14 votes

Post-SSRI Sexual Dysfunction

26 comments

  1. reifyresonance
    Link
    Hm. Anecdote: I was on lexapro for a month or so about a year ago. It pretty much completely killed my sex drive. After I stopped taking it, I remember joking a few months later that that effect...
    • Exemplary

    Hm. Anecdote: I was on lexapro for a month or so about a year ago. It pretty much completely killed my sex drive. After I stopped taking it, I remember joking a few months later that that effect was persisting. It seemed kinda ridiculous that a medication I was no longer taking was still having effects.

    At the time I figured the lack of sex drive/enjoyment was a function of habit and environment - habit, in that the "sex is good, actually" pathways had atrophied (I do remember being surprised and having the thought "I should do this more often!" more than once), and environment, in that I was no longer as close to my partner emotionally. I settled down into a routine of doing it occasionally because it made my partner happy and that made me happy, but after I told her that was the main reason I was doing it, we pretty much stopped. I think another component was gender dysphoria, and a general sense of not feeling safe in my body due to lingering effects of traumas.

    slight tmi I wasn't even really doing any... self-pleasuring activities either. And when I did (and I find this very funny in retrospect) it was with the reasoning "yes, this is good for my Health." (I think I wrote a little on here about my health anxiety in the past.)

    I (finally) broke up with her a few weeks ago. The emotional relief of this has been great, and I'm starting to get some manner of libido back.

    If I were to try and organize this story into a theory, or narrative, it's that for me, an SSRI knocked me into a lower local minimum of sex drive and exerted a pull to keep me there while I was taking it. When I stopped taking it, I didn't really try to do anything to get out of the hole. However, I think it is possible, with time and attending to other causes. I can't see this being permanent -- brains are too plastic for that. For example, I realized the other day while doing a body scan meditation that I don't notice bodily sensations unless I'm in pain. I didn't realize I could tell how much I had been standing during a day by feeling my feet -- I only recognized "fine" and "in pain from too much walking."

    tangent Reminded of something an acquaintance said a few weeks ago about perception of range of emotions, and what's "okay" for men specifically to feel, and how we should push for more than just "fine" and "upset." Like, there's a whole wheel of descriptive words, and like color, internalizing categories changes the nuance of perception. (Periwinkle: blue as resentful: anger). And how certain definitions of masculinity don't permit the necessary range of being in touch with your emotions.

    So I've been trying mindfulness, to notice what this body is feeling, and to be kinder to it, rather than being like a parent who only responds to a child when they throw a tantrum. This has, over the past few weeks, been good for my relationship with my body, and by extension, my sex drive. (Agh - trying to move away from dualistic mind vs body thinking instead of embedded bodymind.) Whatever role SSRIs may have played, I think I am moving past it.

    7 votes
  2. [2]
    frostycakes
    Link
    This was one of the main reasons why I tapered off and eventually stopped taking sertraline last year. It had gotten to the point where it was affecting my relationship, and ironically was making...

    This was one of the main reasons why I tapered off and eventually stopped taking sertraline last year. It had gotten to the point where it was affecting my relationship, and ironically was making me feel incredibly depressed about it, defeating half the purpose of my taking the medication in the first place. (Other reason is that I have ADHD as well, and even with my meds for that, sertraline seemed to exacerbate my ADHD symptoms, since I do use a certain amount of anxiety as a motivational coping mechanism there.)

    It's frustrating because it's been almost a year and a half since I was finally fully tapered off (my PCP worked with me on the plan for that, so thankfully I avoided most of the brain zaps and other SSRI withdrawal symptoms), and while the flattened affect and worsened ADHD symptoms have abated, I'm still dealing with the sexual dysfunction-- an absolute nightmare now that I'm single and in the dating game too. I've been avoiding trying the ED drugs as a solution, but I'm starting to worry that that might be the only way to fix this.

    Another frustration is that when I first broached the depression and anxiety issues with my doctor and therapist that led to me being placed on sertraline, I explicitly mentioned the sexual side effects as something I wanted to avoid, since I have friends and family who have been dealing with these issues from SSRIs as well. I even tried suggesting that we do something like buproprion instead, since it has a much lower incidence of these side effects, but nope, it was an SSRI or nothing for the first round. It's hard, since had I known that I'd still be dealing with this going on two years after discontinuation, I don't think I would have gone on it--yet I also know that I needed pharmacological assistance on top of therapy to deal with my depression at the time.

    7 votes
    1. onion
      Link Parent
      I have ADHD and still experience some minor ED even after trying a half dozen medications and dosages. I'm currently on Vyvanse and have stair-stepped down to half the dosage I was on at my peak....

      I have ADHD as well

      I have ADHD and still experience some minor ED even after trying a half dozen medications and dosages. I'm currently on Vyvanse and have stair-stepped down to half the dosage I was on at my peak. It was really bad when I was on a high dosage of Concerta during HS and college because that was when I would have had the strongest libido. I could not get an erection to save my life until late PM once my meds started to wear off, and even then it was a struggle. Thankfully I had an amazingly understanding partner throughout college who would eventually become my wife, but it led to more abuse of alcohol and cannabis to try and offset the wired, on-edge effect of my medication. The irritability problem was always there when I was medicated and often compounded the ED. I'd also sometimes have this weird discharge (like semen but grainier and lower viscosity) when I thought I needed to pee. I just thought that was the cost of treating my ADHD and being productive/focused in life.

      This experience will have a huge impact on how I approach the mental health of my children as they get older - I had been medicated since age 13-14 and didn't know any better. I was trusting my parents and medical professionals to know what to do. In retrospect, I would not agree to give my child such a high dose of any ADHD medication like that without easing into it first and proving that a high dose is necessary. I have no idea why my PCP started me out so high from the outset, I didn't know to question it, and I never remember having a conversation about side effects. I'm not saying I know better than medical professionals, just that I will handle the situation differently. We have a whole generation of people who grew up in the 90s and 00s who will be informed and cautious about medicating their children through their own personal experiences in being medicated themselves.

      I got off on my own tangent here, but I just wanted to share my personal experience of how medical treatment can become a runaway train of sorts before we realize what we're getting ourselves into as patients (or parents of patients).

      4 votes
  3. [3]
    corleone
    (edited )
    Link
    I wouldn't say escitalopram caused me a sexual dysfunction per se, everything was working fine. I lasted longer, which actually made my partner quite happy, but with time I just lost interest in...

    I wouldn't say escitalopram caused me a sexual dysfunction per se, everything was working fine. I lasted longer, which actually made my partner quite happy, but with time I just lost interest in it. My libido was greatly reduced and I felt bad. We're trying to get pregnant and we gotta use every opportunity, specially in our age.

    So I stopped taking it. Luckily, it turns out I didn't really need it anymore.

    7 votes
    1. [2]
      jcdl
      Link Parent
      I’m currently on the same drug and have been for a long time. I have had so much positive and healthy change in my life since I started taking it and I find myself wondering if I really need to be...

      I’m currently on the same drug and have been for a long time. I have had so much positive and healthy change in my life since I started taking it and I find myself wondering if I really need to be on it for the next ~10 years.

      Back when I started on it, I couldn’t afford proper psychotherapy but thankfully I now have a good job and great insurance, though my preferred therapist has paused their practice indefinitely. I can’t imagine going off Cipralex without that support.

      It has been so long on them. I have equal parts dread of withdrawals (brain zaps in particular are the worst), fear of reverting to the unstable angry person I was a decade ago, and on the flip side, a yearning for clarity of mind. Writing this, my depression and anger pre-escitalopram didn’t give me any true mind clarity. I feel that I owe it to myself to try.

      7 votes
      1. corleone
        Link Parent
        I cannot and will not say how anyone's treatment should proceed. However, I will say that I experienced SSRI withdrawal more than once, the "brain zapping" is real and sometimes it feels like...

        I cannot and will not say how anyone's treatment should proceed. However, I will say that I experienced SSRI withdrawal more than once, the "brain zapping" is real and sometimes it feels like they'll never go away. But, in my experience, eventually they did and I was fine. I'd like to add that a few antidepressants do not cause sexual disfunctions, while others cause much less, or at least less frequently. Talk to your doctor. Good luck!

        5 votes
  4. [18]
    jcdl
    Link
    Hey everyone, This article was posted recently on Hacker News and spawned a predictably horrible comment section, especially this one. I'm someone who has been on SSRIs for a long time because...

    Hey everyone,

    This article was posted recently on Hacker News and spawned a predictably horrible comment section, especially this one.

    I'm someone who has been on SSRIs for a long time because they work for me, and have of course experienced these side effects. I'm hoping for a better conversation here.

    5 votes
    1. FluffyKittens
      Link Parent
      Hot take, but I think websites like HN/Reddit/Tildes just suck for general audience discussion of in-depth science/academic topics (exception being /r/AskHistorians). Hacker News comments are gold...

      Hot take, but I think websites like HN/Reddit/Tildes just suck for general audience discussion of in-depth science/academic topics (exception being /r/AskHistorians).

      Hacker News comments are gold when it comes to tech/business knowledge, but you might as well be reading Facebook when it comes to HN comments on medicine/experimental physics/political/law articles. Reason being, Hacker News has an audience with a very high percentage of tech professionals, but similar number (within an order of magnitude, that is) of MDs/physicists/political scientists/lawyers when compared to Facebook.

      Now when some hypothetical tech rookie starts coming in to Hacker News and posting bad information in the comments, there's a critical mass of knowledgeable individuals able to correct it and keep the conversation well-informed, but when it comes to medicine et al., the HN population may be somewhat more educated than your average Joe, but the experts are still outnumbered ten-to-one. Maybe that would be fifteen-to-one on Facebook, but there's a non-linear effect; some sort of critical ratio around (e.g.) two non-experts to every one expert where the conversation just goes to shit.

      Point being, I think HN and even Tildes are bad fits for these sorts of articles. "Neo-BB" social media is great when it comes to tech and creative(/subjective) topics, but in my book, just flat out not the place to get research analysis.

      17 votes
    2. [3]
      teaearlgraycold
      (edited )
      Link Parent
      "Men aren't making me feel sexy and it's the fault of medication that makes them able to function"

      especially this one.

      "Men aren't making me feel sexy and it's the fault of medication that makes them able to function"

      6 votes
      1. [2]
        Grzmot
        Link Parent
        I feel like it's a bit too mean to reduce that comment down to this sentences, but at the same time, they did attribute the sexual problems of a generation to heavy antidepressant that not a lot...

        I feel like it's a bit too mean to reduce that comment down to this sentences, but at the same time, they did attribute the sexual problems of a generation to heavy antidepressant that not a lot of people are on, so, I don't know, go get 'em, tiger?

        6 votes
        1. teaearlgraycold
          (edited )
          Link Parent
          Yeah. I’m not adding to anyone’s happiness here. I just wanted @jcdl to know that I agreed with that call out in particular. Edit: I’m extremely jaded having read reddit comments for a total of...

          Yeah. I’m not adding to anyone’s happiness here. I just wanted @jcdl to know that I agreed with that call out in particular.

          Edit: I’m extremely jaded having read reddit comments for a total of thousands of hours of my life. Getting reminded of the shitty things people spew on larger discussion boards triggers a backlash.

          2 votes
    3. [13]
      Adys
      Link Parent
      I thought that comment thread was insightful. I'm going to take a stab at why you thought it was "horrible": it's raw and honest, and people are shallow assholes. The thing is, life is tough and...

      I thought that comment thread was insightful.

      I'm going to take a stab at why you thought it was "horrible": it's raw and honest, and people are shallow assholes.

      The thing is, life is tough and people are shallow assholes, on the whole. It's one thing to alter your behaviour to be more inclusive, accepting and open minded. But to coddle people by telling them everything is fine and the whole world is good with you, that is lying to them. Or worse, and I'll make a parallel there to something i have a bit more experience with, TELLING them "you're beautiful" when you actually don't honestly think that.

      I say this as an unattractive person myself. I could always tell the guys and girls who actually found me attractive from the ones who were straight up lying to me. My physical shape has improved a lot in recent years and it's already flagrant the difference in how certain people treat me.

      Are they shallow? Maybe. We all have our preferences. I have other ways to judge whether somebody is truly shallow (which we can talk about in another thread). But the point is, I truly, truly despised being lied to and told "you're beautiful as you are" -- no, fuck you, you don't think that, so stop lying already.

      The thread in question talks about sexual function. This is important to a lot of people, thus to a lot of couples. What do you want, lies? Is that what a good comment section looks like?

      There are excellent ways to talk about both solutions and alternatives. For some, this is a genuine problem for themselves, and they want to solve both the potency and depression problems, which will likely affect each other. For others, they may want to wean off of sex but still want a relationship and there is a highly inclusive and diverse community of asexuals who have gone through the motions and can talk about this at length.

      I'm so tired of reading feel-good bullshit on the internet, especially when seeking actual advice, that i found it refreshing to read someone just be honest about this.

      I think this is a cultural thing, though. America seems to value superficiality a lot more than Europe. Being polite is more important than being honest. (Of course, that isn't to excuse impolite behaviour, I believe the golden standard is finding a way to be honest all the while seeking not to hurt the person).

      Now WITH THAT SAID, as personal anecdote, I've myself been with all kinds of partners with all kinds of sex drives and capacities, and their ability to orgasm isn't something i really care about. While it is fun to make my partner orgasm, what i care about is that they have a nice time. And you can read that as absolute honesty, all while knowing that not everybody is like me but that i am certain that plenty are.

      Ostrich parenting. Sorry for the nearly off topic rant.

      7 votes
      1. [12]
        jcdl
        Link Parent
        I don’t want to be coddled nor do I like it. SSRIs are serious drugs with serious side effects that deserve serious discussion. The guy found someone he could have good sex with, but that wasn’t...

        I don’t want to be coddled nor do I like it. SSRIs are serious drugs with serious side effects that deserve serious discussion. The guy found someone he could have good sex with, but that wasn’t enough for him, apparently.

        My issues with that post are twofold. Of course the poster is a total asshole with the shear superficiality and selfishness of it. Worse though are the unsubstantiated hyperbolic statements about permanency of side effects, anecdotes about friends’ lives being “ruined”, the casual suggestion that the side effects make things worse… The guy has no idea what he’s talking about.

        7 votes
        1. [11]
          Adys
          Link Parent
          Huh? They didn't specify whether it was "enough" for them, just that it was important for them. As for whether they have any idea about the subject ... it sounds like they're sharing personal...

          The guy found someone he could have good sex with, but that wasn’t enough for him, apparently.

          Huh? They didn't specify whether it was "enough" for them, just that it was important for them.

          As for whether they have any idea about the subject ... it sounds like they're sharing personal experience. And it sounds like the side effects can in fact make things worse for some according to others in the thread (again, via personal experience).

          It sounds to me like you disagree with some assertions and are displeased with that person's behaviour. None of that convinces me the thread is "horrible".

          Honest communication is a pillar of a good relationship (sexual, emotional, be it short or long term). If we end up in bed together and you have bad sex because of ANY REASON, I want to hear about it, especially if there is something that can be done about it.

          "Your inability to finish makes the experience worse for me" is a fucking important thing to voice. And to be honest, as someone who doesn't care about it, i do not find it superficial... Just like i don't find it superficial when a partner tells me "You should shave down there, i find the hair gross". It's a sexual preference.

          If you don't read this post as medical advice (and you shouldn't, be it here, on HN, on Twitter or on Tumblr or a random IRC chat room), then what it comes across at least to me is: someone sharing personal, anecdotal experience about several unpleasant sexual encounters where a common factor may have been medically sourced.

          I hear your argument that this person is superficial. I disagree but i can see your point. I definitely don't agree that this person is an asshole, however, especially if they weren't specifically an asshole to the people they had negative sexual encounters with (and I have no reason to believe they were; innocent until proven guilty).

          5 votes
          1. [9]
            kfwyre
            Link Parent
            The commenter on HN comes across as a jerk because they ignore and dismiss the reasons people would choose to go on SSRIs in the first place. There’s no appreciation for the actual experiences of...

            The commenter on HN comes across as a jerk because they ignore and dismiss the reasons people would choose to go on SSRIs in the first place. There’s no appreciation for the actual experiences of depression or anxiety — just a lot of handwaving and judgment, with plenty of implication that the people on meds don’t have real issues, are stupid for not knowing what they’re getting themselves into, or can solve their complex problems with this One Simple Trick.

            When I went on SSRIs I had to sign a bunch of shit explicitly acknowledging their risks in great detail because the psychiatrist prescribing them to me wanted to reduce his liability should I commit suicide after taking them, which was the reason I was going on them in the first place — I had already made one attempt, and additional ones were likely. I don’t think most people are as ignorant about their medications as the HN commenter makes them out to be, but I do think the commenter is ignorant to the kind of pains that drive people to those medications in the first place.

            That’s what bothers me most about that comment. I can’t speak for @jcdl, but I had a similar, visceral negative response when I read it. Indicting people who are treating difficult mental health disorders for subpar sex is selfish and demeaning, but, more than anything, it completely misses the point. Even if it is an honest assessment of their experiences, there are so many ways they could have better broached the topic, starting with actually understanding and honoring the depth of the issues that prompt SSRI use in the first place.

            12 votes
            1. [7]
              Adys
              Link Parent
              I wonder why both you and @jcdl read the post as implicating “all people” on those meds rather than simply “some”. I don’t think it’s a secret that the US especially suffers from trigger happy...

              I wonder why both you and @jcdl read the post as implicating “all people” on those meds rather than simply “some”.

              I don’t think it’s a secret that the US especially suffers from trigger happy overprescriptions. My mother back in France, years ago during her divorce, was prescribed SSRIs for something that wasn’t fixable by such meds and suffered some of the more gnarly side effects. Not a happy time.

              Its anecdotal, I’m not making a generalisation, and that is how I’m reading the post as well. But I’m not particularly happy defending someone who does come across as an asshole so I don’t exactly want to dwell on it, I just find the “HN bad” meme a bit tired and in this case unjustified.

              3 votes
              1. [2]
                corleone
                Link Parent
                Most people take ages to look for mental health professionals and some never do, due in part to stigma and the general idea that only the weak should seek help. There's no such thing as an annual...

                Most people take ages to look for mental health professionals and some never do, due in part to stigma and the general idea that only the weak should seek help. There's no such thing as an annual mental health checkup. Because of that, if you're at the psychiatrists office already, there's a great chance that you do need help. No one goes to the doctor because they're mildly depressed, they go when they can't stop thinking about suicide. That is one of the reasons why psychiatrists tend to prescribe medications to most of their patients. Not that overprescription is not a problem, it most certainly is. But so is underprescription.

                5 votes
                1. Adys
                  Link Parent
                  I just want to stress that this stigma, although it exists, is way lower than it used to be. The mental health awareness campaigns etc, they do work. And I can anecdotally share that I’ve been...

                  No one goes to the doctor because they're mildly depressed

                  I just want to stress that this stigma, although it exists, is way lower than it used to be. The mental health awareness campaigns etc, they do work. And I can anecdotally share that I’ve been seeing a therapist for the past year, starting because of Covid-related mild depression and now that I’m out of that, I’m still seeing him every 3 weeks just as a check in.

                  2 votes
              2. [2]
                kfwyre
                Link Parent
                I think our frustrations share the same root. You’re tired of people hating on HN and its commenters, and I’m tired of people dismissing mental health issues and those it affects. I think we’re...

                I think our frustrations share the same root. You’re tired of people hating on HN and its commenters, and I’m tired of people dismissing mental health issues and those it affects. I think we’re both responding because we feel unfairness at play. I also don’t mean to hate on HN — I honestly don’t spend time on that site at all and only read that one comment for context on its discussion here. I also don’t want to take away from you the value you found in that comment.

                Also, for context, I was commenting from a bad place last night. In my other comment to you I mentioned that my Screen Time reminder popped on, and that was my cue to go to sleep instead of stay up and churn through frustrations on the internet. I’m sorry that I made you my sounding board. I made our mutual frustrations escalate instead of ease, which wasn’t productive or courteous.

                I don’t know about SSRI prescriptions in the US and whether or not they’re overdone, but I do know that many people outright avoid seeking treatment here for fear of significant healthcare costs and interfacing with a kafkaesque system of coverage and providers. I also know there’s been a long-standing dismissal of mental health issues in general here, with “man up” being the widespread cultural response to them especially in, of course, men. It’s something I’m sensitive to due to my own experiences as well as that of friends, and I tend to bristle pretty badly when I encounter comments that I feel reinforce that cultural trope. Communicating that bristle isn’t always the right call though, and much in the same way I criticized the HN commenter for their messaging, I also could have handled my own response better.

                5 votes
                1. Adys
                  Link Parent
                  I didn’t feel your response was hostile or anything like that, don’t worry. And even if I did, nobody on Tildes is more deserving of good faith and the benefit of the doubt than you. Anyhow, I...

                  I didn’t feel your response was hostile or anything like that, don’t worry. And even if I did, nobody on Tildes is more deserving of good faith and the benefit of the doubt than you.

                  Anyhow, I feel you. I have a lot of opinions on this but they all stem from my want of honesty from people so I’m quite appreciative when I see somebody share something like this, even if it makes them come across as an asshole. I’m not gonna spend more time defending that post though because I don’t think it’s especially worth of any of our times.

                  3 votes
              3. [2]
                jcdl
                Link Parent
                The "HN bad meme" is extremely relevant in this case, and for the record I generally like HN. Come on @Adys, you're reading this guy way too charitably.

                it is getting hard to find people who aren’t having SSRI-related dysfunction

                I guess good for half the 20-something cohort for not being able to orgasm really ever

                when half the prime age population isn’t able to have a fulfilling or enjoyable sex life

                The "HN bad meme" is extremely relevant in this case, and for the record I generally like HN. Come on @Adys, you're reading this guy way too charitably.

                2 votes
            2. jcdl
              Link Parent
              Thank you @kywyre, you've summed up my feelings much more eloquently than I have been able to.

              Thank you @kywyre, you've summed up my feelings much more eloquently than I have been able to.

              3 votes
          2. jcdl
            (edited )
            Link Parent
            Okay, I really regret posting this now. Whatever, here we go. That is fine and true in the bedroom. I don't think the same thing applies to online discussions, and why should it? This poster is...

            Okay, I really regret posting this now. Whatever, here we go.

            Honest communication is a pillar of a good relationship

            That is fine and true in the bedroom. I don't think the same thing applies to online discussions, and why should it?

            This poster is foisting their sexual dissatisfaction onto the SSRI boogey-man and blaming the medical industrial complex for it.

            They really seem to be handing out these serious, almost-impossible-to-withdraw medications like candy on Halloween.
            They don’t actually solve the problem long term, you can’t really come off them ever

            Yeah, okay doctor. [citation needed]

            I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs.

            Yeah, thanks doc. I don't smoke weed, I don't drink heavily and I still find SSRIs helpful. Again, the poster doesn't have a fucking clue why people use these drugs.

            I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change.

            What a complete trivialization of a complex problem, also [citation needed].

            If you don't read this post as medical advice (and you shouldn't, be it here, on HN, on Twitter or on Tumblr or a random IRC chat room), then what it comes across at least to me is: someone sharing personal, anecdotal experience about several unpleasant sexual encounters where a common factor may have been medically sourced.

            It's obviously not medical advice. It can still be true that the claims are complete fucking bullshit and are utterly misguided, if not deliberate misinformation.

            I get that I’m the asshole

            Hey, he admit it.

            I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.

            Half? [citation needed] How can anyone read this as an interesting or valuable take when it's so clearly pulled straight out of their arse?

            3 votes
  5. [2]
    mosburger
    Link
    I've been on various SSRIs and SNRIs over the past almost-20 years now. Just this week I switched onto my sixth one. They all have had side effects like this one, and frankly I'm really worried...

    I've been on various SSRIs and SNRIs over the past almost-20 years now. Just this week I switched onto my sixth one. They all have had side effects like this one, and frankly I'm really worried after reading this that I'll never be the same. Worse, the drugs are only somewhat effective at treating my depression.

    Ugh. Not what I needed right now I guess.

    1 vote
    1. jcdl
      Link Parent
      I had a similar sense of dread reading it too, which has definitely negatively impacted my behaviour over the last few days (on- and offline).

      I had a similar sense of dread reading it too, which has definitely negatively impacted my behaviour over the last few days (on- and offline).

      2 votes