Antidepressant patients are being warned to watch out for side effects that could leave them ‘asexual’ even after they stop taking them – a problem that could affect millions of Britons.
Selective serotonin reuptake inhibitors (SSRIs), the most common class of antidepressants in the UK, are relied upon by one in eight Britons – 8.6 million in total – who struggle with mental health problems such as anxiety and depression.
Common SSRIs prescribed in the UK include citalopram, fluoxetine and sertraline, sometimes known by the brand names Cipramil, Prozac and Lustral – but their use has been linked to long-term and even permanent sexual dysfunction, according to researchers.
The NHS has warned that side effects such as loss of libido and orgasm, lower sperm count and erectile dysfunction can “persist” after taking them – and patients have described feeling “cut out”, relationships destroyed while taking them.
Men and women say the side effects of SSRIs have curtailed their sex lives, even after stopping the drugs – a condition known as Post-SSRI Sexual Dysfunction (PSSD), which is not officially recognized by UK health authorities.
Antidepressants can be a life-saving drug for millions – but the authors of a US petition calling for more warnings on the drugs say it may be “impossible … to weigh the benefits of treatment against the harms”.
Has your sex drive been curbed by SSRIs? By email jon.brady@mailonline.co.uk
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The side effects of antidepressants affecting men and women have been well-known for decades after the first trials in the 1980s — but the drugs have expanded in their use to treat depression, anxiety and other mental disorders.
One London student, who spoke on condition of anonymity, previously told the Mail his genitals were left “basically lifeless” after he started taking the SSRI escitalopram.
He said: “This area of ​​my life used to be so much fun and is now a source of anxiety and has become a dark place in my head.
“I feel like someone took a scalpel into my brain, cut some pieces out of it, and left me with this weird, numb, asexual person.
“No doctor would even think that it could be related to SSRIs.”
Rebecca Graham, a Briton in her 40s, said she had ‘given up on the idea of ​​having children’ – but that she was ‘fired up’ by doctors who refused to believe that SSRIs cause numbness below the waist.
“I feel like I’ve been castrated,” she added.
Despite this, drugs are being readily prescribed to Britons as they try to overcome the conditions, which affect between four and ten per cent of people in England during their lifetime, according to the Mental Health Foundation.
Dr Ben Davis, an expert in sexual medicine, said antidepressants were often prescribed quickly – perhaps too quickly.
“There are people for whom these are life-saving drugs,” he told BBC News.
“But on the other hand, a ten-minute consultation with someone you’ve never met before is under the pressure of someone who sees 30 people a day.
“Are good long-term treatment decisions being made in this environment? I think not.’
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Advocacy groups such as the PSSD Network have called for better recognition of the condition and better support for those experiencing loss of libido.
However, their campaign is limited by a lack of research into the long-term effects of SSRI use.
In the US, a Harvard molecular biologist has filed a lawsuit against the Food and Drug Administration (FDA) for allegedly ignoring requests for SSRI warnings about the long-term and even permanent consequences of their use.
Dr. Antonei Csoka, an adviser to the PSSD network, said in filings that the FDA never followed up on a petition he co-signed in 2018 asking officials to require drug companies to add warnings to their drugs.
They believe that long-term use of SSRIs can rewrite DNA – which in turn can affect genes related to sexual function. But exactly why this happens in some patients and not in others is unknown – and research is still lacking.
Dr Csoka said: “Without adequate warning about the risk of potentially permanent damage to sexual function, patients and health professionals cannot weigh the benefits of taking drugs against the potential harms.”
Researchers are not sure how many people are affected by PSSD, although more than half of all antidepressant users report some degree of sexual dysfunction while taking them.
And a 2018 review of the scientific literature on PSSD found that about five to 15 percent of people taking antidepressants developed sexual side effects, such as erectile dysfunction and lack of sex drive, after taking SSRIs and SNRIs.
Patients sharing their stories through the PSSD network have described a range of disorders from erectile dysfunction, genital shrinkage and numbness to a lack of any sense of attraction to others and an inability to feel pleasure.
One male patient was prescribed different antidepressants at different times when he was 16 to cope with the death of his father and was able to stop taking them in his 20s.
Now, at 25 and off medication, he has “extreme genital shrinkage and discomfort, I have neurological smooth muscle dysfunction in my penis that causes hypercontractions or persistent arousal disorder.
“I have an overactive bladder all the time, I’m urinating, I have severe erectile dysfunction and premature ejaculation… I didn’t have any of that before the medication.”
He added: “I have seen a urologist who specializes in sexual health who recognizes the existence of PSSD; he did an ultrasound on my privates and told me I had fibrosis in it and said it’s very common to see in men who have been on anti-depressants for a while.’
One patient, meanwhile, stopped taking antidepressants three years ago, but said her sexuality is now gone.
She said, “My clitoris feels like a dead lump.”
And a third patient, who had been taking Lexapro for about three months, said he was “asexual now because of the drug.”
He said: ‘I used to be able to look at people who were attracted to me and you feel something, but now I don’t feel anything, it’s like looking at a wall. They basically took almost all the positive emotions, they went from 100 to maybe less than one, so that’s powerful.”
He added that the hardest part of the overall emotional numbing caused by the medication: “When you hug the people you love, your mother, your father, your nephew, you don’t feel anything… You can’t get any emotional connection at all. ‘
Dr. Csoka has been researching sexual dysfunction related to antidepressants since the early 2000s and was one of the first to hypothesize that these drugs, as a side effect of increasing serotonin levels in the brain, cause DNA modifications that affect the activity of genes that regulate sexual function.
He told the Guardian: “Various scientists, including myself, have published studies showing that SSRIs can change epigenetics and human cells.
“If that happens, then those cells or tissues may not immediately go back to the state they were in once the treatment is over.” As if there was an imprint left. However, it is still not known exactly what these epigenetic changes are. So what we have to do is narrow it down—what’s going on?’
His lawsuit, filed in the U.S. District Court for the District of Columbia, seeks to compel the FDA to issue a ruling on the petition.
A 2022 meta-analysis in Frontiers in Pharmacology found that SSRIs have “statistically significant impairments in sperm quality such as sperm concentration, sperm morphology, sperm motility,” the researchers wrote. However, sperm volume was not affected.
However, it is not possible to say whether SSRI use has an effect on UK birth rates.
In England, the prescription of antidepressants more than tripled between 1998 and 2018, according to an analytical study of prescribing data.
Over the same time period, the average number of births per woman in the UK rose from 1.73 to a peak of 1.94 in 2010 – falling to 1.65 in 2018, according to the Office for National Statistics.