Persistent Sexual Dysfunction after Discontinuation of Selective Serotonin Reuptake Inhibitors

Abstract

Introduction Sexual dysfunctions such as low libido, anorgasmia, genital anesthesia, and erectile dysfunction are very common in patients taking selective serotonin reuptake inhibitors (SSRIs). It has been assumed that these side effects always resolve after discontinuing treatment, but recently, four cases were presented in which sexual function did not return to baseline. Here, we describe three more cases. Case #1: A 29-year-old with apparently permanent erectile dysfunction after taking fluoxetine 20 mg once daily for a 4-month period in 1996. Case #2: A 44-year-old male with persistent loss of libido, genital anesthesia, ejaculatory anhedonia, and erectile dysfunction after taking 20-mg once daily citalopram for 18 months. Case #3: A 28-year-old male with persistent loss of libido, genital anesthesia, and ejaculatory anhedonia since taking several different SSRIs over a 2-year period from 2003–2005. Results No psychological issues related to sexuality were found in any of the three cases, and all common causes of sexual dysfunction such as decreased testosterone, increased prolactin or diabetes were ruled out. Erectile capacity is temporarily restored for Case #1 with injectable alprostadil, and for Case #2 with oral sildenafil, but their other symptoms remain. Case #3 has had some reversal of symptoms with extended-release methylphenidate, although it is not yet known if these prosexual effects will persist when the drug is discontinued. Conclusion SSRIs can cause long-term effects on all aspects of the sexual response cycle that may persist after they are discontinued. Mechanistic hypotheses including persistent endocrine and epigenetic gene expression alterations were briefly discussed.

Persistence of Sexual Dysfunction Side Effects after Discontinuation of Antidepressant Medications: Emerging Evidence

“…It is possible as well, that PE populations may differ in some neurophysiological dimension, as compared to depressed or other clinical populations for whom SSRIs are commonly prescribed. However, post SSRI persistence of biological changes or adaptations can by no means be ruled out [8], are supported by animal studies [50][51][52], and thus ought to be a cause for concern.…”

“…Delayed ejaculation or orgasm, and anorgasmia have been those symptoms that the literature links most clearly and most frequently to SSRI treatment, vs. to depression itself [16]. However the symptoms of genital anesthesia and pleasureless orgasm, outside the range of common experience and appearing to often occur together, are frequently reported among men and women in Internet communities, in an accumulating case reports literature [6][7][8][9][31][32][33][34][35][36], and in one research investigation [37].…”

“…SSRIsex@yahoogroups.com; http://www.sexual-dysfunction.info/forum/], and described in a series of recent case reports [6][7][8][9]. My immersion in the formal literature, in my clinical practice, and in consumerbased Internet information has led me to believe that the existing knowledge base with regards to SSRI/SNRI sexual side effects is unintegrated, inadequate, and even inaccurate, raising concerns about informed consent, and leaving clini-cians vulnerable to unknowingly contributing to iatrogenic harm.…”

Association between 5HT2A polymorphism and selective serotonin re‐uptake inhibitor (SSRI)‐induced sexual desire disorder (SDD) among Malaysian women

“…Arguably, a prospective analysis would be more appropriate to study treatment-emergent SD. Having said this, SD is likely to be a persistent side-effect of SSRIs (Csoka et al 2008), with over 85-90% of patients who had SD not experiencing resolution after 6 months of treatment (Montejo-Gonzalez et al 1997;Osis & Bishop 2010). To minimize the confounding effects of residual depressive symptoms, we enrolled only subjects who had been on SSRI for at least 4 weeks so that they would have an adequate chance to respond to the medication and any sexual problem could be possibly attributed to the SSRI they were taking.…”

The Controversy Over Antidepressant Drugs in an Era of Evidence-Based Practice

“…Rosen, Lane, and Menza (1999) report that 80% of persons taking an SSRI will experience sexual dysfunction which includes anorgasmia, erectile dysfunction, diminished libido, and genital anesthesia. Csoka, Bahrick & Mehtonen (2008) report that sexual dysfunction can continue even after drugs are discontinued. Serotonin transporters, the target for the SSRIs, are also found on blood platelets and SSRIs are associated with risk of bleeding ulcers (Loke, Trivedi, and Singh, 2008;Serebruany, 2006) and stroke (Wu, Wang, Cheng, & Gau, 2011).…”