How to Manage Post-SSRI Antidepressant Sexual Dysfunction (PSSD)


Super Moderator

This ISSM Webinar is on Post SSRI Sexual Dysfunction.

The webinar will be opened by Annamaria Giraldi, ISSM President (Denmark). The webinar will be moderated by Alan Shindel (USA) and Marco Gonçalves (Portugal). Topics:

Post-SSRI Sexual Dysfunction (PSSD): history and relevance – David Healy (Republic of Ireland) Explanatory Processes and Diagnosis of PSSD: what do we still need to know? – Yacov Reisman (the Netherlands)

Q&A Session led by the moderator

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Nelson Vergel


Nelson Vergel

I did not know that this drug could be a possible treatment: Ganisetron (Kytril,) Injectable

It can prevent nausea and vomiting caused by cancer treatments such as radiation and chemotherapy, including cisplatin. It can also treat and prevent nausea and vomiting after surgery.

It did not seem to work well in this study:

A Placebo-Controlled, Crossover Trial of Granisetron in SRI-Induced Sexual Dysfunction
July 2001The Journal of Clinical Psychiatry 62(6):469-73

Sexual side effects are commonly associated with serotonin reuptake inhibitor (SRI) therapy. The mechanism underlying SRI-induced sexual dysfunction has been hypothesized to be mediated by direct serotonergic effects. Evidence from open-label reports suggests that cyproheptadine, nefazodone, mirtazapine, and mianserin, which block one or more serotonin receptors, may reverse sexual side effects. The current study was a prospective, randomized, crossover trial comparing granisetron, a serotonin-3 antagonist, with placebo in outpatients who developed sexual dysfunction during SRI treatment. Thirty-one outpatients who were currently experiencing sexual dysfunction associated with SRIs were randomly assigned to double-blind treatment with granisetron (1-1.5 mg) or placebo for use 1 to 2 hours prior to sexual activity. Patients rated sexual symptoms after each trial using the Sexual Side Effect Scale (SSES). After 4 trials of the medication, patients crossed over to the other treatment for 4 more trials. Twenty patients received at least 1 dose of placebo and granisetron. Analysis by repeated-measures analysis of variance showed no significant effects of granisetron relative to placebo. Significant improvement between baseline and treatment-phase SSES scores was observed for both granisetron (p = .0004) and placebo (p = .0081). The study medication was generally well tolerated. The results of this study do not support the efficacy of granisetron (1-2 mg) in the treatment of SRI-associated sexual side effects. A significant placebo response may be associated with the treatment of SRI-induced sexual dysfunction.

Nelson Vergel

Sexual side effects are common with antidepressants in both men and women, so your concern is understandable. Effects on sexual function can include:

A change in your desire for sex
Erectile problems
Orgasm problems
Problems with arousal, comfort and satisfaction
The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem.

Antidepressants with the lowest rate of sexual side effects include:

Bupropion (Wellbutrin XL, Wellbutrin SR)
Mirtazapine (Remeron)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)

Antidepressants most likely to cause sexual side effects include:

Selective serotonin reuptake inhibitors (SSRIs), which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include venlafaxine (Effexor XR), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).

Tricyclic and tetracyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and clomipramine (Anafranil).

Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). However, selegiline (Emsam), an MAOI that you stick on your skin as a patch, has a low risk of sexual side effects.
If you're taking an antidepressant that causes sexual side effects, your doctor may recommend one or more of these strategies:

Waiting several weeks to see whether sexual side effects get better.
Adjusting the dose of your antidepressant to reduce the risk of sexual side effects. But always talk with your doctor before changing your dose.

Switching to another antidepressant that may be less likely to cause sexual side effects.
Adding a second antidepressant or another type of medication to counter sexual side effects. For example, the addition of the antidepressant bupropion may ease sexual side effects caused by another antidepressant.

Adding a medication to improve sexual function, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra, Staxyn). These medications are approved by the Food and Drug Administration only to treat sexual problems in men. Limited research suggests that sildenafil may improve sexual problems caused by antidepressants in some women, but more information is needed on its effectiveness and safety in women.



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