FAQ

PSSD Explainer video

Questions and answers

It is common to develop side effects while taking antidepressants, unfortunately, for some people, these side effects do not go away even after quitting the medication. For others, symptoms only start appearing when they stop taking the medication or begin to reduce the dose. [1]

Post-SSRI sexual dysfunction is an iatrogenic disorder in which individuals who have been administered selective serotonin reuptake inhibitors (SSRIs) or other serotonin reuptake-inhibiting (SRI) drugs experience persistent changes in sexual, cognitive and emotional function for an extended period after ceasing to take the drug. Although it is most commonly caused by SSRIs, cases have also been reported following the use of serotonin-norepinephrine reuptake inhibitors (SNRIs), SRI tricyclic antidepressants, SRI antihistamines, tetracycline antibiotics such as doxycycline, and analgesics such as tramadol. [1]

The medical term, 'PSSD', does not accurately highlight the debilitating cognitive and emotional impairment that many people with this condition also suffer from. [1]

SSRIs	SNRIs
Citalopram (Celexa)	Venlafaxine (Effexor)
Escitalopram (Lexapro)	Des-venlafaxine (Pristiq)
Fluoxetine (Prozac)	Duloxetine (Cymbalta)
Fluvoxamine (Luvox)	Atomoxetine (Strattera)
Paroxetine (Paxil)	Levo-milnacipran (Fetzima)
Sertraline (Zoloft)	Vortioxetine (Trintellix)

Anecdotally, PSSD has also been reported to occur with certain antipsychotics and tricyclic antidepressants.

It is common to develop side effects while taking one of these medications, however, it is not currently known what proportion of people do not recover fully when they stop taking them. For some people with PSSD, symptoms only appear when they stop taking the medication or begin to reduce the dose.

These are some of the more common symptoms experienced by people with PSSD. [1] [2] [3] [4] [5]

        
              Sexual symptoms
              Other symptoms
            
              Erectile dysfunction
              
                Inability to feel certain emotions (e.g. fear, euphoria, love)
              
              Loss of libido
              Skin numbness
            
              Numb genitals
              Cognitive impairment (memory, thinking)
            
              Pleasureless orgasms
              Other sensory disturbances (smell, taste, vision)
            
              Loss of nocturnal erections
              Depersonalisation
            
              Vaginal dryness
              Changes in menstrual cycle
            
              Decreased seminal volume and/or quality
              Anhedonia
            
              Inability to orgasm (anorgasmia)
              
              Decreased penile or testicular size
              
              Reduced ability to become sexually aroused

This list cannot fully convey the distressing nature of living with PSSD. Patients describe the loss of emotion as completely removing color from their lives as if someone had turned off a switch – they find themselves in a world without love, passion, excitement, or awe. The loss of emotion and cognitive symptoms create difficulties with navigating the world of work, study, relationships, and other social situations and can leave people with PSSD feeling extremely isolated and in need of support from those around them.

PSSD is a poorly understood condition for which there are currently no reliable estimates of its prevalence or incidence. Due to a lack of large-scale, well-controlled studies, it is unclear how many individuals worldwide suffer from PSSD, or what fraction of SRI users develop PSSD after stopping the drug. Additionally, the condition is likely underreported [5] [22] due to various factors, such as misdiagnosis, lack of recognition by medical practitioners, and social stigma surrounding sexual dysfunction.

However, data released in 2021 by the Medicines and Healthcare Products Regulatory Agency under the UK's Freedom of Information Act shed some light on the issue. The data showed that among 1654 cases of sexual dysfunction from SSRIs, 225 cases continued after withdrawal with the recovery time being unknown, and 144 cases continued after withdrawal with the recovery time being known. These numbers suggest that a significant number of patients may experience persistent sexual dysfunction after stopping SSRIs. [8]

A 2020 retrospective review published in The Journal of Urology reported that 4% of the male patients whose charts were assessed in the review (43 patients total) met the criteria for PSSD. These patients had displayed sexual dysfunction symptoms for longer than 6 months after stopping an SSRI between 2009 and 2019. [6] While this is a small sample size, it suggests that PSSD is a real phenomenon that warrants further investigation.

Lastly, A retrospective analysis conducted in 2023 examined patient records spanning 19 years at Clalit Health Services, the largest HMO in Israel. The analysis revealed that 0.46% (1 in 216) of the surveyed patients who had received serotonergic antidepressant treatment exhibited symptoms consistent with Post-SSRI Sexual Dysfunction (PSSD). [34]

The lack of recognition and awareness of PSSD among medical professionals can compound the challenges that patients face. Many individuals with PSSD have reported difficulties in finding support and validation for their condition. In many cases, medical practitioners are not knowledgeable about PSSD, and patients have not been listened to or have received unsympathetic or inappropriate responses. Additionally, some medical professionals have been reluctant to engage with the published medical literature on PSSD. These challenges can make it harder for individuals with PSSD to get the help and support they need. [9]

Unfortunately, PSSD is an under-researched and under-recognized condition. As a result, many medical professionals are not aware that this condition exists, and people with PSSD are often misdiagnosed as experiencing a relapse of depression [9].

It is important to note that PSSD is not limited to individuals who currently struggle or have struggled with mental illness. There have been numerous reports of SSRI/SNRI-induced PSSD in patients who took the medication for other reasons, such as PMS [10], pain [11] or IBS [12].

Publications and studies

We've compiled an extensive collection of research papers, articles, and FOI requests on PSSD. You can access the list here.

Reported cases

PSSD was first formally recognized in the medical literature back in 2006, [7] however, reports of persistent sexual dysfunction post SSRI usage date back as far as the 90s. [2]

Dr. David Healy has confirmed that there are over 1000 validated reports of PSSD which have been reported to RxISK with many others that are yet to be completed or do not meet strict criteria.

In a study published by Dr. Healy et al., 300 cases of PSSD, PFS (Post-Finasteride Syndrome), and PRSD (Post-Retinoid Sexual Dysfunction) were fully evaluated. Reports came from more than 37 different countries of people of all ages, sexes, and ethnic groups. [13]

Data released (on 28 May 2021) under Freedom of Information laws by the Medicines and Healthcare Products Regulatory Agency shows that 360 (216 + 144) of 1654 reports of sexual dysfunction associated with SSRI use continued after stopping the drugs. [8]

Notable studies

Montejo et al. carried out a study in which patients that were experiencing sexual side effects, switched from an SSRI to a dopaminergic antidepressant, namely amineptine. 55% of these patients were still experiencing some form of sexual dysfunction 6 months after switching to amineptine. Compared to the control group, who were treated with amineptine alone, this was only 4%. [14]

Three large placebo-controlled studies have found that the ejaculation-delaying effects of SSRI medication persist for a significant number of participants after discontinuing the medication. [15] [16] [17]

An online survey of 610 young adults (66% women) assessed childhood and current mental health and use of antidepressants and other psychiatric medications before the age of 16 years and currently, partnered and solitary sexual desire, and frequency of masturbation and partnered sexual activity. The results concluded that: [18]

“For women, childhood SSRI use was associated with significantly lower solitary sexual desire, desire for an attractive other, and frequency of masturbation. This was true even when controlling for childhood mental health concerns, current mental health, and current antidepressant use.”

“In men, childhood use of non-SSRI antidepressants was associated with significantly higher frequency of partnered sexual activity.”

Medication leaflets and labels

The following SSRI medications have been issued with informational leaflets and/or labels containing warnings about post-discontinuation sexual side effects:

Diagnostic and Statistical Manual of Mental Disorders

The DSM (Diagnostic and Statistical Manual of Mental Disorders) contains a section on substance/medication-induced sexual dysfunction. Page 449 states:

“In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.”

Acknowledgment by health and medicines agencies

RxISK and the European Medicines Agency

In 2018 the paper: ‘Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors, and isotretinoin: 300 cases’ by Dr. David Healy et al. was published in the International Journal of Risk & Safety in Medicine.

Following this study, RxISK submitted the citizen petition 'Sexual side effects of SSRIs and SNRIs' to the FDA (Food and Drug Administration) and EMA (European Medicines Agency) in which they urged that the labels of SSRI/SNRI medications should be updated to warn about the possibility of enduring sexual dysfunction that persists after quitting the drug.

On September 14, 2018, EMA replied saying they had begun a review of sexual dysfunctions after the discontinuation of SSRIs and SNRIs. One year later, EMA's safety committee concluded their review into sexual dysfunction after the discontinuation of SSRIs and SNRIs. They stated that:

“PRAC concluded that sexual dysfunction, which is known to occur with treatment with SSRIs and SNRIs and usually resolves after treatment has stopped, can be long-lasting in some patients, even after treatment withdrawal.”

With the conclusion of the review, EMA recommended that drug manufacturers update the labels of all SSRIs/SNRIs to include that sexual dysfunction can be long-lasting in some patients, even after treatment withdrawal.

The petition made to the FDA is unfortunately still lodged within the official Citizen Petition process.

Health Canada

On January 25, 2019, Health Canada informed RxISK that they were going to assess the potential risk of post-treatment sexual dysfunction associated with the use of SSRIs/SNRIs.

On 6 January 2021, a summary of their post-review findings was published, in which they stated the following:

“Health Canada will work with manufacturers to update the product safety information for all SSRIs and SNRIs to recommend that healthcare professionals inform patients about the potential risk of long lasting (possibly weeks to years) sexual dysfunction despite discontinuation of SSRIs or SNRIs.”

Hong Kong Department of Health

The Hong Kong Department of Health released a warning about PSSD in 2021. [19]

Therapeutic Goods Administration

On May 23rd, 2024, the Therapeutic Goods Administration (TGA) of Australia, released an official statement regarding Post-SSRI Sexual Dysfunction. “Sexual dysfunction can refer to disorders of sexual drive (reduced or loss of libido), arousal and orgasm, and ejaculation. Patients may also report associated painful intercourse (dyspareunia), prolonged erection (priapism) or genital numbness. These effects can persist for weeks to years and can significantly harm patients’ quality of life. Persistent sexual dysfunction after treatment is stopped is thought to be rare. However, these symptoms are likely to be underreported and their prevalence is not currently known.” The regulator has instructed all product makers of SSRIs & SNRIs to update their Product Information (PI) documents to include the following information: 4.4 Special warnings and precautions for use: Sexual dysfunction Selective serotonin reuptake inhibitors (SSRIs)/serotonin norepinephrine reuptake inhibitors (SNRIs) may cause symptoms of sexual dysfunction (see section 4.8). There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs/SNRI. The TGA also stated that “Three products – desvenlafaxine, sertraline and venlafaxine – already carry warnings about persistent sexual dysfunction.” TGA Statement on PSSD.

National Health Service

The NHS has published the following statement regarding Sertraline (Zoloft) on their website: [20]

Long-term side effects – A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.

Animal studies

Treatment with fluoxetine has been shown to cause persistent desensitization of 5-HT1A receptors after the removal of the SSRI in rats. Rodent studies have shown that treatment with SSRIs at a young age results in permanently decreased sexual behavior in adulthood, including the presence of long-term neurological changes. Maternal exposure to fluoxetine was also found to impair sexual motivation in adult male mice. In 2016, Simonsen et al published a systematic review of 14 animal studies measuring sexual behavior after discontinuation of treatment with SSRIs. It concluded:

“Our results showed substantial and lasting effects on sexual behaviour in rats after exposure to an SSRI early in life on important sexual outcomes.”

Patient communities

There are a lot of communities where patients with PSSD seek help and support.

While this is not scientific evidence, it does give a rough idea of how many people are suffering from this condition. The PSSD subreddit is seeing exponential growth due to increased awareness, recognition, and the recent COVID-19 pandemic.

PSSD Subreddit (6759 members)

PSSD Forum (2030 members)

PSSD Facebook group (1565 members)

At this stage it is understandable that you may be starting to worry more about your situation. This is normal and there are resources available to help.

We encourage patients at this stage to focus on:

Self-care. Self-care varies by patient, so try to find routines and activities that help you personally. Be practical about your work and life situation. Try not to think too far ahead and catastrophize.
Engaging intelligently with the issue. Our website contains many resources to help you understand the current state of scientific literature, and to navigate conversations with family and loved ones.
Contributing to community progress where possible. Get in touch if you are interested in volunteering. Every effort counts!

Some patients have exhibited an unusual and marked sensitivity to substances with anti-androgenic effects, as well as substances that drastically affect serotonin levels. Substances such as psilocybin, marijuana, 5-HTP, and other antidepressants have in some cases made patients their condition permanently worse in attempts at alleviating their existing symptoms. [3]

Atypical antidepressants such as Bupropion (sold under the brand name Wellbutrin) and Buspirone (sold under the brand name Buspar) are often prescribed as a way to counteract the sexual symptoms of antidepressants.

Unfortunately, in regard to PSSD, the efficacy of these antidepressants is very hit or miss. There have been reports of people developing PSSD from atypical antidepressants, others have reported that their condition was permanently worsened after taking them.

Some patients have come forward saying they have fully or partially recovered over time.

What is not clear yet is how common recovery is. There are a lot of people who have had the condition for a long time, but this could be because these are the people who are most likely to have found their way to the forums.

There will be an unknown number of people who simply recovered before they made the connection between their symptoms and their previous antidepressant use. We do not know for sure what exactly the patterns of recovery are.

It is uncertain how medication can cause PSSD and why the condition can last so long after discontinuing. Nevertheless, a number of studies have produced possibly pertinent results that could indicate a mechanism for PSSD. The development of PSSD may be brought on by a number of different factors.

Potential role of epigenetic changes in 5-HT1A receptor expression

According to a literature study from 2017: [5]

“Long-term usage of SSRIs is hypothesized to cause persistent downregulation of 5HT1A (even after discontinuation of SSRIs) by epigenetic changes in the form of increased expression of methyl binding proteins MeCP2 and MBD1. This leads to more production of HDAC2 mRNA and lowers the production of histone H3 deacetylase.”

The 5-HT1A receptor is involved in a number of neurological processes, including the control of erectile function and sexual arousal.

Potential endocrine disruption by SSRIs

The six most widely used SSRIs (fluoxetine, paroxetine, escitalopram, citalopram, sertraline, and fluvoxamine) were found to disrupt steroid synthesis in cultured H295R (human adrenocortical carcinoma) cells; all six drugs were found to decrease androgen production and produce a compensatory increase in estrogen production, with stimulation of CYP19 aromatase apparently being a common factor. [23] According to a review of studies on the endocrine disruption caused by SSRIs published in 2021, the majority of SSRIs have shown the potential to affect patients' levels of testosterone and estrogen. [24]

In rats, paroxetine has been shown to affect the expression of enzymes involved in the production of neuroactive steroids, with a reduction in enzyme expression being observed upon cessation of treatment. [25]

Potential role of persistent electrophysiological changes

According to a 2020 study, planarians (flatworms) exposed to fluoxetine over a three-day period experienced changes in their cells' resting potential that persisted for at least a week after the drug was stopped. [26] The authors hypothesized that the sometimes-permanent effects seen following SSRI treatment may be due to persistent effects of this kind in human neurons. [26]

Potential correlation with small fiber neuropathy

In September 2022, a subset of 36 Finnish individuals who were diagnosed with PSSD underwent testing for small fiber neuropathy (SFN) through a skin biopsy. The results of the test showed that all of the tested individuals had an unusually low density of intra-epidermal nerve fibers (IENF), which is indicative of SFN. [32] Even though SFN is usually accompanied by painful burning sensations, which are not a common symptom of PSSD, there are instances where SFN can exist without pain, manifesting only as autonomic dysfunction. [33]

Potential role of ACE2

According to preliminary research findings submitted to RxISK in December 2022 by Luisa Guerrini of the University of Milan, sertraline (Zoloft) treatment of human cells caused a persistent downregulation in the expression of the proteins p63 and ACE2. [28] Finasteride and isotretinoin (Accutane), two non-SSRI medications that are known to cause post-discontinuation syndromes resembling PSSD, showed similar outcomes. While ACE2 in its soluble (non-membrane-bound) form (sACE2) acts to degrade the vasoconstriction-inducing hormone angiotensin II to angiotensin, p63's main function is to regulate the replication and differentiation of epidermal skin cells (1-7).

In particular, the intronic ACE2 mutation G8790A was associated with significantly better response to SSRI treatment, according to a study published in 2021. This suggests that genetic variation within the ACE2 gene may determine the degree to which depressed patients respond favorably to treatment with SSRIs. [29]

It is worth mentioning that the membrane-bound form of ACE2 (mACE2) is also the receptor protein that SARS-CoV-2 uses as an entry point into the cell, and binding of the SARS-CoV-2 spike protein to ACE2 has been suggested to stimulate an inflammatory response that could cause ‘long COVID’, a post-infection syndrome exhibiting multiple symptoms that overlap with PSSD.

ACE2 is highly expressed in the epithelium of the intestines, where it plays a role in maintaining innate immunity and homeostasis of gut microbial communities. [30] Treatment with SSRIs [31] have been demonstrated to cause changes in gut microbiota populations.

Donate to help further ongoing research

There currently are two fundraisers for PSSD research, check out the donation page to learn more.

It's unknown if the length of time a person has been taking an SRI affects how likely they are to get PSSD. There have been instances of cases arising after only a few, or even one dose, of an SRI. [5]

Experiencing these symptoms while on the medication is unfortunate, however it is normal to experience this while still taking antidepressants. If you choose to stop your medication, please find assistance before tapering. It is not PSSD unless you are off the medication for atleast 3 months and do not see any improvements within your symptoms. [5]

New patients are understandably desperate for relief. As a result, it’s common to look for simplistic explanations or quick fixes. Unfortunately, currently, there is no effective treatment for PSSD.

There are several anecdotal self-reports that claim that different strategies, such as pharmaceutical or psychiatric therapies, dietary adjustments, or lifestyle modifications, are associated with improvements in PSSD symptoms, but these findings have not been objectively validated or repeated. We highly discourage against self-experimentation with any medications, supplements, etc... due to the potential risk of causing worsening of your existing symptoms.

Some studies have been carried out in an effort to find effective PSSD treatments [21] [22], but generally speaking, they suffer from a limited sample size and a lack of controls, limiting their usefulness as informational sources.

It is impossible to predict when there might be a treatment for PSSD at this time. Our challenges at the moment are to better understand the mechanisms underlying the syndrome and who is affected and why.

Research that may lead to a better understanding of the potential mechanisms underlying PSSD is taking place and more will be known about this condition over the next few years.

Report your condition to your country’s drug regulator and to RxISK

Visit our adverse effects page to find all your country’s drug regulators.

Join our fundraising group or support group

This is a friendly and informal group of patients and family members who support each other and donate monthly to the various PSSD research funds. It is completely understood that people have different circumstances and even small donations are welcomed by all. It’s just nicer doing it together. Fill out the form on this page to request to join our Whatsapp group.

Donate individually

If you would prefer not to join the donation group, that’s fine, but please donate if you can. PSSD research is not currently being funded by governments, so we are going to have to do this ourselves until it is. This can be done and there is a long history of patient groups successfully raising funds to get research off the ground.

Participate in our community efforts

We need to show the world that ordinary people are being affected by PSSD. Please consider participating in any of our community efforts:

Raise awareness

We need to make it impossible for PSSD to be ignored any longer. Write to your government representative and ask them to support calls for research funding and better information for doctors and patients, write to the media to make them aware of the existence of PSSD and the impact that it is having on lives, write to your healthcare provider to ask why you were not warned about such long-term and debilitating effects before you took the medication. If you want to volunteer and raise awareness together, please get in touch with us and we’ll be in touch with you!

References

Healy, D., Bahrick, A., Bak, M., Barbato, A., Calabrò, R. S., Chubak, B. M., Cosci, F., Csoka, A. B., D'Avanzo, B., Diviccaro, S., Giatti, S., Goldstein, I., Graf, H., Hellstrom, W. J. G., Irwig, M. S., Jannini, E. A., Janssen, P. K. C., Khera, M., Kumar, M. T., Le Noury, J., … Waraich, A. (2022). Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. The International journal of risk & safety in medicine, 33(1), 65–76. https://doi.org/10.3233/JRS-210023
Healy D. (2018). Citizen petition: Sexual side effects of SSRIs and SNRIs. The International journal of risk & safety in medicine, 29(3-4), 135–147. https://doi.org/10.3233/JRS-180745
Peleg, L. C., Rabinovitch, D., Lavie, Y., Rabbie, D. M., Horowitz, I., Fruchter, E., & Gruenwald, I. (2022). Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sexual medicine reviews, 10(1), 91–98. https://doi.org/10.1016/j.sxmr.2021.07.001
Reisman Y. (2020). Post-SSRI sexual dysfunction. BMJ (Clinical research ed.), 368, m754. https://doi.org/10.1136/bmj.m754
Bala, A., Nguyen, H. M. T., & Hellstrom, W. J. G. (2018). Post-SSRI Sexual Dysfunction: A Literature Review. Sexual medicine reviews, 6(1), 29–34. https://doi.org/10.1016/j.sxmr.2017.07.002
Waraich, Ahad & Clemons, Channing & Ramirez, Roma & Yih, Jessica & Goldstein, Sue & Goldstein, Irwin. (2020). MP78-15 POST-SSRI SEXUAL DYSFUNCTION (PSSD): TEN YEAR RETROSPECTIVE CHART REVIEW. The Journal of Urology. 203. e1179. https://www.auajournals.org/doi/10.1097/JU.0000000000000964.015
Csoka, A. B., & Shipko, S. (2006). Persistent sexual side effects after SSRI discontinuation. Psychotherapy and psychosomatics, 75(3), 187–188. https://doi.org/10.1159/000091777
Medicines and Healthcare products Regulatory Agency. (2021, May 26). Freedom of Information request on adverse sexual dysfunction reactions to SSRI use (FOI 21-232). GOV.UK. https://www.gov.uk/government/publications/freedom-of-information-responses-from-the-mhra-week-commencing-5-april-2021/freedom-of-information-request-on-adverse-sexual-dysfunction-reactions-to-ssri-use-foi-21-232
Healy, D., Le Noury, J., & Mangin, D. (2019). Post-SSRI sexual dysfunction: Patient experiences of engagement with healthcare professionals. The International journal of risk & safety in medicine, 30(3), 167–178. https://doi.org/10.3233/JRS-191005
Marjoribanks, J., Brown, J., O'Brien, P. M., & Wyatt, K. (2013). Selective serotonin reuptake inhibitors for premenstrual syndrome. The Cochrane database of systematic reviews, 2013(6), CD001396. https://doi.org/10.1002/14651858.CD001396.pub3
Patetsos, E., & Horjales-Araujo, E. (2016). Treating Chronic Pain with SSRIs: What Do We Know?. Pain research & management, 2016, 2020915. https://doi.org/10.1155/2016/2020915
Kułak-Bejda, A., Bejda, G., & Waszkiewicz, N. (2017). Antidepressants for irritable bowel syndrome-A systematic review. Pharmacological reports : PR, 69(6), 1366–1379. https://doi.org/10.1016/j.pharep.2017.05.014
Healy, D., Le Noury, J., & Mangin, D. (2018). Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. The International journal of risk & safety in medicine, 29(3-4), 125–134. https://doi.org/10.3233/JRS-180744
Montejo, A. L., Llorca, G., Izquierdo, J. A., Carrasco, J. L., Daniel, E., Pérez-Sola, V., Vicens, E., Bousoño, M., Sánchez-Iglesias, S., Franco, M., Cabezudo, A., Rubio, V., Ortega, M. A., Puigdellivol, M., Domenech, J. R., Allué, B., Sáez, C., Mezquita, B., Gálvez, I., Pacheco, L., … de Miguel E (1999). Disfunción sexual con antidepresivos. Efecto del cambio a amineptino en pacientes con disfunción sexual secundaria a ISRS [Sexual dysfunction with antidepressive agents. Effect of the change to amineptine in patients with sexual dysfunction secondary to SSRI]. Actas espanolas de psiquiatria, 27(1), 23–34.
Safarinejad, M. R., & Hosseini, S. Y. (2006). Safety and efficacy of citalopram in the treatment of premature ejaculation: a double-blind placebo-controlled, fixed dose, randomized study. International journal of impotence research, 18(2), 164–169. https://doi.org/10.1038/sj.ijir.3901384
Arafa, M., & Shamloul, R. (2006). Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire. International journal of impotence research, 18(6), 534–538. https://doi.org/10.1038/sj.ijir.3901469
Safarinejad M. R. (2007). Safety and efficacy of escitalopram in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. Journal of clinical psychopharmacology, 27(5), 444–450. https://doi.org/10.1097/jcp.0b013e31814b98d4 (Retraction published J Clin Psychopharmacol. 2022 Mar-Apr 01;42(2):230)
Lorenz T. K. (2020). Antidepressant Use During Development May Impair Women's Sexual Desire in Adulthood. The journal of sexual medicine, 17(3), 470–476. https://doi.org/10.1016/j.jsxm.2019.12.012
HongKong Warning. 7 January 2021. Archived from the original on 12 December 2022. https://web.archive.org/web/20221213074708/https://www.drugoffice.gov.hk/eps/news/showNews/newsTitle/healthcare_providers/2021-01-07/en/42770.html
NHS website. (2022b, February 14). Side effects of sertraline. nhs.uk. https://www.nhs.uk/medicines/sertraline/side-effects-of-sertraline
Yacov Reisman, Tommaso B. Jannini, Emmanuele A. Jannini. Post-Selective Serotonin Reuptake Inhibitor Sexual Dysfunctions (PSSD): Clinical Experience with a Multimodal Approach. J. Mens. Health 2022, 18(8), 165. https://doi.org/10.31083/j.jomh1808165
De Luca, R., Bonanno, M., Manuli, A., & Calabrò, R. S. (2022). Cutting the First Turf to Heal Post-SSRI Sexual Dysfunction: A Male Retrospective Cohort Study. Medicines (Basel, Switzerland), 9(9), 45. https://doi.org/10.3390/medicines9090045
Hansen, C. H., Larsen, L. W., Sørensen, A. M., Halling-Sørensen, B., & Styrishave, B. (2017). The six most widely used selective serotonin reuptake inhibitors decrease androgens and increase estrogens in the H295R cell line. Toxicology in vitro : an international journal published in association with BIBRA, 41, 1–11. https://doi.org/10.1016/j.tiv.2017.02.001
Pavlidi, P., Kokras, N., & Dalla, C. (2021). Antidepressants' effects on testosterone and estrogens: What do we know?. European journal of pharmacology, 899, 173998. https://doi.org/10.1016/j.ejphar.2021.173998
Giatti, S., Diviccaro, S., Cioffi, L., Falvo, E., Caruso, D., & Melcangi, R. C. (2021). Effects of paroxetine treatment and its withdrawal on neurosteroidogenesis. Psychoneuroendocrinology, 132, 105364. https://doi.org/10.1016/j.psyneuen.2021.105364
Healy, D., LaPalme, J., & Levin, M. (2020). Post-SSRI Sexual Dysfunction: A Bioelectric Mechanism?. Bioelectricity, 2(1), 7–13. https://doi.org/10.1089/bioe.2019.0010
Healy, D. (2022, October 10). Sensory Receptors, Small Fibres and Neuropathy. RxISK. https://rxisk.org/sensory-receptors-small-fibres-and-neuropathy/
Healy, D. (2022b, December 5). A Cure for PSSD, PFS and Post-Isotretinoin Syndrome. RxISK. https://rxisk.org/a-cure-for-pssd-pfs-and-post-isotretinoin-syndrome/
Firouzabadi, N., Farshadfar, P., Haghnegahdar, M., Alavi-Shoushtari, A., & Ghanbarinejad, V. (2022). Impact of ACE2 genetic variant on antidepressant efficacy of SSRIs. Acta neuropsychiatrica, 34(1), 30–36. https://doi.org/10.1017/neu.2021.32
Yu, Z., Yang, Z., Wang, Y., Zhou, F., Li, S., Li, C., Li, L., Zhang, W., & Li, X. (2021). Recent advance of ACE2 and microbiota dysfunction in COVID-19 pathogenesis. Heliyon, 7(7), e07548. https://doi.org/10.1016/j.heliyon.2021.e07548
Shen, Y., Yang, X., Li, G., Gao, J., & Liang, Y. (2021). The change of gut microbiota in MDD patients under SSRIs treatment. Scientific reports, 11(1), 14918. https://doi.org/10.1038/s41598-021-94481-1
Healy, D. (2021, Septepber 2). Sensory Receptors, Small Fibres and Neuropathy. Syndrome. RxISK. https://rxisk.org/sensory-receptors-small-fibres-and-neuropathy/
Levine T. D. (2018). Small Fiber Neuropathy: Disease Classification Beyond Pain and Burning. Journal of central nervous system disease, 10, 1179573518771703. https://doi.org/10.1177/1179573518771703
Ben-Sheetrit, J., Hermon, Y., Birkenfeld, S., Gutman, Y., Csoka, A. B., & Toren, P. (2023). Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Annals of general psychiatry, 22(1), 15. https://doi.org/10.1186/s12991-023-00447-0