Doctors and patients have long known that antidepressant drugs can cause sexual problems: low libido, joyless orgasms, numb genitalia. More than half of people taking these medications experience these side effects.
Now, a small but vocal group of patients is speaking out about serious sexual problems that persist long after they stop taking selective serotonin reuptake inhibitors (SSRIs), the most popular type of antidepressants. He claims that the effects of the drugs have been devastating, leaving him unable to enjoy sex or maintain romantic relationships.
“I feel like my clitoris is a knuckle,” said Emily Gray, 27, of Vancouver, British Columbia. Who took one of these drugs, Celexa, to treat depression between the ages of 17 and 23. “It’s not a normal thing to accept.”
The safety label for Prozac, one of the most commonly prescribed SSRIs, warns that sexual problems may persist even after stopping the drug. And health officials in Europe and Canada have recently acknowledged that the drugs may cause long-lasting sexual problems.
However, researchers are just beginning to determine how many people suffer from these long-term problems, known as post-SSRI sexual dysfunction. Additionally, this chronic condition remains controversial among some psychiatrists, who point out that depression can also curb sexual desire. Clinical trials have not followed people who stop taking the drug to determine whether these sexual problems are caused by the drug.
“I think it’s recurrent depression until proven otherwise,” said Anita Clayton, chief of psychiatry at the University of Virginia School of Medicine and leader of a group of experts meeting in Spain next year. ” The disease.
Clayton published some of the first research showing that SSRIs had widespread sexual side effects. Patients with these problems should talk to their doctors about switching to another antidepressant or combination of drugs, he said.
They worry that focusing too much on apparently rare cases of sexual dysfunction after stopping SSRIs could discourage suicidal patients from taking these drugs. “It scares me a lot,” he said.
By the mid-2000s, the sexual effects of SSRIs were well known. In fact, the drugs shut down sexual responses so strongly that doctors began prescribing them to men with premature ejaculation.
However, sexual symptoms that persist after discontinuation of 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 of the American Psychological Association described new data on the drugs’ lasting sexual effects.
“I think we are just beginning to appreciate the breadth and complexity of the effects of these drugs on sexuality,” Audrey Bahrick, then a psychologist at the University of Iowa, wrote in the article.
In an interview, Bahrick said she felt a moral obligation to draw attention to the problem because she had experienced it.
He began taking Prozac in 1993, when he was 37 years old and facing a difficult job in a new city. The day after taking the pill, she felt her clitoris and vagina go numb. “It felt like they had a glove on them, a very cushioned feeling,” he recalled.
For a while, she said, the benefits were worth it: Antidepressants made her feel more energetic and resilient. But after two years he stopped taking it for the sake of his relationship. However, sexual symptoms persisted and the relationship ended.
“It never occurred to me that this would be something that, in fact, would never be resolved in my lifetime,” said Bahrick, now 67.
In the decades since, SSRI use has skyrocketed, especially among teenagers. They are prescribed not only for depression and anxiety, but also for other conditions, such as 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.
These medications act on serotonin, an important chemical connector in the brain and other parts of the body. This molecule is involved in modulating sexual responses, including the orgasm reflex generated in the spinal cord. Serotonin also affects estrogen levels, which in turn can affect arousal.
But depression also reduces sexual appetite. Among depressed men not taking medication, 40 percent report losing sexual arousal and desire, and twenty percent have difficulty reaching orgasm. Common conditions like diabetes and heart disease can also cause sexual problems.
Drug trials rarely look at what happens when a drug is stopped. And studying what happens after stopping SSRIs is particularly difficult because many people never stop taking them.
Given the lack of data, “persistent sexual dysfunction caused by SSRIs is a hypothesis, not a proven phenomenon,” explained Robert Taylor Segraves, professor emeritus of psychiatry at Case Western Reserve University School of Medicine, who has studied the effects of antidepressant drugs. Have studied. Sexuality.
Still, some researchers have found ways to estimate the prevalence of the condition. A recent study in Israel found that one in every 216 men who stopped taking SSRIs were later prescribed an ED medication, at least three times higher than the general population.
Audrey Bahrick, a former University of Iowa psychologist who started taking Prozac in 1993, when she was 37 and struggling with a difficult job in a new city, at her home in Iowa City, Iowa, on November 1, 2023. (Catherine Gamble/The New York Times)
Roy Whaley, who briefly took the antidepressant citalopram at the age of 22 to treat his obsessive-compulsive disorder, died on November 6, 2023 in Somerset County, England. (Francesca Jones/The New York Times)