Medications known to cause PSSD

  • Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

    In June 2019, the European Medicines Agency mandated that all package inserts for SSRIs (with the exception of Dapoxetine) and SNRIs include the following warning about the potential for persistent sexual dysfunction:


    Selective serotonin reuptake inhibitors (SSRIs)/serotonin norepinephrine reuptake inhibitors (SNRIs) may cause symptoms of sexual dysfunction (see section 4.8). There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs/SNRI.

  • Other psychotropic medications

    We are aware of several cases where PSSD symptoms were caused by other psychopharmaceuticals such as tricyclic antidepressants (e.g. amitriptyline), non-selective serotonin reuptake inhibitors (e.g. trazodone, which is believed to have a pro-sexual effect), and atypical antipsychotics. So far, there is no official warning regarding persistent side effects caused by these medications.

  • Other drug groups

    There are other drug-induced syndromes that are very similar to PSSD. The most well-known ones are the Post-Finasteride Syndrome, which can be caused by the use of the hair growth medication Finasteride, and the Post-Retinoid Sexual Dysfunction, which can occur after taking the acne medication Isotretinoin.

Note: PSSD symptoms cannot only be triggered by SSRIs. Rather, the term Post SSRI Sexual Dysfunction is misleading.

The following overview, with the exception of Dapoxetine, is based on information about the respective drugs from the  "Kompendium der Psychiatrischen Pharmakotherapie" by Benkert and Hippius (eds.), 11th edition.

The links lead to an overview on https://medlineplus.gov/druginformation.html. For Dapoxetine, the link leads to https://patient.info/medicine.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Citalopram

(Celexa)

  • Indication for depression and panic disorders
  • most common side effects: drowsiness, insomnia, headache, agitation, nervousness, lethargy, asthenia (feeling weak), sweating, tremor (shaking) and dizziness
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Escitalopram

(Laxapro)

  • Indication for depression, panic disorder, generalized anxiety disorder, social anxiety disorder and obsessive-compulsive disorder.
  • Most common side effects: nausea, fatigue, yawning, restlessness, insomnia, drowsiness, dizziness, anxiety, altered appetite and vomiting
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Fluoxetine

(Prozac)

  • Indication for depression, obsessive-compulsive disorders and bulimia
  • Longest half-life among SSRIs, therefore still detectable weeks after discontinuation
  • Most common side effects: insomnia, headache, diarrhea, nausea, fatigue, drowsiness, forced yawning, anxiety, nervousness and inner restlessness
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Fluvoxamin

(Luvox)

  • Indication for depression and obsessive-compulsive disorders
  • most common side effects: dizziness, headache, drowsiness, sleep disorders, compulsive yawning, agitation, nervousness, anxiety, asthenia (feeling weak), tremor (shaking)
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Paroxetine

(Paxil)

  • Indication for depression, panic disorder, social anxiety disorder/social phobia, generalized anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder.
  • Most common side effects: nausea, sexual dysfunction, headache, difficulty concentrating, forced yawning, drowsiness, insomnia, dizziness, asthenia (feeling weak) and agitation
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Sertraline

(Zoloft)

  • Indication for depression, for relapse prevention after depressive episodes, for panic disorder, obsessive-compulsive disorder, social anxiety disorder and post-traumatic stress disorder.
  • Most common side effects: insomnia, fatigue, headache, dizziness, diarrhea, nausea, dry mouth, ejaculation delay, forced yawning and nightmares
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Dapoxetine

(Priligy)

  • Premature Ejaculation Indication
  • This drug is used to market one of the common undesirable side effects of SSRIs: delayed orgasm
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Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Venlafaxine

(Effexor)

  • Indication for depression, for relapse prevention after depressive episodes, for generalized anxiety disorder, panic disorder and social anxiety disorder.
  • Most common side effects: headache, dizziness, dry mouth, nausea, sweating, asthenia (feeling of weakness), nervousness, tremors, dizziness and forced yawning
  • known for pronounced withdrawal syndrome
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Milnacipran

(Savella)

  • Indication for depression
  • most common side effects: dizziness, nausea, anxiety, sweating, hot flushes, dysuria (difficult urination), drowsiness, sensory disturbances, tremor (shaking) and migraine
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Duloxetine

(Cymbalta)

  • Indication for depression, generalized anxiety disorder, moderate to severe stress urinary incontinence and pain associated with diabetic polyneuropathy
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