PSSD

Post-SSRI Sexual Dysfunction or PSSD is a medical condition caused by previous use of certain substances. In most (not all) cases it is caused by SSRIs and sexual function is affected the most but it is not the only thing damaged.

Symptoms

Following symptoms can be present in PSSD:

• Anhedonia (inability to feel pleasure)
• Apathy
• Blunted affect (Flattened emotions)
• Changes in semen
• Decrease or loss of nocturnal/morning/spontaneous erections
• Decreased or absent libido
• Decreased or absent vaginal lubrication
• Depersonalization
• Derealization
• Difficulty achieving orgasm or premature ejaculation
• Difficulty concentrating
• Dryness of skin, mouth, and/or eyes
• Erectile dysfunction
• Fatigue
• Flaccid glans during erection
• Genital numbness which is reduced or absent genital sensation, especially erogenous sensation
• Insomnia or excessive daytime sleepiness.
• Intense anxiety or complete loss of the ability to feel anxiety.
• Lack of imagination and fantasy
• Lack of motivation
• Lack of pre-cum
• Loss of appetite, taste and smell
• Loss of empathic and romantic feelings
• Numbness of body
• Pleasureless or weak orgasms
• Poor memory
• Reduced nipple sensitivity
• Reduced/absent response to sexual stimuli
• Shrinkage/atrophy of penis/testicles/clitoris
• Vision changes

PSSD is commonly misdiagnosed as a psychological problem, nocebo effect, or a mental illness such as depression or somatoform but in fact it is a iatrogenic biologically-induced medical condition.

Causes

PSSD is most commonly caused by psychiatric drugs especially those that are marketed as "antidepressants". List of them is below.

Psychiatric drugs

• Agomelatine
• Amitriptiline
• Aripiprazole
• Atomoxetine
• Brexpiprazole
• Bupropion
• Citalopram
• Clomipramine
• Desvenlafaxine
• Duloxetine
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Imipramite
• Mirtazapine
• Nefazodone
• Olanzapine
• Paroxetine
• Sertraline
• Trazodone
• Venlafaxine
• Vortioxetine

Other causes

This is the list of drugs, supplements, and topical products which also cause a condition which is either PSSD itself or something similar. For some of these substances a separate name is used for condition they cause.

• 5HTP
• Abiraterone acetate
• Ashwagandha
• Bicalutamide
• Cyprotone acetate
• Dutasteride
• Enzalutamide
• Finasteride ("Post-Finasteride Syndrome")
• Genistein
• Goserelin
• Isotretinion ("Post Accutane Syndrome")
• Ketoconazole
• Leuprorelin
• MDMA
• Milk Thistle
• Minoxidil
• Nandrolone ("Deca Dick")
• Resveratrol
• Rutin
• Sam-E
• Saw palmetto
• Spironolactone
• Tretinoin
• Triptorelin

Diagnostics

According to the Healy et al. 2021 paper, the diagnostic criteria is following:

Necessary

(1) Prior treatment with a serotonin reuptake inhibitor.

(2) An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops.

Additional

(3) Enduring reduction or loss of sexual desire.

(4) Enduring erectile dysfunction (males).

(5) Enduring inability to orgasm or decreased sensation of pleasure during orgasm.

(6) The problem is present for ≥3 months after stopping treatment.

There should be

(7) No evidence of pre-drug sexual dysfunction that matches the current profile.

(8) No current medical conditions that could account for the symptoms.

(9) No current medication or substance misuse that could account for the symptoms.

Ancillary sexual symptoms may include:

• genital pain

• reduced nipple sensitivity

• decreased or loss of nocturnal erections (males)

• reduced ejaculatory force (males)

• flaccid glans during erection (males)

• decreased vaginal lubrication (females).

Ancillary non-sexual symptoms may include:

• emotional numbing

• depersonalization

• other sensory problems involving skin, smell, taste or vision • cognitive impairment.