How are SSRIs used to treat depression and anxiety?
Antidepressants such as SSRIs can be lifesaving for people suffering from depression, OCD, anxiety, and other mental health conditions. The process is as follows.
WASHINGTON — In a lively ballroom at a luxury hotel, Laura Friedman, 23, sat on stage and talked about her sex life. Specifically, sexual dysfunction.
The Vanderbilt University senior explained that after stopping antidepressants, she completely lost sensation in her genitals and experienced what she called “chemical castration.”
She also loses her sense of emotional connection. “I can’t feel the love for my mother. It’s the hardest thing on earth.”
Mr. Friedman’s talk about the “overmedicalization” of mental health riveted the audience at an event hosted by the MAHA Institute, an enthusiast group for Secretary of Health and Human Services Robert F. Kennedy Jr.’s “Make America Healthy Again” movement.
Other young people who accompanied Friedman said they also faced unexpected challenges from psychiatric medications and SSRIs (selective serotonin reuptake inhibitors, a type of antidepressant).
SSRIs can be life-changing for people suffering from mental health issues. There are several types of antidepressants, but health care providers usually make SSRIs the first choice because they tend to have “fewer and milder side effects than other options,” according to the Cleveland Clinic.
Friedman was clearly reluctant to participate and had no intention of becoming a spokesperson for post-SSRI sexual dysfunction (PSSD), a condition not officially recognized in the United States. People like Friedman are sounding the alarm.
“I think it’s obvious that I don’t want to be here,” she said. “It feels so humiliating and dehumanizing to share this to a group of strangers, to the press, and inevitably to the Internet. So much so that I am literally sexually dysfunctional and emotionally lobotomyd. This is the complete opposite of who I have always been.”
But she was there to make a certain point. She doesn’t want PSSD to happen to anyone else.
SSRIs have been a major issue in the MAHA movement, including at an event where speakers argued that these drugs are being overprescribed.
According to a 2024 study published in the journal Pediatrics, monthly antidepressant medication rates among young people increased by 66.3% from January 2016 to December 2022 as depression rates rose.
Speakers at the event called for greater emphasis on non-drug treatments for depression, including psychotherapy and lifestyle changes such as improved sleep hygiene, exercise and diet.
But when talk therapy alone doesn’t work (or you don’t have access to this type of support), antidepressants can be an important option for people suffering from depression, OCD, anxiety, and other mental health conditions, but antidepressants should always be closely monitored by a doctor.
What do you need to know about PSSD? Here’s what the experts say.
What is PSSD?
Although the manifestation of sexual dysfunction after SSRIs varies from patient to patient, doctors who study the condition say it is primarily defined by the onset or persistence of sexual dysfunction after SSRI use.
“Most of us expect that if we take a drug and experience side effects, we can stop the drug and the side effects will go away, but the opposite is true,” explains Dr. Kenneth Peters, chief of urology at Corewell Health in southeastern Michigan and medical director of the Beaumont Center for Women’s Urology and Pelvic Health.
Peters said side effects such as genital numbness, difficulty getting an erection and difficulty reaching orgasm may increase even more after the drug is stopped.
And it’s not necessarily just sexual side effects. Peters said some patients may lose interest in things they used to love, struggle with emotional connection, or experience physical symptoms such as changes in bladder or bowel function.
“As a clinician, this is surprising,” he says.
According to Dr. Irwin Goldstein, chief physician, co-founder and director of the San Diego Society of Sexual Medicine, for many years the explanation for this change was the original mood problem for which SSRIs were prescribed. However, he explained that his research has discovered physiological changes in people who experience PSSD, including neurological function and tissue damage.
Peters points out that people who have stopped non-psychiatric medications for skin health or hair loss have also reported similar problems.
In 2019, PSSD was approved by the European Medicines Agency, a regulatory authority similar to the US Food and Drug Administration. Peters explained that similar recognition does not exist in the United States, and there are no formal diagnostic criteria.
How MAHA is involved in the SSRI debate
Shortly after RFK Jr. became health secretary, President Donald Trump directed his administration to assess the “threat” posed to children by prescribing SSRIs, antipsychotics, mood stabilizers, and stimulants.
An executive order aimed at ending “over-reliance on drugs and treatments” has sparked panic among people who rely on SSRIs and other psychiatric drugs to manage their mental health.
“Literally, I wouldn’t be alive today without my SSRIs,” one user posted on X in response to the executive order. “If they take away these drugs it will cause a mass tragedy,” another X user wrote.
President Kennedy, for example, has shared conspiracy theories that falsely link antidepressants to school shootings, while promoting the idea that he is focused on “gold standard science.”
But is there a way to balance raising awareness of PSSD while making SSRIs available to people who need them? Experts think so.
“We don’t want to eliminate drugs; we want to make that clear,” Goldstein said. “But we don’t want to cause this PSSD issue. This is a separate bad condition.”
How common is PSSD?
Approximately 1 in 6 Americans takes SSRIs. Goldstein said the percentage of people who develop PSSD appears to be very small, but difficult to estimate.
“Not everyone who takes drugs will experience these problems,” he says. “It could be 1%, it could be 4%. We just don’t know what to make of it.”
But Goldstein said the state shouldn’t lose credibility just because the percentage is small, missing or not publicly recognized.
Peters went a step further and said it’s dangerous not to listen to patients who are going through this kind of experience. In an international survey on PSSD he conducted with Corewell Health, the majority of participants said they sought medical care for their symptoms, but more than 50% of the clinicians they consulted ignored them, he said.
Are there treatment options?
For some people, symptoms of PSSD subside within months or years, but for others they can be “forever,” Peters said, adding that there is no formal treatment.
“I think most patients get their medical information from subreddit accounts, where people who have tried millions of different things talk about their experiences,” he said, adding that people have researched everything from hormone manipulation to electrical stimulation. Health-related subreddits can help many people feel heard, but it’s important to remember that not all health information on social media or the internet at large can be trusted.
While a solution is a long-term goal, he and Goldstein hope that short-term research can identify people most at risk for PSSD.
“The issue is funding,” Peters said, adding that most of the PSSD research that exists is funded by patients. He hopes the grant he’s applying for from the National Institutes of Health will lead to further research.
In the meantime, experts and advocates are calling for more information about the potential risks to be shared with patients prescribed these drugs.
“We also don’t need to scare people away from taking something that could potentially save their lives,” Peters said.
