Diagnostic Criteria for Enduring Sexual Dysfunction

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December 19, 2021 | 11 Comments


  1. Professor Healy, Thank you for ensuring that this important, valuable and patient centred publication is available: open access.
    I am certain that those who follow your invaluable work will be sharing widely.
    Congratulations, and thanks to all who have contributed.

  2. The federal government quietly acknowledged the rare risk of PSSD in a January report that followed freedom of information requests from Emily and other advocates, as well as reports of adverse events collected by experts at the Rxisk platform.


    But he’s worried that without expanded access to clinical trial data and better monitoring and treatment of PSSD and other rare side-effects, critical research is “up against a religious belief system” that sees prescription medications as sacraments rather than flawed solutions.

    Cassels agrees. Writing a prescription, he says, satisfies both parties: it’s quick and doctors feel as though they helped someone, and patients feels as though they were heard and now have a solution.

    But given that “every medication with an effect has a side-effect,” Cassels says medicine needs to get better at exploring non-pharmaceutical options when appropriate to mitigate the risk of side-effects.

    If knowledge of side-effects and risks has a chilling effect on SSRI uptake, or other prescriptions for that matter, Cassels says “so be it.” “I think most people would want to know a drug could cause serious sexual dysfunction before they take it,” he said.

    But making these shifts in mindset and policy will require government to legislate reporting standards and greater transparency from pharmaceutical companies. “They’re only going to do it if they’re forced to do it,” Cassels noted. “It’s in their interest not to focus on adverse risks more than they have to.”

  3. Thank you to RxISK for your immense support and contribution to those who suffer from post-SSRI sexual dysfunction (PSSD).
    I would also like to take this opportunity to thank all those people who come to RXISK and share their journey of tribulations with us.
    It is indeed, very humbling to know that RXISK is doing so much to educate the populace about this debilitating condition.
    Keep up the good work!

  4. Medscape UK has an article today (21st Dec 2021) entitled: More Cautious Antidepressant Prescribing Needed by Doctors. It mentions sexual difficulties just once (which is better than not at all).


    However, it does link to a review published in the Drugs and Therapeutics Bulletin this month by Mark Horowitz and Michael Wilcock, Newer generation antidepressants and withdrawal effects: reconsidering the role of antidepressants and helping patients to stop. This review mentions this side effect more often but makes no attempt to describe it. Though it does reference DH’s paper Antidepressants and sexual dysfunction: a history. J R Soc Med 2020;113:133–5

    I would imagine ever doctor is currently having to absorb an O’levels worth of new information every quarter and don’t have time to read anything other than a small fraction of what is being published. Well, together with this new Diagnostic Criteria it looks like this info needs to be hand-delivered in person.

    • Pogo – fortunately the article you refer to is freely available online here:


      Drug and Therapeutics Bulletin “D&TB” has long had a good reputation for providing expert opinion; I think it is relatively immune to political influence.

      One of the problems that currently need to be addressed in the UK is the fact that a lot of hospital psychiatrists (in both adult and child subspecialties) are locums (i.e.temporary). They commonly will start a patient on additional medication and arrange for the patient to return in six months for review – when they will no longer be there. And then they see another locum, and the process repeats itself. Sooner or later the patient will be on more than one drug linked with Enduring Sexual Dysfunction.

  5. Mark Horowitz


    (From 2:52)

    with Sir Simon who schooled me in media prowess (but not EBM interpretation)
    Times (paywall): https://bit.ly/3stUmv7 17/n

    Stop dishing out antidepressants, doctors told

    Kat Lay, Health Editor

    Tuesday December 21 2021, 12.01am, The Times

    Doctors should prescribe fewer antidepressants and for a shorter time, experts said, after a review found no strong evidence that the drugs were effective.

    The benefits of the medication were uncertain but many patients had side effects and withdrawal symptoms, which could be severe, researchers said.




    Mark Horowitz
    Strong agree! I was too polite and let Sir Simon trot out a highly flawed study that mistook withdrawal for relapse https://bmj.com/content/374/bmj.n2403/rr-4… Schooled on media savvy, but not EBM

    Just as Mark is disabusing Simon of the limitations of the ‘Antler’ Study, so he is curtailed by something called – ‘Part Liberace’ –

    James Moore

    Wow, an almost carbon copy, you have to admire the consistency if nothing else!


    Letter in @thetimes response to @markhoro ‘review’ of antidepressants.

  6. Danish article on SSRI sexual dysfunction published in April 2022 has a paragraph on PSSD, but unfortunately failed to mention the Diagnostic Criteria: https://ugeskriftet.dk/videnskab/seksuelle-bivirkninger-ved-ssri

    ” Post-SSRI syndrome
    A few patients experience persistent sexual dysfunction after discontinuation of SSRI treatment. The incidence of the phenomenon is unknown but probably low, and knowledge is based on case reports. Decreased genital sensitivity is the central symptom and may apparently occur shortly after the first SSRI dose. In addition, the most frequent symptoms are decreased sexual desire, erectile dysfunction, decreased lubrication, limited or no orgasmic experience, premature ejaculation and decreased nipple sensitivity. Symptoms occur during SSRI treatment and in some cases worsen further when treatment is discontinued [29]. There may be fluctuations in the severity of symptoms, and a proportion of patients experience spontaneous remission over time, but the syndrome may persist for several years [30]. There is wide variation in the presentation of the syndrome and as yet no clear diagnostic criteria. The etiology of the problem is controversial. Theories for the underlying pathophysiology include epigenetic downregulation of the 5-HT1A receptor, serotonergic neurotoxicity with axonal damage, hormonal changes in both the central and peripheral nervous systems through interaction with dopamine, testosterone and oxytocin, and disruption of transient receptor potential channels with implications for skin sensitivity [29].

    There is as yet no effective treatment for the syndrome. However, cognitive behavioural therapy and sexological counselling can often improve coping and relieve symptoms [29].

    In 2019, the syndrome was recognised by the European Medicines Agency, which recommends that all patients be informed of the risk of treatment-induced persistent sexual dysfunction before starting SSRI treatment [30]. “

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