Moderator Emeritus Addax Posted June 25, 2023 Moderator Emeritus Posted June 25, 2023 Annals of General Psychiatry (2023): Link to website link to PDF of Article: Here Abstract Background Sexual dysfunction is a common side effect of Serotonergic antidepressants (SA) treatment, and per‐ sists in some patients despite drug discontinuation, a condition termed post‐SSRI sexual dysfunction (PSSD). The risk for PSSD is unknown but is thought to be rare and difficult to assess. This study aims to estimate the risk of erectile dysfunction (ED) and PSSD in males treated with SAs. Methods A 19‐year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase‐5 inhibitors prescriptions. 12,302 males aged 21–49 met the following criteria: non‐smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or sub‐ stance use. Logistic regression was used for estimation of ED risk in SA‐treated subjects compared to non‐SA‐treated controls, assessed with and without the effects of age, body mass index (BMI), socioeconomic status (SES), depression and anxiety, yielding crude and adjusted odds ratios (cOR and aOR, respectively). Results SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8–4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3–4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000. Conclusions This work offers a first assessment of the small but significant risk of irreversible ED associated with the most commonly prescribed class of antidepressants which should enhance the process of receiving adequate informed consent for therapy. 1988-2012: Prozac @ 60mg (with a few stops and starts) Fall 2012: Returned to 40mg after discontinuing and horrid withdrawal Fall 2013: 40mg Fluoxetine, added 150mg Wellbutrin to treat fatigue Winter 2014: Attempting to taper both (too fast) April 2014: 9mg Fluoxetine + 37.5 Wellbutrin Summer 2014: 8 mg Fluoxetine + 0 Wellbutrin (way too fast a drop) Late summer/Early Fall 2014: Debilitating Withdrawal symptoms Fall 2014 - Wellbutrin successfully kicked to the curb but… Oct- Dec 2014: Panicked reinstatement of Fluoxetine ->30mg - held for 5yrs Jan 2021: taper to 20mg Fluoxetine then tapering by 1mg every 2-3 months Fall 2022 - held at 10mg->December 2022: 9mg->Feb 2023: 8mg ->March 2023: brassmonkey slide begins: 7.8mg -> 7.6 -> 7.4->2 week hold (April)->7.2->7mg->6.8->2 week hold->6.6-> 1-month hold ->(June)-6.5->4-week hold-> (July)-6.4 (discontinued brassmonkey slide and slowed taper)-> (Aug)-6.2->(Sept)-6.0->(Oct)-5.9->(Nov)-5.8->(Dec)-5.7->wave!->(Jan)-5.8->(Feb)-6mg and holding. My 2014 withdrawal experience: https://rxisk.org/antidepressant-withdrawal-a-prozac-story/
Fairsome Posted October 28, 2023 Posted October 28, 2023 On 6/25/2023 at 11:48 PM, Addax said: Annals of General Psychiatry (2023): Link to website link to PDF of Article: Here Abstract Background Sexual dysfunction is a common side effect of Serotonergic antidepressants (SA) treatment, and per‐ sists in some patients despite drug discontinuation, a condition termed post‐SSRI sexual dysfunction (PSSD). The risk for PSSD is unknown but is thought to be rare and difficult to assess. This study aims to estimate the risk of erectile dysfunction (ED) and PSSD in males treated with SAs. Methods A 19‐year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase‐5 inhibitors prescriptions. 12,302 males aged 21–49 met the following criteria: non‐smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or sub‐ stance use. Logistic regression was used for estimation of ED risk in SA‐treated subjects compared to non‐SA‐treated controls, assessed with and without the effects of age, body mass index (BMI), socioeconomic status (SES), depression and anxiety, yielding crude and adjusted odds ratios (cOR and aOR, respectively). Results SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8–4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3–4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000. Conclusions This work offers a first assessment of the small but significant risk of irreversible ED associated with the most commonly prescribed class of antidepressants which should enhance the process of receiving adequate informed consent for therapy. I personally don't believe this... 0.46% is extremely low, PSSD might be a lot more common, like 10-50 times more common than that. Also some people have it as a persisting effect despite drug discontinuation and other people experience entirely new or worsening sexual dysfunctions after they stop their drug - withdrawal syndrome, if the drug is not tapered correctly. There are other studies claiming much higher percent - around 50% of people experiencing sexual dysfunctions 6 months after discontinuation of serotonergic antidepressants. I have also heard from a therapist that he has seen a significant number of people who have had sexual dysfunction after they had been treated with antidepressants (months or years later). So it is much, much higher than 0.46%. 1 Venlafaxine 75mg, 150mg, 225mg December 2020 - March 2021 Sertraline 50mg, 100mg March 2021 - April 2021 Escitalopram 10mg, 20 mg April 2021 - May 2021
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