1. The pathophysiology of Post SSRI Sexual Dysfunction – Lessons from a case study
- Author
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Samantha Klaas, Jessica Barbut Siva, Maarten Bak, Mark Govers, and Rudy Schreiber
- Subjects
Post-SSRI sexual dysfunction (PSSD) ,Antidepressants ,Selective serotonin reuptake inhibitors (SSRIs) ,Erectile dysfunction ,Genital anaesthesia ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Background: Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated. Objective: Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options. Method: We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient’s symptoms. Results: The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, ‘brain zaps’, overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems. Conclusions: The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic – and possibly noradrenergic – mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes.
- Published
- 2023
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