Can Antidepressants Make You Permanently Asexual?

It’s been long understood that antidepressants can have a negative effect on a person’s libido while taking them. However, it has recently emerged that antidepressant use could cause potentially permanent changes to a person’s sexuality, even long after taking the medication. This condition is called PSSD (Post-SSRI Sexual Dysfunction). 

Gen Z, in particular, has regularly been described as a “sexless generation.” Not only is Gen Z less likely to have been on a date than previous generations, but more and more are beginning to identify as asexual.

The reason for this isn’t entirely clear. Porn addiction may be part of it, and overuse of social media, causing social anxiety, may also be. However, the widespread use of SSRIs (Selective Serotonin Re-uptake Inhibitors) and their side effects on sexuality may also be a contributing factor, especially considering between 40% and 65% of people who take an SSRI are thought to experience some form of sexual dysfunction. 

What Side Effects Are People Suffering?

There is a long list of sexual side effects associated with SSRIs, including total loss of libido, genital numbness, erectile dysfunction, an inability to orgasm, and a complete lack of sexual attraction. Emotional blunting is another side effect many users experience, creating a numbing of positive emotions, a loss of romantic feelings, and difficulty connecting with others. One of the main concerns of PSSD is that it can occur after taking just a few pills and persist for years, maybe even permanently. Plus, the risk of suffering this kind of side effect is very high – around 1 in 216; however, many patients aren’t warned of the risk.

One of the main concerns of PSSD is that it can occur after taking just a few pills and persist for years, maybe even permanently.

Another issue is that many of the patients treated with SSRIs don’t tend to be individuals suffering from the most severe cases of depression. Instead, they’re usually people with milder symptoms, like teenagers and young adults. “They’re being handed out without much thought these days,” says Psychiatrist David Healy, founder and CEO of the company Data Based Medicine. “Now absolutely, people who are at high risk of suicide do need treatment. But the average family doctor is handing SSRIs out to people who are anxious or mildly depressed. They need to realize that if you cause PSSD, you’re going to lead to suicide cases because people feel they can’t live this way.”

A Rise in Asexuality Acceptance

In recent years, we’ve seen a rise in influencers telling young people there’s nothing wrong with them if they’re asexual and it should be celebrated. Of course, there shouldn’t be a stigma against individuals who are genuinely asexual. However, if there is a medical or social reason for an increase in asexuality, it must be addressed.

As we’re learning, it isn’t always completely “normal” not to feel any sexual attraction; sometimes, it’s a side effect of antidepressants, which is why it’s important this rise is investigated, particularly because it’s predominantly affecting girls and women. For example, in the U.S., 86% of people identifying as asexual are female, and 91% are aged between 18 to 27. Plus, women are twice as likely to take antidepressants than men. So, it seems there may be a link between the uptick of women taking SSRIs and the increase of women identifying as asexual. 

Why Is PSSD Such a Problem?

Rosie Tilli, a sufferer of PSSD, recently spoke to The Guardian about her experience on SSRIs and their side effects. Tilli began taking the medication after growing feelings of depression and anxiety during the pandemic. However, she soon noticed a drop in her libido and an inability to feel any sexual sensations at all.

After googling her symptoms, she learned about PSSD and began tapering off the medication after just four months. Unfortunately, the side effects remained. “I reassured myself that I would be fine as soon as I fully ceased the medication, but I wasn’t,” she told The Guardian. “Now, nearly four years on, I’ve learned to put on a sunny disposition, but internally, I am riddled with psychological grief and anguish. I can’t experience any physiological sexual response. No arousal even when physically touched. It’s as if the entire electrical hardwiring of the sexual system has been short circuited. My clitoris feels like my elbow now, and there’s nothing I can do to reverse it.”

Worse still, Tilli’s concerns were dismissed when she contacted her doctor, who insisted SSRIs couldn’t cause sexual dysfunction and was instead sent home to do breathing exercises. “When I reached out for help with my local mental health service, I was sectioned and placed involuntarily into psychiatric care as the psychiatrist said I had ‘delusional disorder’ and tried to put me on antipsychotics,” says Tilli. 

The Research on PSSD Is Limited

Few researchers are working on the mechanism of PSSD and how to reverse it. Two such are Professor Roberto Melcangi of the University of Milan, who has been researching the condition for the last three years, and Antonei Csoka, a researcher on aging at Howard University, who has been studying PSSD off and on since the early 2000s. Both have published studies looking at specific SSRIs and their effects on sexual function. 

Prof. Melcangi told The Guardian, “I believe that PSSD is primarily a neurological disorder relating to altered brain functionality.”  

In the U.S., 86% of people identifying as asexual are female, and 91% are aged between 18 to 27. 

Csoka’s theory, on the other hand, focuses on epigenetic changes, which then affect the genes responsible for sexual function. “Various scientists, including myself, have published studies showing that an SSRI can change epigenetics and human cells,” said Csoka. “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 epigenetic changes are. So what we need to do is narrow it down – what is happening?”

Even though the need for more research is real, the funding for it is extremely difficult to garner. Csoka has used grants related to aging for much of his PSSD research. PSSD patients themselves partly crowdfunded Melcangi’s work. 

Melcangi’s future research will investigate the potential brain pathways leading to sexual dysfunction, as well as the gut microbiome and the gut-brain access. He also hopes to study the differences in male and female microbiomes in relation to PSSD. 

What Should People Consider Before Taking Antidepressants?

Dr. Avigail Lev is a licensed clinical psychologist who says it’s important for anyone choosing an antidepressant to be very careful of the long-term sexual side effects and mindfully weigh the benefits against the risks. “The best way to go about it is to start with medications that have a lower risk of causing sexual side effects, like Wellbutrin, Remeron, or Lamictal. These meds are effective for depression and are less likely to lead to sexual dysfunction or loss of libido. This is especially key for those already experiencing sexual side effects from their depression – they should be extra cautious,” she says. 

However, if these three medications aren’t effective and another antidepressant is being considered, Dr. Lev recommends adding the spice saffron as a supplement. “Research suggests that saffron can boost libido and effectively reduce sexual side effects from antidepressants like Prozac. This makes saffron an option for those needing to manage the sexual side effects of antidepressants. However, people should still be cautious because there is not enough research to fully understand the long-term consequences. Among the options, Wellbutrin seems to be the safest one to start with regarding sexual side effects,” she continues.

Closing Thoughts

It seems that PSSD has been a known side effect for some time now, but many healthcare practitioners have been unaware of it. That’s why it’s essential that those considering taking antidepressants don’t just take what the doctor gives them. Instead, take the time to consider all your options and research the best treatment for yourself. Going on SSRIs isn’t necessarily the right route, even though it’s often presented that way.

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