The New York Times Magazine published an article last week about the lesser-discussed ways selective serotonin reuptake inhibitors, such as fluoxetine and paroxetine, which are frequently prescribed to treat depression and anxiety, affect adolescents‘ sexual development.
Post-SSRI sexual dysfunction is a condition in which sexual side effects from SSRIs (and serotonin and norepinephrine reuptake inhibitors) persist after an individual stops taking the medication. Documented side effects include a loss of sexual desire and arousal, numbness in one’s sexual anatomy, and erectile dysfunction.
In the article, those who took an SSRI during their teenage years or younger also reported no longer experiencing crushes. Some with PSSD described a broader emotional blunting that made connecting with other people difficult, even in platonic situations.
Roughly 2 million 12- to 17-year-olds in the United States take SSRIs. This class of drugs increases serotonin in the brain by blocking the neurotransmitter’s reuptake (or reabsorption), which is believed to help regulate one’s mood.
In terms of the possible mechanisms behind PSSD, ultrasound research has shown a link between some presentations of impotence and SSRI usage. Research has shown that men with PSSD have penile tissue with pervasive scarring, which resembles the penile tissue of men over the age of 50 with risk factors for erectile dysfunction but no history of using SSRIs.
Similar results were not found in men with erectile dysfunction that resulted from physical injury, such as riding a bicycle or being kicked in the groin. The lead researcher concluded that SSRIs produce an excess of oxygen radicals, which translates to scarring, malfunctioning, and, possibly, impotence.
Although mental health professionals recognize PSSD in adults, and the most recent version of the Diagnostic and Statistical Manual of Mental Disorders acknowledges it, such symptoms are often dismissed in young people, believed to be indicative of a problem, such as anxiety or depression, that predates patients’ medication use. Others are told that their PSSD symptoms could be attributed to stopping the antidepressant. For those struggling with their mental health or unaddressed physical symptoms, the last thing they need is to be misled about what they are experiencing or what the appropriate path forward is.
The article notes that practitioners don’t always tell their patients about the sexual side effects of SSRIs out of fear that it will diminish compliance. As well, some mental health professionals may consider sexual wellbeing to be secondary to one’s mental health, particularly if suicidal ideation is of concern. This nevertheless prompts the question: Is a patient truly capable of giving informed consent if he or she isn’t fully aware of the intervention’s possible risks?
Of course, not everyone who takes an SSRI will experience PSSD, and taking antidepressants has surely benefited some. But for those who decide to stop, it may not be a straightforward decision. Suddenly discontinuing an SSRI, as opposed to tapering one’s dosage off safely and with medical supervision, can induce withdrawal (also known as antidepressant discontinuation syndrome), including flu-like symptoms, nausea, insomnia, and a worsening of depression and anxiety.
Social media has conveyed to young people that taking a pill to solve life problems is fashionable and glamorous. Considering that about 5% of Generation Z take antidepressants, could this explain why so many report a disinterest in or an indifference to dating and settling down? We are currently witnessing an unprecedented, global decrease in sexual activity and sharply declining marital and birth rates.
A 29-year-old woman interviewed in the magazine piece experienced PSSD after stopping an SSRI six years earlier. She spoke of how having PSSD has influenced her views on relationships and child-rearing. She chose to have a baby as a single mother by way of in vitro fertilization because she doesn’t “have the capacity for romantic relationships.”
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She explained, “Your sexual life is so core when you consider that the sexual relationship is the basis for most long-term relationships.”
If PSSD so profoundly alters not only the way individuals relate to other people sexually, but also socially, it’s no wonder so many young people today grapple with finding meaningful connections. What will the future hold for a society that has the option, through digital means, of checking out of social interactions entirely?
Dr. Debra Soh is a sex neuroscientist and the author of the forthcoming book Sextinction: The Decline of Sex and the Future of Intimacy.