PSSD is a condition characterized by sexual problems that can persist indefinitely after discontinuing antidepressants¹ ². Beyond sexual dysfunction, patients can experience cognitive deficits, emotional blunting, loss of tactile sensitivity, and anhedonia that severely impact daily functioning and quality of life⁵ ⁷ ⁸.

For some, PSSD is disabling. PSSD can occur from SSRIs, SNRIs, and tricyclic antidepressants. Symptoms can range in severity from mild impairment to complete dysfunction. PSSD can develop after just a few doses³ ⁴, and can present either on the medication, or upon discontinuation⁵. The longest documented case spans 23 years⁶.

Like tardive dyskinesia, PSSD is an iatrogenic condition producing persistent, sometimes irreversible symptoms long after medication discontinuation. There is currently no known cure or treatment¹.

Sexual symptoms³ ⁵ ⁹

• Genital numbness or reduced genital sensation (sometimes described as a persistent anesthesia)

• Pleasureless, muted, or absent orgasm (anorgasmia)

• Decreased vaginal lubrication

• Reduced or absence of sexual desire and response to sexual stimuli

• Reduced sensitivity in other sexually sensitive areas (such as nipples)

• Erectile dysfunction

• Premature or delayed ejaculation

• Absence of morning erections

• Erectile tissue inhomogeneity 

Genital numbness, also known as persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of PSSD. Patients often describe this as a sensation similar to that experienced after receiving a local anesthetic, but it fails to resolve after discontinuing the medication that triggered its onset.

Non-sexual symptoms⁵ ⁷ ⁸

• Emotional numbing 

• Blunted affect 

• Anhedonia (inability to experience pleasure, joy, motivation, or reward)

• Loss of romantic emotion

• Loss of ability to feel empathy

• Cognitive impairment (memory issues, brain fog, learning difficulties, aphantasia)

• Sensory problems (changes in skin, vision, taste, and smell)

Post-SSRI Sexual Dysfunction (PSSD) represents a distinct condition from depression itself. While depression can diminish sexual desire and interest, it does not eliminate the capacity for physical sensation or genital sensitivity. Depression affects motivation and emotional engagement with sexuality but preserves the underlying sensory apparatus. In contrast, PSSD involves what appears to be neurological changes that create complete loss of sexual sensation and physical responsiveness - a fundamental disconnection between mind and body that goes beyond any psychological explanation.

Many people with PSSD were never diagnosed with depression; they were prescribed antidepressants for IBS, OCD, premature ejaculation, or other conditions.

Research suggests that a significant number of people may experience persistent sexual dysfunction after stopping SSRIs or SNRIs. Despite sexual dysfunction being recognized for decades as a primary effect of these drugs, almost all studies to date have failed to evaluate the risk of persisting harms. It is therefore challenging to determine how common PSSD is.

At the higher end of prevalence estimates, a 2024 study of thousands of former patients found that around 13% of past antidepressant users reported persistent genital numbness, compared to about 1% of people who used other psychiatric medications¹⁰. However, this study did not measure symptom duration after medication cessation - therefore, the number of people experiencing this symptom in an enduring fashion is likely lower.

Another 2023 study estimated the risk of PSSD to be 1 in 216 patients who took serotonergic antidepressants (including all serotonergic ADs)¹¹. This is likely a conservative estimate, as the study defined PSSD only as men who continued to receive a PDE-5 inhibitor prescription (Viagra, Cialis) for erectile dysfunction after discontinuing serotonergic antidepressants. It also does not account for the fact that some men with PSSD have other symptoms - such as complete loss of libido - that preclude them from engaging in sexual activity regardless of ED, and that many men with PSSD do not seek treatment for ED.

Short-term FDA trials have underreported the true incidence of sexual dysfunction by an order of magnitude, due to failure to inquire about it. Sexual dysfunction is well established to be underreported, likely driven by stigma, lack of recognition, and misdiagnosis¹².

Due to a lack of research, we still do not yet know how common PSSD is. Therefore, given our limited current scientific understanding, we are not in a position to state whether this is a rare condition or not.

The study Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence reflects the importance of recognizing how skepticism of this condition perpetuates a cycle of neglect. Patients who report PSSD are frequently dismissed, with their symptoms attributed to psychological factors, leading to underreporting and a lack of medical documentation. This, in turn, creates significant barriers to research, as studies struggle with small sample sizes, selection bias, and inconsistent methodologies; further fueling doubt about the condition's legitimacy. Many patients, feeling invalidated and embarrassed by the deeply personal nature of their symptoms, hesitate to speak out, further reducing awareness and available data.

The resulting lack of education on PSSD within the medical community leaves professionals unaware of its existence, limiting both research funding and treatment development. As long as this cycle continues, the medical field remains stuck in a state of inaction, reinforcing its own skepticism, and ensuring that evidence remains scarce.

PSSD can affect anyone—regardless of age, sex, or ethnicity. It is not dose dependent and can occur after a few doses or after years of use³ ¹³. People who previously tolerated these medications without issues can still develop PSSD.

PSSD can occur in anyone who takes one of the associated medications, regardless of their original diagnosis. It can occur in people who took antidepressants for complaints such as insomnia, PMS, chronic pain, IBS, Tourette's syndrome, menopause, etc. as well as for mental health conditions such as depression and anxiety. Prior experience of mental health difficulties or sexual dysfunction are not a requirement for developing PSSD.

Those who took antidepressants before or during adolescence may not recognize symptoms due to a lack of baseline sexual experience¹⁴, and may question sexual identity and asexuality.

PSSD is recognized by health authorities¹⁵ ¹⁶ ¹⁷ ¹⁸ and medical literature, but awareness among healthcare professionals and the general public remains low. This is partly because sexual dysfunction can also be a symptom of depression, and patients or providers may not link persistent symptoms to past antidepressant use¹².

Unfortunately, due to an absence of awareness amongst doctors, PSSD is commonly misdiagnosed as depression or another mental health condition. This leads to underreporting, making it seem rare. That perceived rarity may reinforce skepticism, causing more dismissal, in turn deterring patients from continuing to pursue this differential diagnosis.

However, the hallmark symptoms of PSSD (orgasmic anhedonia/anorgasmia and genital numbness/reduced sensation), are not explained by depression and establish PSSD as a unique condition separate from depression or any mood disorder.

The term “side effects” to describe PSSD can be misleading - as it suggests the symptoms are temporary, rather than a treatment emergent adverse effect that can persist indefinitely. Adjusting the language to “treatment emergent adverse effect” or “legacy effect” more accurately captures the condition and can also help sufferers to feel more validated in their experience.

All medications with serotonin reuptake inhibitor (SRI) properties can cause PSSD. These medications include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), some tricyclic antidepressants (TCAs), SRI antihistamines, and tetracycline antibiotics.

Common SSRIs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).

Common SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).

Vortioxetine (Trintellix) is classified as a serotonin modulator (but it has SRI properties).

Common tricyclic antidepressants with SRI properties include imipramine, nortriptyline, amitriptyline, and clomipramine. Mirtazapine (a tetracyclic antidepressant that acts on serotonin) has also resulted in PSSD⁷.

It should be noted that, while Post-SSRI Sexual Dysfunction (PSSD) was originally named for its association with selective serotonin reuptake inhibitors, the condition has been reported with various classes of antidepressants beyond just SSRIs, including serotonin-norepinephrine reuptake inhibitors (SNRIs), and serotonin modulators such as vortioxetine, tricyclic antidepressants (TCAs), and atypical antidepressants such as mirtazapine.

Additionally, PSSD can include more than just sexual symptoms. Reported symptoms include emotional numbing, blunted affect, anhedonia, loss of romantic emotion, cognitive impairment, brain fog, and other symptoms.

The name PSSD has remained in use despite this broader symptom profile, as it was the term established when the condition was first formally recognized.