What is PSSD?
Post-SSRI Sexual Dysfunction (PSSD) is a potentially severe adverse condition that may arise during treatment with, or following discontinuation of, SSRI or SNRI antidepressants, as well as other serotonergic or related agents. The condition is frequently chronic, with symptoms persisting beyond cessation of the medication and often resulting in substantial, life-altering impairment of quality of life.
Although sexual dysfunction is a defining feature, the term PSSD does not fully capture the broader clinical presentation. Many affected individuals report severe, persistent non-sexual symptoms—including cognitive, emotional, and physical impairments—that are described by sufferers as more debilitating than the sexual symptoms.
PSSD has received formal recognition from regulatory authorities—including the European Medicines Agency (EMA), the UK MHRA, Ireland's HPRA, Health Canada, Hong Kong's Department of Health, Australia's TGA, and Malaysia's NPRA—but remains under-researched and under-acknowledged in clinical practice. The underlying causal mechanisms are still a matter of research, and no clinically validated treatment pathways currently exist.
Symptoms & Progression
For new sufferers, it's important to note that symptoms are often most severe initially. Initial symptom onset can feel life-limiting and unlivable. It's important to know that while there are currently no clinically recognized treatments, many long-term sufferers have reported some improvements and lessening of the most acute symptoms with time to a more manageable baseline, albeit on a timescale of years.
SUPPORT IS AVAILABLE — please see the 'Getting Support' section for details.
Commonly reported symptoms, which may vary in presence and severity among individuals, include:
- Anhedonia (partial or severe loss/blunting of emotional feeling and range)*
- Severe loss of sexual drive & libido
- Genital numbness
- Akathisia (a sensation of overwhelming inner restlessness)
- Altered response to stimulants (severely reduced or absent effects from caffeine, alcohol, nicotine)
- Skin tingling or discomfort
- Cognitive impairment (brain fog, difficulty concentrating, memory issues, slowed thinking)
- Tinnitus (ringing or whistling in the ears)
- Vision disturbances (blurred or double vision, light sensitivity)
- Mild to severe sleep disturbances (insomnia & hypersomnia)
- Depersonalization/Derealization
*Symptoms are reported by patients as qualitatively distinct from depression or anxiety in their subjective presentation, often with acute onset and severity, with many sufferers reporting being unable to feel any emotional response (sadness, happiness, attraction) at all.
For testimonials and first-hand accounts of onset and symptomology, see the PSSD Network channel →
Onset
Onset can be rapid or progressive and may occur during treatment, after re‑instatement, or following discontinuation — anecdotally after a short delay of weeks or months in some cases. Some patients who previously tolerated medication without issue have reported symptom development upon re‑instatement or after exposure to a related serotonergic agent.
Onset does not appear to be dose- or duration-dependent, with some users experiencing symptoms at treatment initiation.
Symptoms are expected to persist following discontinuation to be considered consistent with a PSSD diagnosis.
Implicated Medications
NB: The following is not an exhaustive list. Other serotonergic medications may also be implicated.
PSSD and related syndromes have been associated with these classes of antidepressant:
SSRIs (Selective Serotonin Reuptake Inhibitors)
Fluoxetine (Prozac, Sarafem), Sertraline (Zoloft, Lustral), Paroxetine (Paxil, Seroxat, Aropax, Pexeva, Brisdelle, Deroxat), Citalopram (Celexa, Cipramil, Cipram, Seropram), Escitalopram (Lexapro, Cipralex), Fluvoxamine (Luvox, Faverin), Dapoxetine (Priligy)
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
Venlafaxine (Effexor), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Levomilnacipran (Fetzima), Milnacipran (Savella)
Other serotonergic medications have also been suspected, including certain tricyclic antidepressants, tetracycline antibiotics, and certain painkillers with serotonin reuptake inhibition (incl. tramadol).
Cause
The underlying mechanism for PSSD has not been established. Hypotheses include possible alterations in serotonergic receptor function or downstream signaling, epigenetic effects, and potential involvement of neurosteroid pathways; these remain under investigation.
Similar symptoms have also been reported following exposure to other medications, including certain tricyclic antidepressants and the 5-α-reductase inhibitor finasteride, for which a similarly described condition, Post-Finasteride Syndrome (PFS), has been observed.
Treatment & Prognosis
The following does not constitute medical advice, but reflects the experience of a community of sufferers attempting to navigate the condition.
Currently, there are no known clinically verified treatments for PSSD. The temptation to attempt intervention should be approached with caution.
Symptoms typically do not resolve with additional medication, and some sufferers report that experimental treatments — including supplements or off-label medication — have temporarily or permanently worsened their condition.
Many clinicians remain under-informed about PSSD, which can lead to misdiagnosis or interventions that worsen conditions. The severity is often not clearly understood, or is mischaracterized as a re-emerging underlying condition or mood disorder. Well-meaning clinicians may attempt interventions that worsen the condition — such as re-instating an SSRI or introducing additional medications.
It is advisable to seek clinicians who are familiar with PSSD and to approach further pharmacological interventions with extreme caution.
Consider providing your clinician with a link to this site or the PSSD Network to help raise awareness and improve understanding of the condition.
Getting Support
Connecting with others who understand the condition can be invaluable.
Online communities provide peer support, shared experiences, and practical advice from fellow sufferers. We encourage you to join the PSSD Network — the leading advocacy organization working to raise awareness and drive research.
Report Your Experience to Your Country's Medical Regulator
Reporting to health authorities is one of the most important things you can do.
Every report contributes to the evidence base that regulators and researchers rely on — and may help accelerate recognition, research funding and the development of treatment options.
Media Coverage
Social Media
Social media accounts raising awareness about PSSD.
Patient Testimonials
First-hand video accounts from those living with PSSD.
For information on symptoms, onset and progression, please see the For Sufferers tab.
For media coverage, see Media Coverage.
Patient Testimonials
Regulatory Recognition
PSSD has been formally recognized by regulatory bodies worldwide:
- European Medicines Agency (EMA) — Officially recognized PSSD in 2019, mandating warnings on SSRI/SNRI labels
- UK MHRA — Updated antidepressant safety information and adopted MedDRA code for PSSD
- Ireland HPRA — Added persistent sexual dysfunction warnings following 2019 EMA decision and sent letters to prescribing doctors
- Health Canada — Updated safety information for SSRIs/SNRIs (2021)
- Hong Kong Department of Health — Sent letters to healthcare professionals (2021) and added labels for SSRIs/SNRIs (2022)
- Australian TGA — Issued updated warnings about persistent sexual dysfunction (2024)
- Malaysia NPRA — Issued warning and added persistent sexual dysfunction to labels (2025)
Patient Experience
- Existing warnings, even following regulatory acknowledgment, are widely perceived as understating both the potential severity and the indefinite and often permanent persistence of symptoms.
- Discussion is often narrowly focused on sexual dysfunction. While these effects can be severe and life-altering, many patients report that accompanying physical and emotional dysregulation—particularly anhedonia—are more disabling and, in many cases, lead to severe reduction in quality of life.
- Common clinical interventions, including the addition of other medications (for example, bupropion/Wellbutrin for PSSD-associated anhedonia), have in some cases been reported to significantly worsen symptoms or contribute to further dysregulation.
- Many patients report that both the severity and qualitative nature of their symptoms are poorly understood. They describe a near-complete absence of sexual attraction or emotional response, which they clearly distinguish from reduced libido, depression, or apathy. Instead, they characterize the experience as different in nature and considerably more severe.
- Credible reports of complete recovery appear to be uncommon. However, some patients describe gradual improvements, albeit over the course of years, with partial resolution of specific symptoms in some cases.
- As the condition appears to be under-recognized, sufferers almost universally report clinical skepticism. Many hope that increased regulatory acknowledgment will help change this.
Research
Medical Codes
Report to Health Authorities
Reporting adverse drug reactions is crucial. It helps regulatory bodies track the true prevalence of PSSD and may accelerate research and policy changes. Every report matters.
Most countries have a "Yellow Card" or similar pharmacovigilance system for reporting suspected adverse drug reactions.
UK — Yellow Card (MHRA)
USA — MedWatch (FDA)
EU — EudraVigilance
Australia — TGA
Canada — MedEffect
Germany — BfArM
France — ANSM
Netherlands — Lareb
Ireland — HPRA
New Zealand — Medsafe
Italy — AIFA
Spain — AEMPS
Switzerland — Swissmedic
Sweden — Läkemedelsverket
Japan — PMDA
South Korea — MFDS
Singapore — HSA
India — CDSCO
Brazil — ANVISA
Argentina — ANMAT
Mexico — COFEPRIS
South Africa — SAHPRA
Philippines — FDA
Malaysia — NPRA
Austria — BASG
Belgium — FAMHP
Denmark — DKMA
Norway — NOMA
Finland — Fimea
Greece — EOF
Slovakia — ŠÚKL
Israel — MOH
Thailand — Thai FDA
Taiwan — TFDAContact Your Political Representative
UK — Parliament USA — Find Your Representative USA — Contact Senators Australia — Find Your MP Canada — Find Your MP EU — MEP Directory Ireland — Oireachtas New Zealand — Parliament France — Assemblée nationale Germany — Bundestag India — Lok Sabha Brazil — Câmara Mexico — Cámara de Diputados Argentina — Diputados South Africa — Parliament Japan — House of Representatives South Korea — National Assembly Philippines — Congress Italy — Camera dei Deputati Spain — Congreso Netherlands — Tweede Kamer Belgium — De Kamer Sweden — Riksdag Norway — Stortinget Denmark — Folketing Finland — Eduskunta Austria — Parlament
Poland — Sejm
Portugal — Assembleia Switzerland — Parliament Israel — KnessetResearch & Resources
Organizations and resources dedicated to understanding and treating PSSD.