When did it begin?
Post-SSRI Sexual Dysfunction (PSSD) officially made its debut in the peer-reviewed medical literature in 2006. Case reports were published that identified treatment-emergent sexual dysfunction that persisted after the antidepressant was stopped. The condition was given a name and its features were defined.
This new literature also noted the significance of a study dating back to 1999 by Montejo et al. It appears to be the first published clinical trial to have captured the persisting sexual side effects that SSRIs can cause. However, this wasn’t the purpose of the study and it seems that little was made of the finding at the time.
Between the efforts of drug companies to manage concerns about sexual side effects, through to the wider problem of doctors failing to engage with patients on the subject of treatment-related issues, it’s unsurprising that the condition took such a long time to appear in the medical literature.
We know that even today, people who are diagnosed with PSSD can discover that their doctor hasn’t reported it to the country’s drug regulator, and that their diagnosis can appear somewhat buried in the medical records. There remains a very real sense that PSSD is something that health professionals don’t like to talk about.
Who was talking about it?
Even though the condition didn’t appear in the medical literature until 2006, could it have been mentioned earlier in another type of publication?
We certainly know the condition was being seen in clinical practice. We also know that people were reporting it.
A paper by Hogan et al noted that the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK had received over 200 reports of persistent sexual side effects linked to SSRIs prior to the condition appearing in the literature, and without any public awareness of the issue.
If people were going to the trouble of reporting it to a country’s drug regulator, perhaps someone affected or someone in the health profession was also concerned enough to write about it – though it obviously wouldn’t have been called PSSD at the time.
It’s worth noting that while the problem is most commonly associated with SSRIs and SNRIs, it can also happen with some tricyclics that act as serotonin reuptake inhibitors. It’s therefore possible that something may have even appeared in print prior to the introduction of the SSRIs, although this is less likely as it wasn’t until the marketing of the SSRIs that the use of antidepressants became commonplace.
Were you there?
Perhaps you were working as a healthcare professional or medical researcher in the early 2000s, 1990s or 1980s and remember reading or hearing about the problem. Perhaps you wrote an article that appeared in a magazine, newspaper or some other publication. Maybe you mentioned it in a book that is no longer in print.
Are there any doctors or researchers who attempted to publish an article or case reports, but were turned down by a medical journal?
It would be interesting to hear from anyone working in psychosexual therapy. With the explosion of antidepressant use in the last two decades, they will undoubtedly be seeing patients with medication-related problems. It would be interesting to know when PSSD first came onto their radar.
On March 11th 2014, the Dutch newspaper Volkskrant featured an article about PSSD on its front page, prompted by a report about the condition from Lareb, the Netherlands Pharmacovigilance Centre. Is there a chance that the problem was mentioned in a European magazine or newspaper prior to 2006?
If you are aware of such material, we would like to hear from you. Please either leave a comment at the end of this post, or you can contact us through the website.
It would be interesting to fill out some of the early history of PSSD. Who knows what we might discover?
Heather says
Peter Breggin’s book ‘Toxic Psychiatry’ page 321, has a reference to the try cyclic antidepressant drug Anafranil (clomipramine). ‘In 1987 a study by W. O. Monteiro and others in the British Journal of Psychiatry shows a very high rate of interference with orgasm’. Do not confuse Willie Monteiro with Montejo, whose name you mention in your post, with reference to another later study.
Future says
2 studys that you probably know:
1. https://www.ncbi.nlm.nih.gov/pubmed/14632589?dopt=Abstract from 2003 (but a bit different than PSSD)
2. http://bjp.rcpsych.org/content/176/3/299.2 from 2000, it was reversible, but it took 5(!) weeks: “We substituted her fluoxetine with trazodone 400 mg. She remained euthymic. By the fifth week her vaginal and nipple sensations returned to normal.” Though trazodone can cause sexual dysfunction, too.
3. As far as I know some federal institutes for drugs got reports about persisting sexual dysfunction in the 1990s
Stuart Shipko says
I sent in several case reports of persistent sexual dysfunction to the FDA in the late 90’s however they were recorded as problems during medication and not afterward. It turns out that anything after stopping the drug isn’t considered a side effect.
I mentioned the phenomenon in 2003 In my book Surviving Panic Disorder. It took years to get clean case reports (single drug, no Comorbid medical conditions, minimal or no mental illness) in order to publish them in 2006 in Psychotherapy and Psychosomatics.
Brooks Witzke says
Dr. Shipko,
Glad to see you on here, its great to have your influence on this issue. I had mentioned to Dr. Healy you had discovered PSSD sometime in the mid-1990’s.
I also sent a case report to the FDA in 2013 and never heard back. There is a dark force that is keeping this condition from becoming public. It takes great force to have both the Post SSRI Sexual Dysfunction page and the Post Finasteride Syndrome page taken down from Wikipedia, especially considering Wiki is ran by tree huggers.
They took down the PSSD page twice, I sent a complaint and got some bs excuse from them that the one-line sentence on the SSRI page was sufficient to warn people of the disorder. We had legitimate pubmed studies on there and it was taken down. I hate big pharma, they are some of the most horrible people in history.
Carla says
I am not going to believe anything these drug companies put forth.
They have total disrespect/disregard for those who have been maimed or died as a result of ingesting their meds.
Drug companies are not going to divulge how many people have been impaired or permanently damaged by their meds.
If consumers never had these complaints before they ingested these meds, who else is to blame?
A lot of damages are personal and sexual dysfunction, is not something that people openly discuss.
It is a very sensitive issue,that brings the individuals concerned to embarrassment and a sense of indignation.
The drug companies are not going to tell you that some batches will cause damage to the parasympathetic nerves!
If you mix one med with another med, we don’t need to be a scientist to work out what damages it will do to ones body!
Heather says
Book by Kevin Pezzi MD, ‘The Science of Sex’.
Heather says
Talking to friends who have taken/are taking SSRIs, it seems generally accepted that these meds will temporarily affect their libido and sexual function. No one seems very surprised by this. So one assumes it is referred to in the PILs? What does surprise me greatly, therefore, is that psychiatrists and doctors who are well aware of this, don’t show more understanding towards patients who are distressed by it. Even psychiatrists who have done a Study on it, can still be in denial when the patient reports it or has relationship problems because of it, as we know to our own personal cost.
Kevin Pezzi in ‘The Science of Sex’ is writing in detail about the way he, a doctor, was left suffering this kind of damage for years after taking isotretinoin ~ Accutane for acne. I realise it’s SSRIs you want chapter and verse about here, but maybe any drug which affects hormone balance and neurology can inhibit normal working of all body parts? What really upsets me is that medics brush this ‘side effect’ away as not mattering, and don’t tell the patient about it before they take the meds. I know, in the case of Roaccutane-isotretinoin, Roche refused to have ‘sexual dysfunction’ listed in the PIL, and it’s obvious why. Young people would not touch the stuff, especially if they realised it could quite possibly be permanent. You have only to read the many account of this on the RxISK post about PSSD and Accutane, to understand the horror of so many ruined lives.
Heather says
Apologies, correction, I should have said see RxISK Blog entitled ‘Accutane: 30 years of trading our sex lives for clear skin’. This is not conventional PSSD of course but when you realise that so many of those on (Ro)Accutane are prescribed SSRIs in addition, to help them cope with the regularly reported overwhelming low mood, anxiety, sexual dysfunction, and in some cases, depression. So they can be getting a doubling effect of sexual dysfunction.
And then, to their amazement when they pluck up courage to discuss it with their psychiatrist/GP s/he brushes it aside, makes light of it, and at best, says ‘yes, maybe you are experiencing this but it’s only temporary.’ You can even (amazingly) actually find a psychiatrist who has done a Study on this very subject, written published papers on it, and yet when confronted by a patient of their own, appealing to them for understanding and insight after reporting such concerns, just blames the patient for manifesting attention-seeking behaviour!
So all that is written may well appear interesting but it doesn’t protect the patient unless the writer is sincere in what he has found from his research, and puts it into practice when dealing with a real suffering human being, years later.
Alex_Rox says
For all PSSD sufferers here, please sign in in the pssdforum.com. We are a big community and we are trying to do concrete action to improve our condition.
Daryl says
Eunuch – Anodhenia?
The term eunuch (/ˈjuːnək/; Greek: εὐνοῦχος)[1] generally refers to a man who has been castrated,[2] typically early enough in his life for this change to have major hormonal consequences. In some ancient texts, “eunuch” may also refer to a man who is not castrated but who is impotent, celibate, or otherwise not inclined to marry and procreate. In Latin, the words eunuchus,[3] spado (Greek: σπάδων spadon),[4][5] and castratus were used to denote eunuchs.[6]
Castration was typically carried out on the soon-to-be eunuch without his consent in order that he might perform a specific social function; this was common in many societies. The earliest records for intentional castration to produce eunuchs are from the Sumerian city of Lagash in the 21st century BC.[7][8] Over the millennia since, they have performed a wide variety of functions in many different cultures: courtiers or equivalent domestics, treble singers, religious specialists, soldiers, royal guards, government officials, and guardians of women or harem servants.
Eunuchs would usually be servants or slaves who had been castrated in order to make them reliable servants of a royal court where physical access to the ruler could wield great influence.[9][additional citation needed] Seemingly lowly domestic functions—such as making the ruler’s bed, bathing him, cutting his hair, carrying him in his litter, or even relaying messages—could in theory give a eunuch “the ruler’s ear” and impart de facto power on the formally humble but trusted servant. Similar instances are reflected in the humble origins and etymology of many high offices (e.g., chancellor originally denoted a servant guarding the entrance to an official’s study).
Eunuchs supposedly did not generally have loyalties to the military, the aristocracy, or to a family of their own (having neither offspring nor in-laws, at the very least), and were thus seen as more trustworthy and less interested in establishing a private ‘dynasty’. Because their condition usually lowered their social status, they could also be easily replaced or killed without repercussion. In cultures that had both harems and eunuchs, eunuchs were sometimes used as harem servants (compare the female odalisque) or seraglio guards.[citation needed]
https://en.wikipedia.org/wiki/Eunuch
Ancient Anodhenia?
Just another longstanding plant drug or otherwise method?
Carlos says
Hi,
The television channel ZDF, has created a website to collect data from PSSD sufferers about the stories, treatments they undertook and possible ways of recovery. This will be an outstanding tool no only to share about information between all the PSDD community but also to campaign and show the world about this terrible illness.
Check this out: https://www.propeciahelp.com/sexual-side-effects-from-ssris/
Kind Regards
Carlos