No Sex and the City

PSSD – the most reported syndrome to RxISK

There have to date been 67 reports of Post-SSRI Sexual Dysfunction (PSSD) on paroxetine (Paxil, Aropax and Seroxat), fluoxetine (Prozac and Fludac), sertraline (Zoloft and Lustral), citalopram and escitalopram (Cipramil, Celexa, Lexapro and Cipralex), venlafaxine (Efexor and Pristiq), fluvoxamine and nefazodone. This makes it the most reported clinical syndrome to RxISK.

Of these reports at present 28% are on Paxil, 24% on Lexapro/Celexa, 20% on Prozac, and 14% on Zoloft. We have also had reports on Efexor-Pristiq, Cymbalta and Geodon-Zeldox.

There is an extraordinary contrast between our HeatMaps for adverse event reports on Fluoroquinolone antibiotics (see Flox-Tox) and for PSSD. The HeatMap for Levaquin and Cipro shows reports clustering on the East Coast of the US and in California, but almost none anywhere else in the world and not many in MidWestern or Southern States.

The HeatMap for PSSD in contrast has the most global spread of any RxISK HeatMap. We have reports of PSSD from every continent except Africa. For some countries like India and China at present PSSD constitutes 100% of the reports we have.

No one doubts that Fluoroquinolones can lead Achilles’ tendons to snap or a range of other muscle or related problems. There are warnings to this effect. But there are no warnings about PSSD – almost no one who is affected will ever have the experience of walking into a doctor and being understood or supported.

This is the PSSD HeatMap as it stands today. Even though not recognized by FDA or the main coding dictionary MedDRA, or medicine in general, a problem distributed this globally, affecting both sexes and almost all ages, and so consistently described has to be real.

Global PSSD map

US PSSD reports

No sex or drugs please: We’re New Yorkers

Although the most reports to date come from the United States, there are in fact many more reports per head of the population from the UK than from the US. The PSSD Map from the United States shows that at the moment the most reports per head of population come from Ohio followed by California. There are none from New York – clearly somewhere where people neither take antidepressants nor have sex.

We need many more reports from the US and elsewhere to be able to produce a finer grained picture that might help shed some light on the issues. Finding an answer might turn out to be a case of remembering there was a dog there but no bark – spotting that there is a relative absence of PSSD in some place where another drug is particularly widely used – some illness perhaps that people in New York get or treatment they have that means that any sexual dysfunction they get on antidepressants doesn’t become chronic. What is it about Sex and the City?