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Doctors and patients have long known that antidepressants can cause sexual problems. No libido. Orgasms without pleasure. Numb genitals. More than half of people taking medications report such side effects.
Now, a small but vocal group of patients is speaking out about serious sexual problems that have persisted even long after they stopped taking selective serotonin reuptake inhibitors, the most popular type of antidepressants. The effects of the drugs have been devastating, they said, leaving them unable to enjoy sex or maintain romantic relationships.
“My clitoris feels like a knuckle,” said Emily Gray, a 27-year-old woman from Vancouver, British Columbia, who took one such medication, Celexa, for depression from ages 17 to 23. “It is not normal to have to come to an agreement with.”
He security label Prozac, one of the most prescribed SSRIs, warns that sexual problems may persist after stopping the medication. And the health authorities of Europe and Canada He recently acknowledged that the medications can cause long-lasting sexual problems.
But researchers are just beginning to quantify how many people have these long-term problems, known as post-SSRI sexual dysfunction. And the chronic illness remains controversial among some psychiatrists, who point out that depression itself can curb sexual desire. Clinical trials have not followed people after stopping medications to determine whether such sexual problems stem from the medications.
“I think it’s a recurring depression. Until proven otherwise, that is what it is,” said Dr. Anita Clayton, chief of psychiatry at the University of Virginia School of Medicine and leader of a group of experts which will meet in Spain next year to formally define the condition.
Dr. Clayton published some of the earlier Research showing that SSRIs have widespread sexual side effects. He said patients with these problems should talk to their doctors about switching to a different antidepressant or combination of medications.
He worries that too much attention to seemingly rare cases of sexual dysfunction after stopping SSRIs could discourage suicidal patients from trying the drugs. “I have a very big fear about this,” she said.
By the mid-2000s, the sexual effects of SSRIs were well recognized. In fact, the medications blunted sexual responses so reliably that doctors began to prescribe for men with premature ejaculation.
But sexual symptoms that persist after stopping medications have not received much attention in the medical literature.
In 2006, a few cases of persistent genital numbness were reported in Canada and the United States. That same year, a bulletin from the American Psychological Association described emerging data on the long-lasting sexual effects of drugs.
“I think we’ve only just begun to appreciate the pervasiveness and complexity of the impact of these medications on sexuality,” said Audrey Bahrick, then a psychologist at the University of Iowa. wrote in the article.
In an interview, Dr. Bahrick said she felt an ethical obligation to draw attention to the condition because she had experienced it herself.
He started taking Prozac in 1993, when he was 37 years old and struggling with a difficult job in a new city. One day after taking the pill, she felt numb in her clitoris and vagina. “It was like they had a glove on them, a very, very cushioned feeling,” she recalled.
For a while, she said, the trade-off was worth it: The antidepressant made her feel more energetic and more resilient. But after two years, she stopped taking it for the sake of her relationship. However, the sexual symptoms persisted and the relationship ended.
“It never occurred to me that this would be something that would actually never be resolved in my lifetime,” said Dr. Bahrick, now 67 years old.
In the decades since, the use of SSRIs has skyrocketed, especially among adolescents. They are prescribed not only for depression and anxiety, but also for a variety of other conditions, including irritable bowel syndrome, eating disorders, and premenstrual symptoms. However, researchers are still struggling to understand how SSRIs work and why sexual problems are so widespread.
The drugs target serotonin, an important chemical messenger in the brain and other parts of the body. The molecule is involved in dulling sexual responses, including orgasm reflex which originates in the spinal cord. Serotonin also affects estrogen levels, which in turn can affect arousal.
But depression also dulls sexual desire. Among men with depression who do not receive medication, 40 percent report a loss of sexual arousal and desire, and 20 percent struggle to orgasm. Common conditions such as diabetes and cardiovascular diseases can also cause sexual problems.
Drug trials rarely look at what happens when drugs are stopped. And studying what happens after people stop taking SSRIs is particularly challenging because many people never stop taking them. taking them.
Given the lack of data, “persistent sexual dysfunction caused by SSRIs is a hypothesis, not a proven phenomenon,” said Dr. Robert Taylor Segraves, professor emeritus of psychiatry at Case Western Reserve University School of Medicine, who has studied the effects of antidepressants. about sexuality.
Still, some researchers have found ways to estimate the prevalence of the condition. A recent study in Israel reported that approximately one in 216 Men who stopped SSRIs were subsequently prescribed ED medications, a rate at least three times higher than the general population.
And when many patients report similar problems (such as the hallmark symptom of genital numbness), the signal shouldn’t be discounted, said Dr. Jonathan Alpert, head of the American Psychiatric Association’s research council.
Some patients who have taken finasteridethat treats hair loss in men, or isotretinoin, an acne medication, have also reported genital numbness and other sexual problems after stopping the medication. This may indicate a common biological mechanism, Dr. Alpert said.
“It all starts with anecdotal reports and science must follow,” he said.
Other researchers are particularly concerned about the growing number of young people who start taking medications before their sexuality has fully developed.
“People who take these medications at a young age may never know who they would be if they had not been taking this medication,” said Yassie Pirani, a counselor in Vancouver.
in a new survey of 6,000 LGBTQ youth Although not yet peer-reviewed, Ms. Pirani and her collaborators at Simon Fraser University in British Columbia found that people who had stopped taking antidepressants were 10 times more likely to report persistent genital numbness than those who had never taken antidepressants. the drugs.
Ms. Pirani described one of her patients, 33 years old, who had taken SSRIs from age 11 to age 20. “In her entire sexual history, she could have sex, but she never really felt anything,” she Pirani said.
Some of his patients, he added, wondered for years if they were asexual before realizing that medications might have played a role. When they went to doctors for help, they were often dismissed.
In recent years, many patients have found support for their illness online. About 10,000 people are members of a Reddit group for people with post-SSRI sexual dysfunction, up from 750 members in 2020. In 2018, dozens of patients and doctors requested regulators Europe and the United States added warnings about the risk of persistent sexual problems to drug labels, prompting the European Medicines Agency to do so the following year. (A spokeswoman for the U.S. Food and Drug Administration said the agency was still reviewing the petition.)
“We feel very abandoned,” said Roy Whaley, a 38-year-old from Somerset, England, who belongs to PSSD Network, a global advocacy group formed last year.
Whaley briefly took the antidepressant Citalopram at age 22 to treat his obsessive-compulsive disorder. Sixteen years later, his penis feels almost as if it had been injected with a local anesthetic, she said. He has lost his libido and does not feel pleasure from orgasms. At times, he said, this loss of sexuality has made him feel suicidal.
Over the years, doctors have repeatedly suggested that Mr. Whaley’s sexual problems were psychological, according to medical records reviewed by The New York Times. A 2009 report said it was “exceptionally unlikely” that citalopram was the cause.
His current doctor does believe him, he said, in part because of the statement from European regulators.
For Dr. Bahrick, who has continued to publish research on the topic, the recent recognition of her condition is little consolation, considering the unknown number of people who have lost a fundamental human experience.
“It’s not just about numb genitals,” Dr. Bahrick said. “It’s a reorientation to being in the world.”
Audio produced by Tally Abecassis.