a German medical journal. The title is "Post-SSRI Sexual Dysfunction: Definition, Symptome, Praxisimplikationen". The article is aimed at medical professionals and summarizes the most important information on PSSD. It can be downloaded here after registration.

What is PSSD?

PSSD is a drug-induced syndrome, which is a complex disease that can be triggered by psychopharmaceuticals and persists even after discontinuing the medication.

The term PSSD stands for Post-SSRI Sexual Dysfunction, but the term is misleading because

• PSSD can be triggered not only by SSRI (selective serotonin reuptake inhibitors) but also by other drugs, and
• the symptoms can extend beyond the sexual domain.

Thus, PSSD is a syndrome that can affect not only the sexual domain but also

• emotional,
• cognitive and
• neurological domains,

such as perception, thinking, emotions, nerves, and muscles. Besides sexual dysfunction, emotional blunting is a common symptom that can be extremely distressing.

Note: PSSD is more than just an SSRI-induced erection disorder. The symptoms are often so severe that they significantly impair the quality of life, and there have been reports of suicide in the PSSD community.

Affected individuals often describe the experience as if a switch has been flipped, turning them into a different person. They suddenly feel castrated and/or numb, and most of them emphasize that they have never experienced such feelings before.

However, the problem is often attributed to psychosomatic causes, which complicates the situation for affected individuals. Similar long-term effects have also been reported for other medications, such as finasteride, a medication for hair loss, or isotretinoin, an acne medication.

Who is affected?

Both men and women of different ages are affected. In some of the few German-language articles on PSSD, it is claimed that the syndrome occurs less frequently or not at all in women. This is misinformation. Currently, it is not possible to make statements about whether men or women are more commonly affected.

Experience has shown that women have a greater inhibition threshold to talk about sexual dysfunction, as the topic is not really addressed in therapeutic communication.

Men often initially turn to a urologist or seek a specific clinic for erectile dysfunction.

High number of unreported cases

Overall, it is not known how many people are affected by PSSD. However, a high number of unreported cases are assumed because:

• the topic is stigmatized. Many affected individuals only speak about their problems after a long time. The fact that the complaints were caused by a psychotropic drug, i.e., a drug that acts on the psyche, increases the inhibition threshold, as many affected individuals do not want to openly discuss the reason for taking medication - both with doctors and with friends and family members.
• the majority of affected individuals experience that their complaints are wrongly attributed to psychosomatic causes. In particular, in communication with doctors, PSSD is unfortunately still not taken seriously. This repeatedly leads to strong feelings of despair and helplessness in affected individuals.

The following sexual symptoms can occur:

Most commonly observed are:

• reduced sexual desire/libido up to acquired asexuality
• erectile dysfunction/erection problems
• genital numbness ("genital anesthesia") or reduced sensitivity in erogenous zones (e.g. glans penis, testicles, nipples, clitoris, G-spot, etc.)
• delayed orgasm up to anorgasmia
• weak or completely pleasureless orgasms that only trigger muscle contractions ("orgasmic anhedonia")

Also possible:

• reduced or absent lubrication or altered vaginal discharge
• sensory disturbances/pain in penis or testicles or in the vagina
• reduction in penis/testicle/clitoris size
• difficulty in maintaining sexual arousal
• absence of erotic dreams
• lack of reaction to sexual stimuli and erotic memories (no tingling/"butterflies in the stomach")

Non-sexual symptoms that may occur include:

• inability to experience pleasure (anhedonia)
• inability to perceive emotions of any kind ("emotional numbing") including lack of empathy
• derealization
• depersonalization
• "brain fog" (feeling of mental confusion)
• "brain zaps" (electric shock-like sensations in the head and/or body)
• visual disturbances, including palinopsia
• memory problems, including impaired short-term and working memory
• absence of dreams
• reduced sense of smell and/or taste
• altered reactions to medication/alcohol
• altered sweating
• disturbances in sleep-wake cycle/sleep disorders