An unspoken pandemic
PSSD: post-SSRI sexual dysfunction after taking antidepressants such as Prozac, Cipramil and Lustral
Dear Church Leaders (and everyone else)
PSSD — post-SSRI sexual dysfunction — is something more people should know more about.
Some background information on SSRIs
According to this NHS website, SSRIs — selective serotonin reuptake inhibitors — are mainly prescribed to treat depression. They are described as:
…usually the first choice… because they generally have fewer side effects than most other types of antidepressant
The same website also says that SSRIs can be used to treat a number of other mental health conditions, including:
generalised anxiety disorder (GAD)
obsessive compulsive disorder (OCD)
panic disorder
severe phobias, such as agoraphobia and social phobia
bulimia
post-traumatic stress disorder (PTSD)
This BBC article from 2022 reported that 8.3 million adults in the UK were taking antidepressants. Along with 12,000 children aged 10-14, and more than 180,000 young people aged 15-19.
And the numbers are growing. Here is a snapshot of the most recent NHS data (for England only):
Around 15% of the population are on antidepressant drugs.
With SSRIs being the most widely prescribed type of medication. In the words of this report (p14) from 2015:
Most of the antidepressants prescribed in the UK as first line treatment are SSRIs like Prozac
And this is still the case.
Moreover, the proportion of people taking antidepressants in the UK is, according to the data here, higher than almost every other country in the world:
A personal testimony
But there can be life-ruining consequences from taking SSRIs.
This recent podcast1 featuring Rosie Tilli, a young Australian, a provides an overview of the effects that some people suffer:
Here is a transcript of the opening few minutes:
[Doc Malik] I’ve already done a podcast2 about PSSD, but that was with someone whose partner had it… I’m talking to you because you’ve got PSSD, am I right?
[Rosie Tilli] I’m coming up to… the 4-year mark this year.
[Doc Malik] I know this might be difficult for you… but… can you just remind the listeners… What is PSSD? What does it stand for?
[Rosie Tilli] PSSD was the name that was originally given to the condition back when people first started reporting it. It stands for post-SSRI sexual dysfunction. But myself and a lot of others that have this condition really would like to change the name to post-SSRI syndrome because there are so many more symptoms than just sexual dysfunction. But when people first started reporting this… they thought that it was just the one thing. And then as research and time has gone on, they’ve realised that there’s… a larger cluster of symptoms that involve multiple different aspects of… your brain functionality.
Essentially you take an SSRI or an SNRI,3 and you have either side-effects when you take it — like sexual side-effects, cognitive, emotional, that real blunting feeling when you take it — and once you stop taking the drug, that is supposed to [mean you] go back to how you were before, but with PSSD it doesn’t.
Or you can actually be on an SSRI for however long — I’ve seen people be on them for years with no side-effects whatsoever — and just stopping the drug triggers this condition to occur which has a very weird paradoxical reaction. You would think by stopping the drug all of the side-effects would go away, but for some people that’s when it actually starts… it’s only when you withdraw from the medication.
For me, it feels like there’s some sort of adaptation that occurs in your brain that we just haven’t properly looked into yet. But it’s very life-ruining if you do have it.
[Doc Malik] It sounds like a complete nightmare… So… it can exaggerate the side-effects of SSRIs when you’re taking them. It can only come on if you stop it, even if you’ve never had any side-effects. And it can just persist. It seems like such a variable, unpredictable beast of a syndrome…
[Rosie Tilli] …It’s completely life-ruining. A lot of people… might look at PSSD and say… it’s sexual dysfunction, you have a lull of libido. PSSD is not like that at all. This is a complete chemical castration… similar to what you would see in people who are on gonadotrophin hormone blockers… people have comparable levels of sexual dysfunction. I’ve seen people in the PSSD community have almost worse chemical castration than actual chemical castration drugs.
I don’t know how it happens… It’s like it’s affecting a part of the brain… I don’t want to theorise too much because we don’t 100% know, but there’s just no response from the brain any more to sexual stimuli… romantic stimuli… any emotional stimuli. People feel like that they have been completely flatlined. They have this emotional blunting… I can’t feel my negative emotions that much. And I know some people might [say] that’s a good thing. But it’s actually not. I can’t really cry… If something is supposed to affect me…
I remember I went to my friend’s Dad’s funeral, and I didn’t have a single tear. And everyone around me was bawling their eyes out. That was someone that I grew up with, and I just couldn’t even cry. Your brain feels like your neurons are not activating. There’s a complete suppression of something which… I know I wasn’t like this before because I was almost the opposite before the drug…
[Doc Malik] …You said it was four years. How old were you when you went on these… SSRIs?
[Rosie Tilli] I was 20. I was… in the lockdowns in Melbourn… the covid lockdowns… and they just went on for… eight months.
I know that not every single person was affected really negatively by it… I don’t know why [but] it just really mentally affected me. I need to be around people. I love my friends. I love my family and events and everything. I needed to have things to do and I just didn’t for extended period of time.
I was also really into going to the gym and I thought that was a way that I [could] really mentally look after my health and wellbeing. And when they closed the gym… I could go for a run.. but it was just not the same… this structure that I had in my life.
And after a while I just thought I need to get some external support and help. And that’s why I decided to take the medication… I went to my GP and they prescribed it, and at first I [thought] I don’t know if I want it. So then they gave me a referral to a psychiatrist. And… he basically assured me that the drug is very safe and if this one doesn’t work we’ll just get you off it [and] try another one. And that’s not what happened.
[Doc Malik] You’re feeling down, which is very normal… I’m just like you… I love being a social animal because I love humans and interacting with people and hearing people’s stories. I’m not an introvert. I don’t want to be on my own all the time. So I was feeling quite down…
But instead of getting support and helping you and talking to you and getting therapy… it was just, here’s a pill, even the psychiatrist? They didn’t offer you anything else?
[Rosie Tilli] I was actually going to therapy at the time… I would see a psychologist over Zoom for one hour once a week. [But] my problems were my surroundings. That person is not magic. One hour once a week is not going to fix the situation that was causing me to feel like that. I needed to see people regularly. I needed to have my friends [around me].
Our lockdowns here were so bad… I had my 21st birthday at home, basically on my own. I know you’re not supposed to have people over but I had… two friends over. That was all I could have. And that was not even at the end…
The isolation, when you think about it in retrospect it doesn’t seem that bad, but when you’re in it and you don’t know how long it’s going to go on for, and you’re already feeling like that… that’s what was perpetuating the situation. In retrospect I didn’t need medication. I needed the lockdown to finish. And I would have been fine.
Meanwhile the likes of the BBC were running articles like this:
A problem made worse
I am reminded of the short film made in 2020 by a 15-year-old Canadian girl for a school project that I featured in this brief post:
I recommend taking three minutes to watch it if you haven’t seen it.
Perhaps unsurprisingly, it appears that a lot of people were prescribed SSRIs for the first time during the covid era. Here is the UK prescription data for the past five years:
Quite a change there in Spring 2020.
Between February and April/May 2020, spending on SSRIs roughly quadrupled to more than £20 million per month. And SSRIs are not expensive drugs. Eli Lilly’s patent for fluoxetine, the active ingredient of Prozac, expired in 2001. And Tata 1mg4 sells it for a few pence per tablet. The cost of sertraline, the active ingredient of Lustral,5 the most commonly dispensed SSRI in England, is little more. And some of the other leading SSRIs are even cheaper.
Note too the context in which the “covid measures” — including the lockdowns which had such a devastating impact on the lives of young people — were introduced:
TL;DR: official UK government data shows that, before the introduction of the “covid measures” on 23rd March, the rate at which people were dying was normal (and, if anything, slightly lower than usual) for the time of year. Despite the fact that covid had apparently been circulating since January.
These really are the official numbers from the UK Office of National Statistics (ONS), available here for anyone who wants to check — no expertise is required.
And yes, the number of registered deaths in absolute terms for the week ending 20th March — i.e. just before Boris Johnson ordered the nation to stay at home in fear of a deadly virus — was the lowest of the year.
Hmm.
Some wider context
Big business
Antidepressants have of course been big business for decades. And the market continues to grow. According to this recent report:
The global antidepressants market size was valued at USD 11.67 billion in 2019 and is projected to grow from USD 14.93 billion in 2020 to USD 18.29 billion in 2027, exhibiting a CAGR [compound annual growth rate] of 2.9% during the forecast period (2020-2027). Based on our analysis, the global market will exhibit a stellar growth of 28.0% in 2020. The global impact of COVID-19 has been unprecedented and staggering, with depression medications witnessing a positive demand shock across all regions amid the pandemic. The sudden decline in CAGR is attributable to this market’s demand and growth, returning to pre-pandemic levels once the pandemic is over. [Emphasis added]
But does anyone think that the world at large is significantly less depressed than (say) 30 years ago? Or that the increasing availability of antidepressants is helping much?
Lack of information
Lack of information doesn’t help.
The NHS webpage entitled Side effects — Selective serotonin reuptake inhibitors (SSRIs) — does mention “loss of libido” and related problems, albeit at the bottom of the list of common side-effects, but that seems rather to understate the experience of the likes of Rosie Tilli. Suicidal thoughts are mentioned, but much further down the page. And there is no mention of problems for those coming off medication.
And websites such as Tata 1mg have even less information:
As to patients who are prescribed SSRIs on the NHS, I wonder to what extent they ever receive properly informed consent, i.e. all of the information about what the treatment involves, including the benefits and risks.
And I wonder too how much support there is for those suffering side-effects — including those that are listed on the NHS website above.
Lack of awareness among medical professionals
It does not help that there seems to be something of a lack of awareness among medical professionals — in Australia at least.
Here is more of Rosie Tilli’s story in a 2023 article entitled Antidepressants can cause ‘chemical castration’:6
After four months, Rosie decided to slowly wean herself off the medication. Some of her symptoms improved and the fog lifted, but over the next two years her libido faded to nothing.
“It has been two years of hell. Now, I have no sexual function. I’m numb down there. I can't have an orgasm. It feels like my soul has just been vacuumed out of my body. I feel completely asexual,” said Rosie.
She sought help from various professionals, but none believed it could be the antidepressant because the drug had already left her system. They concluded it was all in her mind.
Rosie went to a local youth centre for help, but they ended up sectioning her under the Mental Health Act with an Involuntary Treatment Order, insisting she take antipsychotic medication.
“I refused to take an antipsychotic because I knew I wasn’t psychotic. Instead, they forced me to take another antidepressant against my will in order to leave the facility,” said Rosie.
“It was the most traumatic thing I’ve ever been through in my life. I felt helpless and my parents just looked on and said, ‘trust the professionals, they know what they are doing’.”
In her clinical notes, the doctors wrote that “Rosie exhibits fixated beliefs of a delusional intensity about ongoing sexual side effects from Lexapro [sold as Cipralex7 in the UK]”.
“One psychologist actually asked me if I’d tried seeing a male sex worker to help bring back my libido. I was shocked. They said it would reduce my anxiety and help me get in touch with my body,” said Rosie.
“I’m chemically castrated, and no one believes me. In retrospect, my original anxiety was not even a problem compared to this. This has absolutely ruined my quality of life. I feel trapped inside my own body,” she added.
The above is consistent with this testimony from someone else whose life has been “completely destroyed by SSRIs” and who is “fighting to help others avoid this brutal existence”:
SSRIs completely obliterated my chance at a normal life. I don’t know what they did to my brain but since getting PSSD I can’t connect with people, can’t form a relationship, can’t enjoy hobbies. My family mourn the old me and they can cry… I can’t even do that! What’s left?
The same person posted this:
Hi, I think I’m depressed. My anxiety is through the roof.
Ok here’s a prescription for some #SSRIs.
Hi, my depression seems to be worse now.
Ok let’s up your dose.
Hi, my depression isn’t going away, I feel tired all the time with this debilitating brain fog and slurred speech.
Ok let’s put you on a different #antidepressant.
Hi, I don’t think these different antidepressants are working for me. I’m done with them and want to try and fix my lifestyle rather than rely on pills.
Ok you can taper off them in 2 weeks.
But I’ve been on them for 10 years, are you sure that’s a good idea?
Yeh you’ll be fine.
Hi, since stopping… my genitals are completely numb, my sex drive has completely disappeared and I can no longer enjoy anything, not even a cup of coffee or a pint of beer. I can no longer appreciate a sunset.
I understand you’re upset that you now have permanent #PSSD, but I think there must be some underlying cause for your depression.
I’m depressed because I've been permanently chemically castrated by the drugs you prescribed me and I wasn’t warned this could happen. I feel brain damaged, lobotomised.
I’m not an expert in PSSD, sorry.
Ok I guess I’m on my own then. Bye
The use of SSRIs as a drug treatment for sexual offenders (or those at risk of offending)
What makes the above worse still is that it is no secret that:
SSRIs are actually given as a drug treatment for sexual offenders
to reduce their sex drive
This 2015 study from Cochrane, which at the time was widely considered as a highly reputable source of information, says in its background information that:
Medications used to treat sex offenders (‘antilibidinal’ medications) act by limiting the sexual drive (libido). There are two types, those which work by suppressing testosterone (e.g., progestogens, antiandrogens, and gonadotropin-releasing hormone (GnRH) analogues), and those that reduce sexual drive by other mechanisms (i.e., antipsychotics and serotonergic antidepressants (SSRIs)). [Emphasis added]
[Update: as far as I can tell, it seems that the doses used to reduce sex drive are around 3x that of a typical starting dose for depression, but still within the window of what is sometimes used]
The extent of the problem
The number of people affected by PSSD
It is not easy to answer the question of how many people are affected by PSSD. A recent summary of what is known can be found here:
It isn’t known how many people regain 100% of their original sexual function and sensation after using an antidepressant. It has been suggested that based on the available data, PSSD may be quite common.
In one study, a group of patients who were experiencing sexual side effects on an SSRI were switched to the [non-SSRI] dopaminergic antidepressant, amineptine. After six months, 55% still had at least some type of sexual dysfunction. This is compared to only 4% in the control group who were treated with amineptine alone and were not exposed to an SSRI.
A large placebo-controlled study into the use of sertraline (Lustral) as a treatment for premature ejaculation found that the ejaculation-delaying effect of the drug persisted for 34% of participants 6 months after it was discontinued.
A healthy volunteer study which assessed the effects of paroxetine (Seroxat) on sperm and sexual function reported that brief sexual function inventory (BSFI) scores for erectile and ejaculatory functions had not returned to baseline four weeks after discontinuation of the drug, with 9% of patients complaining of more than mild dysfunction.
There are several factors that make it difficult to accurately estimate the incidence and prevalence of PSSD:
These include designing a suitable study method, patient embarrassment at raising sexual concerns, the response of healthcare professionals, inability to stop an antidepressant due to withdrawal issues, patient unawareness that their sexual difficulties are linked to prior medication, variability of online information, and a lack of information aimed at public education.
But there seems little doubt that there is a substantial problem:
A US/Canada survey of sexual and gender minority youth aged 15 to 29 reported that 13.2% of patients treated with antidepressants had a persistent post-treatment genital hypoesthesia compared to 0.9% of those treated with other medications.
A problem which for many is, to echo Rosie Tilli’s words from earlier, life-ruining:
PSSD can be extremely distressing to those affected. It can lead to marriage break-up, job loss and suicide.
The lack of will to address the issues
At the end of the podcast featured at the beginning of this post, Rosie Tilli says:
There was a study that I saw, and it compared published data versus unpublished research on the effectiveness of SSRIs. And if you look at all of the published literature it will show you how great these drugs are.
But then if you go through all the clinical trials data that were done that were just never published, so many of them… it’s not only that people got harmed. [The drugs] just didn’t even work… The drug just did not really help at all…
Where does the problem start though?… It’s such a huge problem of misinformation… People just being allowed to get away with harming people… ripping families apart with these drugs, causing havoc in people’s lives. People have lost everything. It’s really sad…
The biggest thing that I’m trying to get out there is this awareness that we use SSRIs to sexually castrate sex offenders. They are used in paraphilias. And we give these same drugs to kids. Some people have been given these drugs at the age of 10. And then they grow up thinking that they are [naturally] asexual, not because they took a drug that is used to castrate a sex offender. Now we have a huge increase in people that are asexual and everyone says, “I don’t know why”. What do you mean?! Have a look around! We need more research on this topic…
We’ve banned puberty blockers for kids in the UK because of this reason. But SSRIs do the exact same thing. So why are we allowing kids to have [SSRIs], but then puberty blockers are banned? What’s the difference? They both cause permanent sexual dysfunction which kids cannot consent to, which is the whole reason why we’ve banned [puberty blockers] for kids. All the attention has been on puberty blockers but people don’t actually realise that SSRIs cause [very similar problems]. And that’s something I’m trying to get the word out there about.
And obviously it’s not just children. It’s adults… young adults, people not being informed. People report this [but]… We had reports to the MHRA from people in the UK… And the reports of some of the sexual dysfunction just went missing… [The MHRA] said, for example, “We might have had two reports…” But they [the people in the UK who submitted the reports] said, “There were five of us. We’ve got the receipts from our reports.”
So it’s not even getting reported… The reporting system is completely broken… No-one is properly keeping track of this… It’s a mess.
It appears that there is not only a lack of research, but a lack of will to do research. In the context of an industry worth well over $15 billion, it would be surprising if funding were an issue. But relatively few studies on the effect of SSRIs on sexual function have been done. Read into that what you will.
There is also a growing industry that presumably profits from young people confused about their sexuality:
Some useful sources of information
As to PSSD, there seems to be plenty of information out there for those inclined to look:
The website RxISK — which describes itself as free and independent — was launched in 2012 “to empower you to have better conversations about your medications with your doctor”.
And it has an informative section on PSSD:
One thing worth noting is that it seems that it is not so easy to get reliable information about PSSD into the mainstream media, as illustrated by the account here.
Websites dedicated to PSSD include the PSSD Network, a non-profit charitable organisation based in Australia, led by PSSD patients and their loved ones:
And the UK PSSD Association:
But I doubt that most people being prescribed antidepressants have even heard of PSSD, let alone researched it. I was largely unaware of it until fairly recently, and I have rarely heard it mentioned in conversation — hence the title of this post.
And as with other medical products, not least the covid injections, there seems to be a lack of properly informed consent. Maybe this is no accident. After all, if people knew about the potential side-effects of SSRIs, how many people would actually start taking them? And what effect would that have on an industry that is worth well over $15 billion?
For my own part, I share the sentiments of the title of UK cardiologist Dr Aseem Malhotra’s recent film, First Do No Pharm. I am increasingly inclined to look hard at changes in diet and lifestyle before even considering pharmaceutical interventions. As to SSRIs, “think twice” would now for me be an understatement.
I am reminded again of the words of the angel in Revelation 18:23, where the Greek word translated “magic spell” is pharmakeia, from which we get the modern English word “pharmacy”, with the word “pharmaceutical” (as in Big Pharma) having the same root.
The light of a lamp will never shine in you [Babylon] again. The voice of bridegroom and bride will never be heard in you again. Your merchants were the world’s important people. By your magic spell [pharmakeia] all the nations were led astray. In her was found the blood of prophets and of God’s holy people, of all who have been slaughtered on the earth.’ (Emphasis added)
Dear Church Leaders most-read articles
Some posts, including a version of this one, can also be found on Unexpected Turns
The Big Reveal: Christianity carefully considered
Available to paid subscribers only; I have produced the transcript here with Doc Malik’s permission
Also available to paid subscribers only
A Serotonin-Norepinephrine Reuptake Inhibitor, similar to an SSRI
Which brands itself as India’s Leading Online Pharmacy & Healthcare Platform
Sold in the US as Zoloft
c/o Maryanne Demasi, an independent scientist and journalist who is well worth following
The second most commonly dispensed SSRI in England (NB amitriptyline, the second most commonly dispensed antidepressant, is not an SSRI)