Diagnostic Criteria for PSSD

Post-SSRI sexual dysfunction (PSSD)

Significant sexual dysfunction can happen while on treatment and after stopping any serotonin reuptake inhibiting (SRI) drug.

SRIs include the selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), SRI tricyclic antidepressants, SRI antihistamines, tetracycline antibiotics such as doxycycline, and analgesics like tramadol.

PSSD here refers to a common syndrome happening after any SRI. It is independent of any pre-existing or reactive mental health problem and can be triggered in healthy volunteers.

Criteria

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.