What Is PSSD? Post-SSRI Sexual Dysfunction Explained

Defining PSSD

Post-SSRI Sexual Dysfunction (PSSD) is defined by the persistence of sexual dysfunction and/or emotional blunting after the discontinuation of SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-norepinephrine reuptake inhibitor) antidepressants. The key diagnostic criterion is that symptoms arise during treatment and continue after the drug has been stopped — often for months, years, or indefinitely.

The condition was formally recognised by the European Medicines Agency (EMA) in 2019 following a safety review. The EMA concluded that the evidence supported a causal relationship between SSRI/SNRI use and persistent sexual dysfunction, and mandated that all product information for these medications include PSSD as a potential adverse effect. This was a watershed moment: for the first time, a major regulatory body had officially acknowledged what patients had been reporting for decades.

History of PSSD Recognition

Reports of persistent sexual dysfunction after SSRI discontinuation began appearing in the medical literature in the 1990s, shortly after SSRIs became widely prescribed. However, these reports were largely dismissed by the medical establishment and pharmaceutical companies for over two decades.

The turning point came with a landmark 2019 paper by Healy et al., which documented 62 patients across 23 countries experiencing persistent sexual and emotional symptoms after stopping SSRIs. The majority of these patients reported that their physicians had dismissed or minimised their symptoms. This paper, combined with growing patient advocacy and the accumulation of case reports in the literature, prompted the EMA review that led to formal recognition.

Which Antidepressants Are Implicated?

PSSD has been reported with all major SSRIs and SNRIs. The following table summarises the medications most commonly implicated in published case reports and patient surveys:

How PSSD Differs From Temporary SSRI Sexual Side Effects

The distinction between temporary SSRI sexual side effects and PSSD is critical for diagnosis and patient advocacy:

• Temporary SSRI sexual side effects occur during treatment and resolve within days to weeks of stopping the medication. They are dose-dependent and affect the majority of SSRI users to some degree.
• PSSD is defined by persistence after discontinuation. Symptoms may begin during treatment but continue — and in some cases worsen — after the drug is stopped. There is no dose-response relationship in the same way; PSSD has been reported after very short courses and low doses.

Who Is at Risk?

PSSD can affect anyone who takes an SSRI or SNRI. Risk factors that have been proposed in the literature include longer duration of treatment, higher doses, younger age at first exposure, and possibly genetic variants in serotonin receptor genes — but none of these have been confirmed as reliable predictors. Cases have been documented after a single dose in rare instances.

The condition affects men and women roughly equally in terms of symptom burden, though the specific manifestations differ. Men more commonly report erectile dysfunction and ejaculatory dysfunction; women more commonly report vaginal numbness and anorgasmia. Emotional blunting is reported at similar rates across sexes.

Return to the PSSD Resource Hub for the complete cluster of articles. Related: Can Psilocybin Help With PSSD? | Emotional Numbness After Stopping Antidepressants | SSRI Genital Numbness | Psilocybin vs Antidepressants