Post-Selective Serotonin Reuptake Inhibitor Sexual Dysfunctions(PSSD): Clinical Experience with a Multimodal Approach

Abstract

Background: Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual disorders, that may arise during the administration of antidepressant Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitor (SNRIs) and may persist after their discontinuation. PSSD is commonly associated with sexual problems with marked distress and poor quality of life. To date, however, no effective treatment is available. The study describes the clinical experience with a newly introduced systems sexology approach involving bio-psycho-social interventions. Methods: In this study we retrospectively analyzed (from July 2019 to July 2020) twelve PSSD male patients (mean age 31.3 ± 6.21 years old) treated according to a recently introduced approach involving system sexology and bio-psycho-social interventions. The protocol was based on a combination of lifestyle changes, nutritional supplementation, pharmacological and behavioral interventions. Results: 12 patients with high probability of PSSD were selected. Patients reported a significant improvement in all International Index of Erectile Function-15 (IIEF) domains and Orgasmometer scores from the baseline at 6 months of follow-up. Conclusions: This study described for the first time a feasible and handy treatment procedure for PSSD, framework to improve patients complains, sexual function and satisfaction, and quality of life. Future randomized, placebo-controlled clinical studies with bigger cohorts will be needed in order to better assess this efficacy and confirm our results.

Selective serotonin reuptake inhibitors, post‐treatment sexual dysfunction and persistent genital arousal disorder: A systematic review

“…Reported adverse effects following SSRI administration and discontinuation, collectively grouped as PSSD, ranged widely and differed between males and females; and included penile anaesthesia, pleasureless orgasm, loss of libido, emotional blunting, difficulty achieving orgasm, loss of nocturnal erections, reduced seminal volume, testicular pain, reduced penis size, premature ejaculation, watery ejaculate, slow leakage of ejaculate, and reduced sense of taste and smell 40 . Most reported adverse effects overlap with adverse effects described during SSRI treatment, 41 or with general symptoms associated with depression, 42,43 with the exception of nipple 40 and genital anaesthesia 6,10,12,13,44–46 …”

“…associated with depression, 42,43 with the exception of nipple 40 and genital anaesthesia. 6,10,12,13,[44][45][46] 3.2 | Post-SSRI PGAD -Prevalence, onset and reported symptoms…”

From Waterloo to the Great Wall: A retrospective, multicenter study on the clinical practice and cultural attitudes in the management of premature ejaculation, in China

“…51 This is surprising also considering the large number of SSRI-induced side effects but also considering the possibility of a severe post-SSRI sexual disease described after chronic use of this drug class, but never in Dapoxetine users. [52][53][54] On the basis of this complex background, in the present study, we retrospectively reviewed data from several Chinese centers active in PE management in order to highlight culturally driven clinical behaviors and to measure, by means of follow-up and treatment switch rates, to what extent different treatments were considered reliable by doctors and patients, and by extension, the prevalence of PE, its duration (LPE vs. APE) and its association with ED, as in the LCEE.…”

“…For example, it has been claimed that the majority of a small number of Dutch patients with LPE prefer daily treatment with high‐risk SSRIs with respect to on‐demand treatment with a better risk/benefit ratio 51 . This is surprising also considering the large number of SSRI‐induced side effects but also considering the possibility of a severe post‐SSRI sexual disease described after chronic use of this drug class, but never in Dapoxetine users 52–54 …”