Dr Sanil Rege, Consultant Psychiatrist explains Post-SSRI Sexual Dysfunction (PSSD).
PSSD is a condition that arises after the use of SSRIs, in which patients continue to have sexual side effects after the discontinuation of SSRIs.
#postssrisexualdysfunction #pssd #antidepressants

Intro to PSSD: 00:00
Clinical Features of PSSD: 01:17
02:35 - Medications associated with PSSD
04:29 - Causes of Post -SSRI Sexual Dysfunction (PSSD)
08:07 - Diagnosing Post -SSRI Sexual Dysfunction (PSSD)
08:48 - Treatment of Post -SSRI Sexual Dysfunction (PSSD)

The prevalence of persistent sexual side effects after discontinuing SSRIs is not well known.
Common symptoms of PSSD are :
1.Genital Anaesthesia
2. Decreased libido
3. Erectile dysfunction
4. Pleasure-less or weak orgasm
5. Premature ejaculation
6. Vaginal lubrication problems
7. Nipple insensitivity

There are two types of PSSD:
1. Sexual dysfunction occurring while SSRIs are being used and persisting after discontinuing treatments
2. After the discontinuation of SSRIs as an aggravation of SSRI-induced sexual side effects.

Causes:
The exact causes are not known. some postulated mechanisms are:
1. 5HT1A persistent downregulation
2. Dopaminergic system involvement
3. HPA axis and Hormone involvement
4. Effect on Transient receptor potentials via ion channels
5. Decreased nitric oxide synthesis (NO)
6. Axonal damage (Neurotoxicity)

Diagnosis:
Challenging
Other medical conditions and psychiatric disorders should be ruled out.

Treatment:
1. Monitoring and prevention are important
2. Consider agents such as Agomelatine, Vortioxetine, Bupropion, Moclobemide, and Mirtazapine with a lower incidence of sexual side effects https://youtu.be/b71OzPujQDg
3. Phototherapy (case report)
4. Switch to amineptine
5. Switch to bupropion
6. Complementary therapies (insufficient evidence)