Among a list of 50-plus possible side-effects of a regularly prescribed anti-depressant was an array of sexual issues, with female sexual dysfunction said to affect one in 100. Photo / Getty Images
The reality of one of the common (and disappointing) side effects of medicating to help mental health.
A few years ago, I found myself struggling with low mood and anxiety. It had come on gradually, triggered by worries over work and relationships. After I’d spent about a year trying deep breathing and cold water swimming, I finally cracked and rang the doctor.
Following a brief chat over the phone, I was prescribed sertraline, a common serotonin reuptake inhibitor (SSRI) known to lift the mood.
Within a few weeks, these magical pills had – despite my scepticism – worked wonders. The negative thoughts had disappeared, I felt calmer and more like my old self. I was very grateful. There was, however, just one problem: I couldn’t orgasm.
First, I would try for five minutes, then 10, then 20. I mean, I was never the quickest to reach climax but this was getting ridiculous. “It must be stress,” I told my weary partner who, God love him, was trying his best. “I must be worried about work, or money … the pet tortoise?”
Even as I puzzlingly put this down to stress, I was still annoyed. My desire and passion were still there. It’s just nothing worked to actually make me orgasm. Try and relax, I would muse.
But the building to a climax just … didn’t build.
Until then, in the chaos of the mid-life jam, and my sense that I was failing at everything, orgasming had felt like the one thing I could still actually achieve. And now I couldn’t even do that. But, being busy, I didn’t really pay it much thought until I skimmed past an article in a newspaper, where a male columnist pointed out that he had stopped taking antidepressants because of sexual dysfunction.
I’m sorry what? Sexual dysfunction? Come again?
I dug out my sertraline packet and unfolded the accompanying leaflet. Sure enough – in small print – among a list of 50 plus possible side-effects was an array of sexual issues, with female sexual dysfunction said to affect one in 100.
Of course, I should have gone back to the doctor and explained my problem. But I was actually quite cross with them for not having spoken about the side-effects (by this point, I also had terrible insomnia). Instead, I took matters into my own hands and snapped the tablets in half.
I found that reducing my dose from 50mg a day to 25mg a day still kept the anxiety at bay, but also allowed me the return of pleasure. “I’m back,” I told my partner. And I think he was pleased.
As it transpired, I wasn’t alone in my need for SSRIs. Each week, my phone would ping with another message from a female friend grappling with the perimenopause, failing health, ageing parents and children.
“My anxiety is so bad I need help,” wrote one. “The doctor has put me on SSRIs,” wrote another. I texted back: “The SSRIs are great. They’ll totally sort your brain out … but you’ll never come again.” It was a flippant comment in the spirit of public duty. But it seems perhaps also a fortuitous one.
This week, a group of scientists in America launched legal action against the Food and Drug Administration (FDA) for failing to warn patients of potential long-term risks of SSRIs. They claim that not only can SSRIs cause sexual dysfunction while on them they can also cause problems way into the future.
In the UK, the NHS website pages on antidepressants do highlight sexual dysfunction as a possible side-effect but they make no mention of long-term effects or PSSD (post-SSRI sexual dysfunction).
The Medicines and Healthcare products Regulatory Agency (MHRA) – responsible for the safety of drugs in the UK – said SSRIs do contain warnings over both immediate and long-lasting use. But when I pointed out that sertraline contained no such warning over long-term use there was also no reply. Their European equivalent, the European Medicines Agency, began issuing warnings in 2019.
Campaigners also point out that the guidance from drug companies on the prevalence of side-effects does not tally with other studies.
For instance, sertraline warns that more than one in 10 men will suffer from failure to ejaculate, up to one in 10 will have erectile dysfunction, while one in 100 women will suffer from female sexual dysfunction.
However, a 2010 study of more than 1000 people in Spain published in the National Library of Medicine found that sexual dysfunction affected roughly 40 per cent of people who took it, rising to 56 per cent on sertraline. It stated: “A review … concluded that 40 per cent of people taking antidepressants will develop some form of sexual dysfunction.”
The frequency of sexual side-effects was highest for paroxetine (65 per cent), fluvoxamine (59 per cent), sertraline (56 per cent) and fluoxetine (54 per cent).
Doctors too have voiced their concerns. Dr Veronika Matutyte, who works in Europe, says: “Research indicates that up to 60-70 per cent of individuals taking SSRIs experience some form of sexual dysfunction. While studies suggest that men might report these issues more frequently, the impact on women is also profound and often underreported. Many patients report that they were not adequately informed about the possibility of sexual side effects before beginning treatment, leading to frustration and decreased quality of life.”
Alarmingly, this is not a new issue. As far back as 2018, the scientists, led by Dr Antonei Csoka, of Howard University, asked the FDA to alert people to the risk of PSSD – a condition they say which can cause genital numbness, loss of libido, erectile dysfunction, premature ejaculation, emotional blunting and other sexual dysfunction for years after going off the medications.
“Without adequate warnings about the risk of potentially permanent damage to sexual function, patients and health care professionals cannot weigh the benefits of the drugs’ use against the potential harms,” Dr Antonei says.
In response to the scientists’ request, the FDA said it would review the science and consider issuing a warning label. But unlike other regulatory agencies in Europe and Canada, it never did. The lawsuit now seeks to force the FDA to issue a decision on the petition.
Scientists don’t know for sure why such changes happen but patients have taken to the PSSD network to share their experiences. One female says her clitoris felt “dead”. Another male in his 20s says four years of antidepressant use left him with severe erectile dysfunction and premature ejaculation. He adds: “I have seen a urologist that specialises in sexual health. He conducted an ultrasound on my privates and told me that I have fibrosis in it, and he said it’s very common to see that in men who are on antidepressants for a while.’
Alarmingly, some scientists are also linking their increasing use to declining fertility rates – with sperm counts having fallen 50 per cent across the globe in the past 50 years. A 2022 meta-analysis in Frontiers in Pharmacology found that SSRIs have “a statistically significant impairment on semen quality, such as sperm concentration, sperm morphology, sperm motility”.
Despite this, antidepressants are hugely popular tools to help with depression and anxiety with the global antidepressant industry now worth more than US$17 billion. Popular antidepressants being citalopram (Cipramil), fluoxetine (Prozac) and sertraline (Lustral). Women are twice as likely to be prescribed antidepressants as men, and young people are also seeing increased use.
Dr Ben Davis, an expert on sexual medicine, adds that antidepressants are often prescribed too quickly. “There are people for whom they are on life-saving medication,” he told BBC News. “But the other side is a 10-minute consultation with someone you’ve never met before, with the pressure of someone who is seeing 30 people a day. Do good decisions about long-term medication happen in that environment? I think not.”
“Various scientists, including myself, have published studies showing that an SSRI can change epigenetics and human cells,” Dr Csoka recently told The Guardian. “If that’s happening, then those cells or tissues may not immediately revert back to how they were once treatment stops. It’s as though an imprint has been left there. However, it’s still not known precisely what these changes are.”
David Healy, of the patient pressure group RxISK, has campaigned for decades to get SSRIs better labelled. His 2019 research paper into the issue heard from countless people who had been affected.
Many said they had met with “disbelief or stronger” from healthcare professionals when seeking support for sexual dysfunction. They reported being told that such a complication from antidepressants was “impossible” that the drugs were “harm free” or that the issue was “all in the head”. One said: “I feel that repeatedly not being believed has significantly increased the distress that living with PSSD has had on me, and has almost been as distressing as living with the condition itself.”
“Huge numbers are potentially affected by these side-effects,” says Healey. “We don’t know how many of them will ever get their normal sexual function back.”
As for me, thankfully, there was no lasting damage. Nor too for my female friends, one of whom also suffered from an inability to orgasm while on sertraline. Both of us feel that the SSRIs were extremely helpful at very difficult times. But would I want to go on them again knowing what I now know? I don’t think so.
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