Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors

Peleg, Liran C; Rabinovitch, David; Lavie, Yaakov; Rabbie, D.M.; Horowitz, Itai; Fruchter, Eyal; Gruenwald, Ilan

doi:10.1016/j.sxmr.2021.07.001

Cited by 20 publications

(9 citation statements)

References 71 publications

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“…Research focused on psychological factors underlines the importance of anxiety and obsessive‐compulsive disorder in pathogenesis 78 . SSRIs are hypothesised to cause receptor desensitisation, 66 at a local genital level or central level, 18 and that discontinuation exacerbates dysfunction as receptors remain desensitised for a longer period while circulating monoamines fall to pre‐treatment levels 8 . SSRI discontinuation has been theorised to induce PGAD through the influence of atrial natriuretic peptide (ANP), 32 which may explain the higher prevalence of sexual dysfunctions in women with cardiovascular disease 33 .…”

Section: Discussionmentioning

confidence: 99%

Selective serotonin reuptake inhibitors, post‐treatment sexual dysfunction and persistent genital arousal disorder: A systematic review

Tarchi,

Merola,

Baccaredda‐Boy

et al. 2023

Pharmacoepidemiology and Drug

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PurposeAdverse effects of selective serotonin reuptake inhibitors (SSRIs) on sexual function have been an important area of research for many years. However, the duration of SSRI‐associated sexual adverse effects, and their possible persistence after treatment discontinuation, is still uncertain. The aims of the current systematic review were first to identify existing evidence of sexual dysfunction following SSRI discontinuation, and to provide an account of reported symptoms and proposed treatment options; and second, to establish whether current literature allows accurate estimates of the prevalence of such sexual dysfunction.MethodsA systematic review was conducted on PubMed, Embase, and Google Scholar; papers with clinical data regarding patients with persistent sexual dysfunction after SSRI treatment suspension were included.ResultsOverall, two retrospective interventional studies, six observational studies and 11 case reports were judged eligible for inclusion. It was not possible to determine reliable estimates of prevalence. Similarly, a cause‐effect relationship between SSRI exposure and persistent sexual impairment could not be ascertained. Nonetheless, the potential for continued sexual disturbances despite discontinuation could not be entirely ruled out.ConclusionsThere is a need to investigate a possible dose–response relationship between SSRI exposure and persistent sexual adverse effects. Treatment options for persistent dysfunctions remain limited, but novel therapeutic approaches may be required in order to address an otherwise neglected need for sexual well‐being.

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Section: Discussionmentioning

confidence: 99%

Selective serotonin reuptake inhibitors, post‐treatment sexual dysfunction and persistent genital arousal disorder: A systematic review

Tarchi,

Merola,

Baccaredda‐Boy

et al. 2023

Pharmacoepidemiology and Drug

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“…Wcześniejsze stosowanie finasterydu lub izotretynoiny również mogą zwiększać ryzyko wystąpienia PSSD. Leki te mogą powodować zmiany w receptorach steroidowych i neurosteroidowych, a leki z grupy SSRI mogą utrwalać te zmiany [51].…”

Section: Czynniki Ryzykaunclassified

Post-SSRI sexual dysfunction and SSRI induced sexual dysfunction - literature review

PANEK

JASŁOWSKI

RZESZUTKO³

et al. 2023

J Educ Health Sport

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Introduction: Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly used drugs. One of the most common side effects are those related to sexual function. We can divide them into sexual dysfunction occurring during the use of SRRIs and those occurring and persisting after discontinuation of SSRIs.Purpose: To review available PubMed data on SSRI-related sexual dysfunction, epidemiology, symptoms and treatment.Current state of knowledge: SSRIs are first-line drugs for depression and other mental disorders. Their use can cause sexual dysfunction. SSRI-induced sexual disorders are more common but easier to treat. Post-SSRI sexual dysfunction is less common and harder to treat. There are several hypotheses regarding its pathomechanism, such as epigenetic changes, serotonin neurotoxicity, endocrine disruption, and downregulation of serotonin receptors.Conclusions: Sexual dysfunction after SSRIs left without treatment increases the chances of self-discontinuation of drugs by patients and contributes to significant suffering. In the case of SSRIs induced sexual dysfunction, there are several possible interventions that can effectively eliminate sexual dysfunction and restore the patient's comfort. There are no effective treatments for post-SSRI sexual dysfunction syndrome. In addition, the diagnosis of PSSD is difficult as there are no specific diagnostic criteria. More research is needed to determine how to diagnose and treat patients who develop PSSD.

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“…Spinal serotonin fibres may regulate erection via 5HT 2C and ejaculation via 5‐HT 1A (possibly expressed in SEG neurons). In human ejaculatory disorders, selective serotonin reuptake inhibitors induces premature ejaculation 105,106 . It is to be hoped that further discoveries can be leveraged to treat a wider range of ejaculatory disorders, although the mechanisms regulating ejaculation are complex.…”

Section: Relationship Between the Oxytocin‐grp System And Other Neuro...mentioning

confidence: 99%

Neuropeptidergic control circuits in the spinal cord for male sexual behaviour: Oxytocin–gastrin‐releasing peptide systems

Oti

Sakamoto

2023

J Neuroendocrinology

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The neuropeptidergic mechanisms controlling socio‐sexual behaviours consist of complex neuronal circuitry systems in widely distributed areas of the brain and spinal cord. At the organismal level, it is now becoming clear that “hormonal regulations” play an important role, in addition to the activation of neuronal circuits. The gastrin‐releasing peptide (GRP) system in the lumbosacral spinal cord is an important component of the neural circuits that control penile reflexes in rats, circuits that are commonly referred to as the “spinal ejaculation generator (SEG).” Oxytocin, long known as a neurohypophyseal hormone, is now known to be involved in the regulation of socio‐sexual behaviors in mammals, ranging from social bonding to empathy. However, the functional interaction between the SEG neurons and the hypothalamo‐spinal oxytocin system remains unclear. Oxytocin is known to be synthesised mainly in hypothalamic neurons and released from the posterior pituitary into the circulation. Oxytocin is also released from the dendrites of the neurons into the hypothalamus where they have important roles in social behaviours via non‐synaptic volume transmission. Because the most familiar functions of oxytocin are to regulate female reproductive functions including parturition, milk ejection, and maternal behaviour, oxytocin is often thought of as a “feminine” hormone. However, there is evidence that a group of parvocellular oxytocin neurons project to the lower spinal cord and control male sexual function in rats. In this report, we review the functional interaction between the SEG neurons and the hypothalamo‐spinal oxytocin system and effects of these neuropeptides on male sexual behaviour. Furthermore, we discuss the finding of a recently identified, localised “volume transmission” role of oxytocin in the spinal cord. Findings from our studies suggest that the newly discovered “oxytocin‐mediated spinal control of male sexual function” may be useful in the treatment of erectile and ejaculatory dysfunction.

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Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors

Cited by 20 publications

References 71 publications

Selective serotonin reuptake inhibitors, post‐treatment sexual dysfunction and persistent genital arousal disorder: A systematic review

Selective serotonin reuptake inhibitors, post‐treatment sexual dysfunction and persistent genital arousal disorder: A systematic review

Post-SSRI sexual dysfunction and SSRI induced sexual dysfunction - literature review

Neuropeptidergic control circuits in the spinal cord for male sexual behaviour: Oxytocin–gastrin‐releasing peptide systems

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