According to the National Health Interview Survey, 11.4% of US adults used antidepressants in 2023. Antidepressants (e.g. SSRIs, SNRIs and TCA) are known to cause sexual dysfunction (SD), but less known are the persistent side effects after withdrawing the medication, causing a condition called PSSD (post SSRI sexual dysfunction). This study aimed to query individuals with PSSD about their symptoms and mental health.

In this observational study, men and women (≥18 years) suffering from persistent side effects after stopping SSRI, SNRI or TCA were recruited through various social media platforms and asked to complete a single Qualtrics survey to assess severity of symptoms. Individuals who had a history of taking finasteride or isotretinoin were excluded because of the potential overlap in symptoms.

380 men (65.3%) and women (34.7%) completed the survey. Responses were collected from United States (35.3%), Canada (7.6%), 7 European (34.7%) and 18 other (22.3%) countries. Out of 35 drugs, Sertraline (SSRI) (42.4%) and Escitalopram (34.5%) were used most frequently, with 41.1% of respondents haven taken 2 or more types of antidepressants. Medications were primarily prescribed by primary care/family physicians (73.2%) and psychiatrists (23.2%). Side effects were the primary reason for drug discontinuation (63.9%) followed ineffectiveness of medication (16.3%). While taking antidepressants, 88.9% experienced SD during treatment, increasing to 96.3% after cessation, with 53.8% reporting their symptoms worsened and only 21.9% saw symptom improvement after drug cessation. Most common SDs after stopping the drug includes reduction/loss of sexual desire (83.7%), reduction in genital sensation (81.6%), and compromised orgasm (80%). Other sexual symptoms (26.8%) included genital atrophy, numbness and ejaculate dysfunction. Only 3.7% of study participants did not report any sexual dysfunction after drug cessation. The majority of respondents (83.9%) shared they were unaware of the potential risk for developing sexual dysfunction while on antidepressants. Furthermore, 92.1% suffered from other symptoms including cognitive impairment 71.1%), loss in previous hobbies/interests (68.4%), and mood changes (54.2%), with only 7.9% reporting experiencing no other symptoms beyond sexual dysfunction. Finally, 61.1% stated having thoughts about hurting themselves or that they’d be better off dead at least once or twice per week.

Antidepressants can result in a broad number of long-term side effects after drug withdrawal, with sexual dysfunction being the most common. However, most patients with PSSD experience other symptoms alongside sexual dysfunction. In addition, two thirds of patients with PSSD have suicidal ideation, which can either be a primary side effect of PSSD or secondary to other side effects and the lack of effective therapies.

Sexual dysfunction is highly prevalent in patients suffering from PSSD. Cognitive impairment, anhedonia, mood changes, and suicidal ideation underscore the burden of SSRI, SNR or TCA use for patient well-being. These findings highlight the importance of appropriate patient counseling, monitoring, and interdisciplinary collaboration in managing antidepressant-related side effects within urology and mental health practice.