Mild NSFW warning: this post mentions sexual side effects of medication.
SSRIs are the most common type of antidepressant (examples are Prozac/fluoxetine, Zoloft/sertraline, Paxil/paroxetine).
If you have experience with them, do you think they’re a good idea?
I came across a paper about side effects which I haven’t heard discussed before. Many people know that SSRIs have sexual effects, but apparently they also affect fertility.
This paper describes SSRIs as “gonadotoxic”, leading to effects like “decreased sperm concentration and motility, increased [DNA] fragmentation, and decreased reproductive organ weights”.
The paper does say “this effect does seem to be reversible”, so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
I would be interested to hear others’ thoughts, if you have any.
Edit: Thanks for the replies to this post, they’re interesting.
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If you have experience with them, do you think they’re a good idea?
If they help with treating one’s illness, absolutely.
The paper does say “this effect does seem to be reversible”, so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
Correct on both points. There are a number of medications that have similar effects and similarly have good profiles for reversal (including TRT).
It’s something that warrants more study, yes, but the risk vs benefit is a very good balance. If further study shows teratogenic effects, it should be widely communicated and handled appropriately. However, there are many lives saved.
If you’re worried by being prescribed them, noone can tell you what’s right for you and your doctor but, I’d probably not pay it any mind. They’re not super scary things and don’t say anything bad about you.
Please don’t ask random, uninformed people on the internet about your medical treatment plan. Talk to an actual psychiatrist about your concerns.
Yeah that makes sense. But I like hearing from people in my position, who take the meds, rather than just dish them out.
In my experience doctors can be dismissive of your concerns, perhaps because they’re busy and overworked.
A major factor with antidepressants, even with ones in the same class of drugs, is that different people respond differently to different drugs. You really need to work closely with a prescribing doctor until you find what’s right for you, which is often a lengthy process. I literally can’t think of a worse place to rely on anecdotal evidence.
I didn’t like SSRIs. I found the effects for me to be very, very marginal, and the side effects–weight gain, sexual dysfunction–to be very unpleasant. The Zyprexa I was given (an atypical antipsychotic, I believe) was even worse for weight gain and sexual dysfunction. I preferred bupropion, which had neither side effect. The effects were still very marginal, IMO.
A lot of people have a REALLY hard time getting off SSRIs if they it doesn’t work, if the side effects are too serious, etc. Some people report ‘brain zaps’, and serious withdrawal. Like, really bad. It can take months for the withdrawal symptoms to ease or go away completely.
If it’s for depression, I’d look into TCMS. It’s probably more expensive up front, but supposedly you can have significant improvement in 50 or fewer sessions.
Personally, I was very resistant to try antidepressents until about a year ago (because I wanted to solve it myself and not be dependent on drugs), but tried them at a low point and they really helped. I’d recommend anyone curious about them to give them ago. If they don’t work then at least you’ll know, and as far as I’m aware, the side effects aren’t permanent*.
However, I think there needs to be some other support in place, like therapy. It’s not going to magically change your outlook and make you happy or give you the tools to deal with challenges. It just lifts your mood enough to be able to push yourself to make those changes. For me, it made me less stressed and anxious about everything, which means I can try and enjoy things more rather than worrying about things changing.
I know there are (or at least, I think there are) a lot of places out there which will prescribe just antidepressants and treat them as a magical cure-all. IMO that’s not the best way of doing it. I think taking antidepressants should be normalized, but at the same time, for the love of god, actually try to treat the underlying issues.
Oh, and don’t force people to take antidepressants without informed consent. I don’t know why I have to clarify this, but I have a friend online who thinks people don’t know what’s best for them and it’s appropriate for them to be forced to take meds. Stop that. People need to find what works for them and be engaged in the treatment process.
I have sadly noticed a reduction in, uh, “friskiness” since taking the meds. Not sure how much of that is because of the meds, and how much of it is because I psyched myself up so much thinking that I’d never orgasm again. Biggest sex organ is the mind and all that. Still, it’s not as bad as I worried it would be, and there are plenty of people out there living with low libedos naturally anyway.
I also feel a bit… Fatigued? Tired? Not really sure how to describe it. Don’t know if that’s the meds or just as a result of bad habits I picked up while being in a bad spot.
* I am not a doctor. This may be false. Don’t use the ramblings of some guy online as medical advice.
though it only coincidentally related SSRIs fucked me up in a different way (which still affected my libido tbf). i didn’t even get to a month of treatment before i decided to quit - they were supposed to help with my anxiety, but instead of helping they made it significantly worse, to the point where i felt as if i was spending my time edging a panic attack at all times of the day. At first i thought i was just getting worse normally, but then i noticed i felt better in the evenings (i was taking them in the mornings). i just couldn’t keep going it was awful
there’s plenty of people for whom SSRIs are life changers, but sadly i’m not in that group
Mine worked out well but was much worse than I expected. The doctor said I might feel “slightly more” anxiety as normal, which is the understatement of the century.
My first two and a half weeks were absolute hell like that, plus lots of digestive issues. Week 3 that faded but I had some depression, fuzzy thinking, and suicidal thoughts (more impulses). At this point I was no longer actively feeling anxious so I decided to continue. Week 4/5 I felt I had a lot more energy and wasn’t getting anxiety from my usual triggers.
I know they don’t work for everyone, but I’m at week 6 and it feels life changing to me. I feel much sharper, more focused, and happier than I have in 15 years or more.
Hopefully you find a solution that works for you. There’s no substitute for trying something and knowing it’s not working for you, so I don’t mean to diminish your experience.
I’d read a lot of negative things online about SSRIs and it was quite discouraging for me. People are very vocal about disliking them. I’m trying to toss out my own experience so it hopefully encourages people to try meds.
So far I don’t have weight gain, I’m within my normal range for the last 7 years, weight gain was a big fear I had.
i’m glad it worked out for you! :)
for me it was a gradual climb of worsening anxiety until those near panic attacks kicked in with no signs of improvement
soon ish i’ll be trying adhd meds since i suspect my anxiety is caused by rejection sensitivity dysphoria and feeling of overall inadequacy and uselessness. And on them i’ll be hopefully able to do things and slowly prove to myself that i’m not useless
I didn’t realize how much depression was affecting me, so probably very different underlying issues to you.
If you are bipolar and unmedicated for it, they will make it worse by increasing instability
nah it was just general light anxiety, and strong situational anxiety. both stemming semi-directly from adhd
Coupled with an excellent therapist, literally saved my life when I was struggling with depression. And my fertility has not been too hampered, if you know what I mean. It can surely have bad side effects for some people, but for others it is life-changing.
I have been on SSRIs for 20 years. For me they’re a good idea, but I’ve known others who have had a terrible time with them.
Sexual dysfunction is definitely a thing: how much of an issue that will be is going to be a personal decision on weighing up pros and cons. If your sex drive is low as a part of your depressive symptoms or you’re already experiencing anhedonia (inability to feel happiness/pleasure) or anorgasmia (inability to achieve orgasm) then going on SSRIs isn’t going to make that any worse. But for others the risk of missing sexual pleasure might be an unacceptable trade-off.
For anyone starting SSRIs I think it’s best to go slowly and keep in touch with your primary doctor throughout the process. There are a number of SSRIs available, and if one doesn’t work out you can try others, and hopefully land on one that works for you.
With all that said, SSRIs don’t work for everyone. It’s not unusual to feel weird or like things are getting worse when you first start them: it takes some time for the effects to settle. But if you’re having a really bad time on them, speak to your doctor about alternatives.
Thanks for this reply. To be honest I’m not so worried about the well-known sexual side effects. Instead I worry about fertility effects. The paper I mentioned in the OP says that fertility should return to normal when you come off SSRIs, so I guess that’s good. But then I came across an article mentioning a study on rats, where they apparently found impaired fertility “which persisted after the drug was stopped”.
I bet most local doctors don’t even know of these effects. They’ll know about erectile dysfunction etc, but this is something different to that.
Maybe I’m worrying too much, I don’t know. I wonder if anybody on this site has heard of these effects before.
I don’t know anything about its effect on fertility. I know people who have conceived while on SSRIs, but that’s purely anecdotal.
It’s going to be a judgement call on your part. SSRIs have been in use for long enough that I would expect there’s a big pool of data around fertility rates, even if it’s not had much analysis done on it. Also, rat models are useful but need to be understood in their context. One study in rats is not overwhelming evidence.
I have battled chronic clinical depression since 1989 and it is possible that I have been prescribed every SSRI ever at one point or another. Two have had pronounced sexual side effects but I cannot remember which did what any more, so I’ll forgo names altogether.
The first, and most disturbing of all, gave me instant erectile dysfunction. I was in my thirties when I started the pill. After a few days my penis was dead to the world. What is sad is that it was really working on my depression and anxiety without the dreaded twitching. ED in my thirties was a non-starter (no pun intended).
The second one I took for years and was in fact the last SSRI I took before I took myself off them entirely and started doing my own thing. On this pill I sort of had the opposite problem, but still a big problem. I could not only get an erection, I could effortlessly maintain it at full strength indefinitely. Well, hours for sure, and if I wanted it back, it was back. The negative side effect was a near complete inability to ejaculate. I could have passionate sex for hours at peak performance, but I could very rarely reach the finish line. As far as clinical effectiveness, the pill was adequate but not great. The combination of only slightly dulled symptoms, sexual trauma, and a virtually unlimited capacity to perform can lead to some very unhealthy behaviors.
Just be mindful, listen to yourself, and make sure that what you are doing works best for you. Good luck.
PS: During the time I was on the last pill I also suffered from acute and chronic insomnia. At my worst I was getting 90 minutes of light sleep in a 24 hour period. I do not mention it as a side effect of the SSRI because I think that was caused by a combination of factors. The pills could have been one of the factors though. I am not sure.
I don’t have any issues with the drugs themselves. That said, there’s serious consent issues around these medications, at least in the U.S.
Such as being overprescribed for conditions that they don’t treat well (CPTSD and PTSD for instance), having the positive effects overstated (they’re okay for mild to moderate depression, and not great for off label uses such as those just mentioned), and having the side effects downplayed (addictive is addictive, we don’t need new words like discontinuation syndrome, when withdrawal communicates clearly). SSRIs aren’t even the worst offenders on the market when it comes to this. SNRIs often have a very short half life, and a single missed dose can cause crippling withdrawal.
But how many of us have been prescribed these off label? With no indication of their addictive nature and potential withdrawal, not to mention sexual dysfunction? And for conditions that they don’t treat well to begin with? That’s not informed consent.
Can I ask what you mean by withdrawal vs discontinuation syndrome?
If you can schedule yourself off of a medicine isn’t that different than withdrawal and addiction? Or do you have a specific use case that you’re considering addictive?
This is all very new to me
Withdrawal and discontinuation syndrome are synonyms. The later term was coined by the pharmaceutical industry in order to distance SSRIs from opioids in the minds of doctors and patients.
You can taper off of heroin and you can taper off of an SSRI but if you stop either cold turkey, you are going into withdrawal.
The common word for a substance that does this is that it is addictive. When a person says heroin is addictive they are referring to the fact that it produces physical withdrawal when you stop it.
Heroin is also habit forming, SSRIs are not habit forming as they do not create psychological reinforcement through dopamine pathways. So, they do not create a psychological addiction or habit, but they remain physically addictive and your body will still suffer from withdrawal when you quit.
When someone quits coffee we say they have caffeine withdrawals. When someone quits SSRIs we say they have discontinuation syndrome?
It’s corporate marketing meant to minimize risks in the minds of doctors and patients. We already had a word for it.
Hence, there’s a lot of informed consent issues with psychiatric medication in general but especially SSRIs.
Thanks again, that makes sense
What does off label mean?
Conditions that are on the label are the conditions the medication is intended to treat, in this case mild to moderate depression. Off label would be using a medication for something else, like using an SSRI to treat hot flushing in menopause or antipsychotics as a sleeping aid. Technically it may work, but the studies are not there to back it, evidence is poor, so it is not shown to he effective and may have associated harm.
Thank you, I wasn’t familiar with the term.
The reason I mentioned it is because the efficacy isn’t there especially with stuff like CPTSD and PTSD. So, you give a patient an antidepressant and you diagnose them with depression so the insurance will pay for it, when the underlying cause is actually childhood trauma and then they get a false hope that the depression medication is going to fix them. And they get misdiagnosed in the process.
All of this is problematic for a number of reasons. And of course if the medication doesn’t work the doctor will just say well let’s try a different SSRI because often we need to go through three or four of them before we find something that works.
What works best for CPTSD is trauma-informed therapy. Thankfully the medical community seems to be getting wiser. And listening to patients better, at least around here.
I would second this. My partner was on an anticonvulsant for a bipolar diagnosis. Why? Because it is used, at a lower dose, as a mood stabiliser. She had limited effect at the sstandard dosage, so the psychiatrist went up in dose to get an effect.
Ultimately she got off all of the meds and is doing better without them, but that is her and her experience, the meds may be useful for some people and not others.
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