Post-SSRI Sexual Dysfunction (PSSD) and PFS : Exploring the Overlaps and Potential Treatments

Post-SSRI Sexual Dysfunction (PSSD) is a condition that has puzzled many in the medical community. For numerous patients, it is a devastating reality that severely affects their quality of life. In this video, Dr. Sanil Rege, a consultant psychiatrist, delves into the complexities of PSSD, drawing insights from Post-Finasteride Syndrome (PFS), another condition known for persistent sexual dysfunction even after medication cessation.
We will explore the pathophysiology, diagnosis, and potential treatment avenues for PSSD. Dr. Rege discusses the overlapping mechanisms between PSSD and PFS, including the role of neuroactive steroids, androgen receptors, gene expression changes, and the gut-brain axis. By examining these commonalities, we aim to shed light on potential treatment strategies that could provide relief to those suffering from these conditions.
The video covers a range of important topics, from the impact of serotonergic inhibition on dopamine release to the role of epigenetic modifications and endocrine abnormalities. Additionally, we discuss how alterations in the gut microbiome can influence sexual behaviour and mood, linking gut health to PSSD and PFS symptoms.
Join us as we tackle this critical topic and strive to understand more about these debilitating conditions. Don't forget to stay until the end of the video, where we explore potential treatment options and emerging research that could offer hope to those affected by PSSD and PFS. From neuroactive steroid therapy to modulation of the gut microbiome and dopamine agonists, we delve into the most promising avenues for future research and treatment development.
Welcome to Psychiatry Simplified! If you're passionate about neuroscience, psychiatry, and mental health, hit the subscribe button to stay updated with our latest releases. Check out our other videos for more in-depth discussions on related topics. Your support and comments are invaluable to us, and we look forward to learning together.
#PSSD #PostSSRISexualDysfunction #PFS #PostFinasterideSyndrome #MentalHealth #PsychiatrySimplified #DrSanilRege #Neuroscience #SexualDysfunction #Psychiatry #GutBrainAxis #Neurosteroids #MentalHealthAwareness #SSRI #Finasteride #Propecia #Proscar #Dutasteride #Avodart #Dopamine #NeuroactiveSteroids
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[@Kalley_Kavia]

It really is unbelievable that these "medications" are legal.

[@remmy908]

Whatever this condition is it is an absolute nightmare. Sexual dysfunction and little to no emotion makes all of life one big boring chore... I both hate Psychiatry for ever pushing these pills on us but also want to thank you for trying to bring this new phenomenon to light (The more research into any working treatment the better!!)

[@Fargo-s5t]

I’ve had PSSD for 3 years and I swear no one believed me including my doctors. I feel for all of us affected by this and I’m really thankful that you are discussing this and I’m also thankful for all the people still staying positive. I don’t think I would be coping as well if it weren’t for people like y’all exploring new options. I hope that one day we can all be happier and healthier. Much love

[@merakli_meleha]

Ben de pssd

[@ElizabethAmbiong]

yes for me they said i am having psychosis when i told my doctor of.my symptoms

[@christopherp.8868]

As someone with PSSD from taking Lexapro and mirtazapine thank you for this video

[@exlincer]

Same. Only took lexapro for 3 weeks and it numbed my genitalia and caused horrible sexual and erectile dysfunction practically overnight. It’s horrible and been 2 years since with persistent side effects.

[@christopherp.8868]

@@exlincer I'm sorry to hear that. Stay strong man. We are all in this together

[@PsychiatrySimplified]

So sorry to hear !

[@PsychiatrySimplified]

Sorry to hear .

[@Drena2]

PSSD guy here, this is probably the best vid discussing PSSD & PFS on YT. You’re up to date on the most recent research including mentioning the cognitive symptoms that often remain neglected by doctors who give their opinions on this. Zuranolone does seem like quite promising for us. Anyway, thanks for covering this.

[@PsychiatrySimplified]

Pleasure 🙏🏻

[@poostenbrug3053]

I got PFS for 8 years now, tried almost everything but to no avail unfortunately, thank you for bringing attention to this.

[@PsychiatrySimplified]

Im sorry to hear.

[@Maxxxmaa]

Thank you for your work! Highly appreciated. In a world where most docs dismiss our symptoms we need experts like you. Thank you!

[@pssdguy]

Thanks for covering the subject! I do have PSSD for 5 years.

[@PsychiatrySimplified]

Sorry to hear. Have agents been tried to address this?

[@jpsittt]

Suffering from PSSD for 6 years now after just 1 week on Citalopram. I am going to give Bupropion a chance. A lot of remission stories from people who also had PSSD from Citalopram. And I think it works on all the things you pointed out in this video! Thanks again. This is gonna be an exciting time for me and a risk at the same time. But I have suffered way too long from this. Keep doing this great work, lots appreciated!!

[@filmbuffoon]

Any luck?

[@Mo-Assaf]

Please let us know

[@San-Vittore-nerazzurra]

@@jpsittt there are many cases of bruproprion induced Pssd

[@minepolz320]

Living with anhedonia and no emotions no libido no pleasure no plans no cognition no interest and untreated endogenous depression on top is absolutely hell

[@merakli_meleha]

Me to pssd

[@rayanmeftah1]

I hope you talk about the rest of the other problems associated with PSSD, including emotional, physical, cognitive, and psychological problems.

[@mindnatic]

thank you for being honest about this. psychiatry is commiting a crime since 1990. risk of chemical castration is not acceptable for a case of moderate anxiety like mine. no one even told me about the side effects DURING de medication. now my life is ruined and all they can say is that "it's psychological", no one cares

[@merakli_meleha]

Me to pssd

[@merakli_meleha]

Ben de pssd oldu

[@karmaindustrie]

I'd say "it's social" :) ... karma needs to get played out - with love (for no bad karma to collect)

[@user-dw9dx2ev9h]

I got PSSD from 1 month of sertraline 5 years ago. Thank you for this video

[@PsychiatrySimplified]

Sorry to hear. Hope you can see a doctor to consider interventions

[@user-dw9dx2ev9h]

@@PsychiatrySimplified They often don't believe me

[@karmaindustrie]

@@user-dw9dx2ev9h they might turn your detriment into charm and confidence via malicious joy. So they can achieve more trust from other patients. It's a business.

[@emreerdemli9770]

Hi Doctor, My story might help contribute to your understanding of the PSSD mechanism. I had IBS 20 years ago, primarily caused by anxiety. I took sertraline for six months, and it significantly improved my condition, although it gave me PSSD. I had diarrhea for five years back then. The SSRI permanently improved my IBS symptoms by 60-70%, and they remain the same after 20 years. I believe it caused partial damage or desensitization in the gut-brain connection, which provided me with significant relief. However, it did the same thing to my brain-sexual functioning (PSSD). So, there might be an interesting connection between gut functioning and PSSD. In other words, whatever the SSRI did to my bowels, it did the same thing to my sexual functioning. It desensitized them both to some extent. Thankfully, my PSSD has improved over the years.

[@PsychiatrySimplified]

Thanks for sharing! There is evidence for this gut brain axis impact that you mention. Appreciate the input. And glad you are improving

[@asmuslim23]

Please don’t forget about Post Accutane syndrome (PAS) just like PFS and PSSD all hair and skin products people need to stay away from!

[@PsychiatrySimplified]

Yes absolutely - that’s the other one

[@josefdez8258]

Why people can get PSSD from only 1 pill ?

[@PsychiatrySimplified]

It really is unknown but the single dose phenomenon may be linked to neurotoxicity similar to MDMA - this is speculation - as to conclusive know this studies are needed

[@cameronm7318]

Thanks for the videos - just noticed your mic may be peaking which affects the sound quality, not a sound professional but it might be to do with the recording settings or the space if there is any echo. Thanks.

[@PsychiatrySimplified]

Thanks for the feedback. Was this throughout the video or specific places? And what do you mean by peaking please?

[@karmaindustrie]

@@PsychiatrySimplified I guess he meant that the sound is too loud so it get's distorted (on some loud "peaks"). But I don't check the video. I'm just reading comments.

[@MrGregsss]

Great video! Would administering a high dosage of manipulated GABA bring any results? When will allopregnanolone be tested?

[@PsychiatrySimplified]

Its difficult to know but we have PAMs ( e.g BZDs ) that are used for other conditions. Also noradrenergic antagonists so a clinician may perform an individual risk benefit analysis to trial these. ALLO-P as far as i know hasn't been tested in a human trial for PSSD.

[@TheStealthPawn]

@@PsychiatrySimplifiedIn the US zuranolone is available but it is ridiculous that pharmacies are not allowing off label prescription (even if patient is willing to pay). Something needs to be done about this. It seems like Z is theoretically what can help these complex gut brain immune axis conditions

[@sgrogan955]

I tried mushrooms one time about 2 years ago. And my genitals finally few normal and my orgasm felt like it did before I began taking Lexapro. Has anyone else tried this?

[@royzevisionneur2045]

Any news regarding PFS and gut issues ?

[@PsychiatrySimplified]

@@royzevisionneur2045 there is an association. It is one of the overlaps.

[@psychiatrist123]

Does fecal transplant help with sexual dysfunction and depression

[@PsychiatrySimplified]

@@psychiatrist123 there is some evidence for depression www.sciencedirect.com/science/article/abs/pii/S027858462300146X Sexual dysfunction - pubmed.ncbi.nlm.nih.gov/29685195/

[@randomuser3741]

I got PSSD after only dose of 2.5 mg of Escitalopram

[@LoquenderoMaster198]

Doctor, mi situation is complej, before to take the medication (antidepressents) i had more sensibility than the moment wich i started to take it, i mean that i had a normal sexual life. When i started the tratament i felt genital anestesia and i could have orgams but it was difficult to get). After to leave the medication my sensations changed too, i can have orgams more easier, but i feel the penis unmbess, and i feel that i lost sensibility. My libido is normal/higher but if i compare the actuallity with the past i can say that i maybe lost a 20/30% sensibility in my sexual life. Thank you and sorry for my english. Im from for argentina

[@enlameramata]

I'm 6 years in from 2018 25mg Zoloft/Sertraline. A true nightmare. Can't even put it into words.

[@liamgordon4007]

How long were you on it?

[@SuperCody888]

Even though you've blocked me on X thank you for spreading awareness, and talking about PSSD

[@PsychiatrySimplified]

Did I ? Sorry. If it’s relevant happy to unblock.

[@3manifold]

Damn 😂 what did you do though

[@SuperCody888]

@@3manifold I cant remember probably counter pointed the narrative that these drugs are life saving. In general psychiatrists/doctors that prescribe these meds dont like to hear the negative about these meds, so they block those that go against or challenge them. They prefer to turn their back on those that they harm, and label them as anti-psychiatry, pill shamers and fear mongers. Im not saying but this Dr. does it, but lots do.

[@halcr0]

Have u seen success treating pssd with mirtazapine? And what dose? Would 30mg be better than 15mg for example? Cheers

[@PsychiatrySimplified]

Most cases we see will be AD induced SD. Mirtazapine higher doses are more dopaminergic and are effective in reversing emotional blunting and SD induced by SSRI- 45-60 mg but this is a risk benefit analysis with the patient. Other dopaminergic agents such as Vortioxetine , Agomelatine, bupropion are options with evidence in PSSD

[@andre.s7224]

Do you know of any cases where PSSD has disappeared again? Unfortunately, it seems to be a permanent brain damage.

[@karmaindustrie]

I am pretty sure, it disappeared for me. Due to the teachings of AJ Miller.

[@karmaindustrie]

If you try to integrate yourself into society without being your true self (and that's what psychologists often force you to do - right into emotional prostitution and stuff like that) then you also will look for a partner that doesn't match your true self and sexuality might make you aware of the "mismatch". That's how I see it. That doesn't mean you have the wrong partner but it might be the right partner, approached from a false angle under false social conditions - as if "your parents" are watching you in your sleeping room or stuff like that. I hope, my precious comment doesn't get cencored.

[@riyadislam2180]

I used mirtazapine 15mg but no improvement, bupropion isn’t available in my country. Doctors treatment doesn’t any improve. My testosterone, prolactin, thyroid, lipid profile, diabetes everything normal.. I have anorgasmia problem. What can i do 🥺? Can you suggest medicine? Age 24 (male)

[@PsychiatrySimplified]

Is this related to Post SSRI? And pre Medication no issues with orgasm? No other issues with erection , libido etc?

[@riyadislam2180]

@@PsychiatrySimplified yes, I used sertaline 5 years ago, but this side effect doesn’t go. Low libido, anorgasmia still have, but erection better by using gingko biloba 60 mg.

[@PsychiatrySimplified]

That’s good to know. Agomelatine , Vortioxetine, other dopamine agonists ( Cabergoline, pramipexole - prescribed for RLS ) are all mentioned . Ps not medical advice. Risk benefit analysis needed with doctor

[@riyadislam2180]

@@PsychiatrySimplified give me a advice, can i take mirtazapine and gingko biloba together? I think mirtazapine block 5ht2c receptor and gingko increase dopamine this process can i treated? I wasted a lot of money because of the doctors but they cant give proper treatment, they always suggest tadalafil and ayurvedic type medicine.

[@tubo1812]

Try modafinil, sulbutiamine, ginseng

[@Ssss-sv1yw]

Is this even related to Tyc or only SSRI and SNRI ?

[@SuperCody888]

i tried wellbutrin for pssd. it gave me horrible side effects, and intrusive thoughts not worth it

[@richhh7772]

What kind of side effects? Did wellbutrin work?

[@SuperCody888]

@richhh7772 besides intrusive thoughts, it gave me anxiety really bad, like I drank 10 redbulls. I tried it 3-4 times. The last time I gave it a few weeks and tried to push through the side-effects it wasn't happening. Even the Dr. said they never seen that happen before.

[@nenadsijakovic6796]

I'm suffering from PSSD after taking Effexor (20 mg) for nearly a year. I don't know what to do. My neurologist turned me down after talking about it.

[@Pac-cm3xx]

Do you know if a similar condition has been reported with ashwaghandha? I feel like I got a less worse version of this condition after taking ashwaghandha.

[@3manifold]

Sir i read a journal online saying that 1 in 4 have social anxiety disorder, what do you say about that? Im thinking that it might be the reason why so many people become mentally unstable

[@kintalivenkatarao9236]

Hi Sir , If i do head bath with cold water or if i sit under A.C (air conditioner) i am not gettling sleep . Max i will sleep 1 hr and later will get wakeup and not able to sleep . Even no feel to sleep . If i do head bath with hot water or no A.C then i will sleep 6 or 7 hrs . Could you please what is the problem which doctor should i consult ? is this allegric reaction . i have visited neurologist and ENT .Did CT scan and doctor told no issues in reports . Could you please suggest me which doctor should i consult .

[@PsychiatrySimplified]

Please see a general practitioner or a psychiatrist as this seems like severe insomnia.

[@kintalivenkatarao9236]

@@PsychiatrySimplified Thankyou sir for your suggestion . One doubt i have is if i don't do head bath with cold water or if i switch off A.C i will get proper sleep ( 6 or 7 hr day). I have observed my self several years and if i sit under AC for 2 or 3 hrs sleep quality reducing and only 2 or 3 hr i am sleeping ..My age is 38 yrs . if i am not using A.C i can able to sleep properly .Still should i consult psychiatrist . I dont have any anxiety and presser in my life.

[@PsychiatrySimplified]

Yes a GP and or Psychaitrist to report Your symptoms.

[@capulcununteki]

After 4 years of paroxetine treatment with 80 mg, I experienced numbness in emotions and musical anhedonia. I have not used paroxetine for 7 months and have not seen any improvement yet. I am currently using 300 mg bupropion for this problem. Is this appropriate or is there a different treatment that you can recommend that I talk to my doctor about?

[@MrGregsss]

I got pssd from paroxetine too. I've tried some meds but it didnt work. I'm hoping for a miracle

[@capulcununteki]

@@MrGregsss Wellbutrin didn't work either? I don't have PSSD caused by paroxetine, I still have sexual power, but it caused permanent anhedonia.

[@MrGregsss]

@@capulcununteki Nothing worked included buprione (Wellbutrin)

[@PsychiatrySimplified]

Dopaminergic potentiation is considered appropriate to target emotional blunting, anhedonia, SD. However are there any anxiety, Hyperarousal symptoms ( pls see video on difference ) including sleep disturbances.

[@capulcununteki]

@@PsychiatrySimplified First of all, thank you very much for your answer☺️ I noticed that my panic attacks disappeared while using paroxetine, but I think it did this by blunting my emotions. I can't panic because I can't get as excited about sexual and emotional issues as I used to, apart from that, my anxiety is less than before paroxetine, but it hasn't disappeared completely. Actually, I don't have a problem with sleep disorders. Btw, was there a video where you talked in detail about DNA demethylation drugs? I have heard that folic acid supplements are used for this. Also, in which video did you mention hyperarousing? Was it this video? Let me check that out too.

[@AndrogenReceptor01]

Dr, does sleep improve on SSRIs with long-term use? I don’t have dreams anymore and I’m not entering REM sleep. Having slight insomnia. Does this get better with time on to acclimate to the medicine? Thank you Dr. As always not asking for medical advice. Will discuss with my personal psych but they never want to discuss with me :(

[@shawnaford5540]

I had a sleep study and that physician said that the SSRI I was on does disturbs sleep architecture. Definitely improved since going off. I took 3 years to get off due to withdrawals.

[@AndrogenReceptor01]

@@shawnaford5540 did you sleep improve while using the SSRI? As in do things start to reach “homeostasis” after while being on the SSRI?

[@PsychiatrySimplified]

SSRIs have varied effects that are linked to the underlying nature of sleep disturbance SSRIs suppress REM sleep - mild REM sleep suppression is helpful in PTSD but excessive REM suppression may not be helpful for emotional processing that is needed in REM sleep 2. SSRIs may disrupt overall sleep architecture including deep sleep ( NREM) - it thus does not do anything for this phase of sleep ( needed for restful sleep) 3. Insomnia is a broad term - the specific nature of insomnia should be evaluated to understand what plan is to be implemented. Please see the video we have done on insomnia.

[@3manifold]

Sir so jan 2023 doctor cold turkey 50mg zoloft resulting protracted withdrawal from march 2023 to jan 2024 first, from jan 2024 i got better (the process is similar to withdrawal) drastically, but since june, the recovery is a lot better but i got brand new symptom cant feel emotion, no testorerone, i had very low zinc, my hair do not grow anymore,low iron. am i worrying too much or is it just recovery thing? Is the fact that anxiety is a lot better sign that my body is just recovering? Should i just wait? Maybe im just being no patient? btw thank you so so so much, you are what a doctor😊

[@johncatalano7101]

You can get this from finasteride, SSRI’s, lions mane, saw pawmetto, Accutane, etc.

[@MrGregsss]

Dr. Sanil do you have instagram?

[@PsychiatrySimplified]

instagram.com/psychiatry.excellence?igsh=aTdrMXh1bTdwM2Qw&

[@hulk-jv6cz]

Pssd since 3 years after quitting zoloft.

[@minepolz320]

4 years since Lexapro and total anhedonia

[@SagarGupta-bt4xo]

Sir can there be a cure for receptor downregulation

[@N-xi2zh]

Stop calling people sir, enough people make fun of indians. and yeah. I cured PSSD and PFS (at least for yrs the latter. I am trying more dht steroids but did TEI mineral balancing, 30 plus days water fasting, perfect diet and exercise, and hackstasis things. u can try mineral balancing Trace elements inc, maybe evenbetternow website ships to india).

[@richhh7772]

Im scared to get on my strattera for ADHD as i have a read that a handful of people online that have said strattera gave them PSSD even though it is a selective NRI. Is Strattera safe?

[@minepolz320]

Strattera is the worst choice ever for ADHD

[@richhh7772]

@@minepolz320 what works in your experience?

[@minepolz320]

@@richhh7772 Strattera also SSRI in some kind

[@N-xi2zh]

just use dexedrine or ritalin brand name they are way better for ADHD. Strattera is trash. ADHD meds can even help PSSD and PFS and raise 5ar. The non stim drugs, almost no one like. May as well use modafinil or provigil and coffee at that point.

[@monceeef]

What is the solution?

[@karmaindustrie]

claiming coolness

[@rayanmeftah1]

Sexual problems are not the only ones, but they are only part/one aspect of the permanent symptoms/changes that we suffer from.

[@Vectorman2X]

saying that is a permanent symptom you can understand that you dont help anyone, and adding more desperation to already depressed people, even if it is true which is not cause there are cases that recovered there is no meaning to mention this.

[@kenpe1455]

Pea raises allopregnenalone.

[@tubo1812]

Low dose fluoxetine increases allopregnenolone

[@nikolaoschif436]

Help pls

[@AbrahamE-f7z]

Pretty good stuff, I just realized that Mario updated his favorite way to tackle ED and it's crazy! Although what he previously talked about was pretty decent, it was difficult to follow, I just go'ogled the latest by Mario Volpstein, it's so much simpler and potent now!

[@Protracted-Withdrawal]

I have recovered from PSSD after 6 years, you can check my story in my bio.

[@PsychiatrySimplified]

Nice to know. Can you share the link here.

[@Protracted-Withdrawal]

@@PsychiatrySimplified I can't youtube has deleted it. Kindly check in my bio :)

[@Protracted-Withdrawal]

@@PsychiatrySimplified You can check my bio :)

[@Dario.121]

​@@Protracted-Withdrawal you are dangerous

[@Protracted-Withdrawal]

@@PsychiatrySimplified I can't past a link here.

[@Vectorman2X]

Devil in a pill

[@simonwright6163]

Under-researched crap.

[@johncatalano7101]

PFS and PSSD are both real.

[@TrueLunacy]

Criminals

[@polashrajkonwar2765]

I hate psychiatrist

[@Odinvillive]

Try coccaine

[@Gerald-q2x]

Honestly speaking I feel robbed and scam by the psychatrist. I seriously dk if my drive would return but most probably not