Klaas, Siva, Bak, Govers, & Shreiber, (2023). The pathophysiology of Post SSRI Sexual Dysfunction – Lessons from a case study

[Addax]

Biomedicine and Psychopharmacology. 2023. https://doi.org/10.1016/j.biopha.2022.114166
 

Link to PDF: HERE

 

Abstract

Background

Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRIand SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated.

Objective

Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options.

Method

We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient’s symptoms.

Results

The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, ‘brain zaps’, overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT_1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems.

Conclusions

The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic – and possibly noradrenergic – mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes.