It's not that common (and it's not proven either)

Earlier this month, The NY Times published an article addressing the increasing number of people grappling with sexual dysfunction, including decreased libido, genital sensation, erectile dysfunction, or the inability to orgasm. Many attribute these issues to past use of selective serotonin re-uptake inhibitors (SSRIs). While it's widely known that certain SSRIs can induce such side effects during medication use, little information exists regarding their long-term impact on sexual functioning.

The author conducted interviews with people attributing their symptoms to SSRIs, as well as several experts, to explore various perspectives on the issue. Numerous anecdotal reports recount difficulties in regaining interest or sensation after discontinuing medications like Celexa, Zoloft, or Prozac. Vague warnings from health organizations in Europe and Canada acknowledge the potential for long-term sexual dysfunction resulting from SSRIs.

In my daily practice of prescribing SSRIs, I routinely discuss sexual side effects or the potential for such effects with many clients. While some experience no sexual side effects, many find resolution after discontinuation and trying a different SSRI. Some people, faced with the symptoms of depression or anxiety, opt to endure the side effects temporarily. Notably, none of my clients have reported ongoing sexual side effects from SSRIs after they've stopped medications in this class.

As I delved into the article, a recurring thought emerged: Determining whether an SSRI causes sexual side effects, such as decreased interest or inability to orgasm, is not a straightforward assessment  while the medication is being taken. This complexity is compounded after the medication is stopped. I recall instances where I changed a client's SSRI due to a sexual side effect, only to discover later that confounding variables such as medical comorbidities, trauma resurfacing, stress, psychological discontent, or relationship discord were the actual culprits. Achieving sexual gratification, navigating relationships, and cultivating self-love are intricate processes.

While The NY Times article undeniably sheds light on the suffering of those interviewed, the scarcity of research on post-SSRI sexual dysfunction, coupled with the myriad of alternative causes of sexual dysfunction, are not likely to significantly influence decisions to initiate or discontinue an SSRI. I don't see this shifting the needle towards people not using SSRIs. Nevertheless, the relatively high incidence of sexual side effects during medication use should unquestionably be a topic in psychiatry appointments.