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Introduction: Selective serotonin reuptake inhibitors (SSRIs) are one of the most commonly used drugs. One of the most common side effects are those related to sexual function. We can divide them into sexual dysfunction occurring during the use of SRRIs and those occurring and persisting after discontinuation of SSRIs. Purpose: To review available PubMed data on SSRI-related sexual dysfunction, epidemiology, symptoms and treatment. Current state of knowledge: SSRIs are first-line drugs for depression and other mental disorders. Their use can cause sexual dysfunction. SSRI-induced sexual disorders are more common but easier to treat. Post-SSRI sexual dysfunction is less common and harder to treat. There are several hypotheses regarding its pathomechanism, such as epigenetic changes, serotonin neurotoxicity, endocrine disruption, and downregulation of serotonin receptors. Conclusions: Sexual dysfunction after SSRIs left without treatment increases the chances of self-discontinuation of drugs by patients and contributes to significant suffering. In the case of SSRIs induced sexual dysfunction, there are several possible interventions that can effectively eliminate sexual dysfunction and restore the patient's comfort. There are no effective treatments for post-SSRI sexual dysfunction syndrome. In addition, the diagnosis of PSSD is difficult as there are no specific diagnostic criteria. More research is needed to determine how to diagnose and treat patients who develop PSSD.

BACKGROUND: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin. OBJECTIVE: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD). METHODS: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts. RESULTS: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor. CONCLUSIONS: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments. [ABSTRACT FROM AUTHOR]

BACKGROUND: Post-SSRI sexual dysfunction (PSSD) is an underrecognized and poorly understood medical condition characterized by sexual dysfunction that persists despite SSRI discontinuation. OBJECTIVE: We conducted a survey of individuals with PSSD to better characterize this condition and its impact on various quality of life concerns. METHODS: Surveys were distributed to an online support group for individuals with PSSD. Surveys assessed medications suspected of causing PSSD and symptoms experienced during and after treatment. Respondents reported the trajectory of their condition, the efficacy of different treatments, and the impact of PSSD on their quality of life. RESULTS: 239 survey responses were included in this study. A majority of respondents had a history of SSRI use (92%) compared to only SNRI or atypical antidepressant use (8%). The overall severity of symptoms improved for 45% and worsened or remained the same for 37% of respondents after discontinuing treatment with serotonin reuptake inhibitors. Only 12% of respondents reported being counseled regarding potential sexual dysfunction while taking antidepressants. The majority rated the effect of PSSD on their quality of life as extremely negative (59%) or very negative (23%). CONCLUSION: PSSD can have an overwhelmingly negative impact on quality of life. Currently, it is unclear why certain individuals develop PSSD and there are no definitive treatments for this condition. Further research of PSSD and greater awareness of this condition is needed among prescribers of serotonin reuptake inhibitors to improve patient care. [ABSTRACT FROM AUTHOR]

Purpose of Review: The goal of this review was to evaluate recent developments in sexual dysfunction associated with psychotropic medications and its management. Recent Findings: Sexual dysfunction associated with psychotropic medications is a serious clinical problem which occurs mostly with antidepressants, especially serotonergic ones, and antipsychotics, especially those causing hyperprolactinemia. Sexual dysfunction(s) seems to be associated to a significantly lesser degree with some newer psychotropic medications, e.g., vilazodone, vortioxetine, and agomelatine among antidepressants, and aripiprazole and lurasidone among antipsychotics. There have been no significant new developments in management of sexual dysfunction(s) associated with psychotropic medications with the exception of using newer medications or switching to them. A new clinical phenomenon—post serotonin reuptake inhibitors sexual dysfunction—has emerged as a difficult management issue. Summary: Sexual dysfunction associated with psychotropic medications continues to be an important issue requiring further research to provide solid evidence for regulatory agencies and for clinicians. [ABSTRACT FROM AUTHOR]

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of drug. Post-SSRI sexual dysfunction (PSSD) is a condition in which patients continue to have sexual side effects after discontinuation of SSRI use. The prevalence of persistent sexual side effects after discontinuing SSRIs is unknown. The recognition and study of PSSD will increase our knowledge base of this underreported and distressing condition., Aim: To provide coverage of the current literature on PSSD, update information on the pathophysiology of PSSD, and discuss potential management options., Methods: Comprehensive review of literature pertaining to PSSD., Main Outcome Measures: The symptoms, classification, pathophysiology, diagnostic considerations, and management of PSSD were reviewed., Results: Common PSSD symptoms include genital anesthesia, pleasure-less or weak orgasm, decreased sex drive, erectile dysfunction, and premature ejaculation. Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression theory, cytochrome actions, dopamine-serotonin interactions, proopiomelanocortin and melanocortin effects, serotonin neurotoxicity, downregulation of 5-hydroxytryptamine receptor 1A, and hormonal changes in the central and peripheral nervous systems. The diagnosis of PSSD is achieved by excluding all other etiologies of sexual dysfunction. Treating PSSD is challenging, and many strategies have been suggested and tried, including serotonergic antagonists and dopaminergic agonists. There is still no definitive treatment for PSSD. Low-power laser irradiation and phototherapy have shown some promising results., Conclusion: PSSD is a debilitating condition that adversely affects quality of life. Further studies are warranted to investigate the prevalence, pathophysiology, and treatment of PSSD. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev 2018;6:29-34., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Sexual dysfunctions are well-known side effects of selective serotonin reuptake inhibitor (SSRI) use. Altered libido, erectile dysfunction, vaginal dryness, ejaculatory disorders, and orgasmic problems are frequently reported by patients treated with SSRIs. Moreover, these antidepressant-emergent sexual dysfunctions do not always resolve after discontinuation of the medication and can persist indefinitely. These complaints are termed post-SSRI sexual dysfunctions (PSSD)., Aim: To examine the existence of this clinical entity, possible theoretical mechanisms, possible risk factors, and possible treatment modalities., Methods: Through literature research and clinical experience, the available information about PSSD is reviewed., Main Outcome Measures: Summary of the current literature with insights into possible causes and management options., Results: There are some indications that antidepressant-emergent sexual dysfunctions do not always resolve after discontinuation of the medication and can persist indefinitely in some individuals. Although some or all sexual side effects that start with the use of SSRIs might continue after stopping the medication, other sexual complaints can develop. Decreased capacity to experience sexual pleasure is the most frequent characteristic of this syndrome., Conclusion: The research and understanding of PSSD remain limited and not well understood; however, the data support the existence of PSSD, which can have a substantial effect on the quality of life of these patients. More research is warranted to show the cause and possible mechanisms of PSSD that could lead to the correct diagnosis and treatment. Reisman Y. Sexual Consequences of Post-SSRI Syndrome. Sex Med Rev 2017;5:429-433., (Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)