And the amount of girls and women on antidepressants because...... they are on hormonal contraceptives(!!!) Seems like that decades-long experiment of messing with female hormones kinda sucked and came with the worst trickle-down effects (which then needed to be treated with other drugs.)
I wish there was more awareness about this. Hormonal birth control can have a huge impact on mental and physical health but it seems like not a lot of women know this.
my wife and I have been together since she was 18 and I have watched libido essentially disappear and it rather dropped off a cliff actually by the time she was 21... by that time I think that she was on birth control pills for about five years. it has really been a sore spot in our 24 year relationship with many years of arguing until I eventually just gave up that things would ever change. parents of young ladies you need to avoid BC pills at all costs, it is poison for many.
Haley this is so true and very sad. We didn't grow up aware of our cycles or had role models as such and therefore it is very easy for girls (or mums) with the best of intentions to put girls early on on the pill not aware of the psychological effects. I am trying to bring awareness to this double bind here (https://theclab.substack.com/) but it is tricky because, as you touched on in your response, many girls have no awareness of how it feels to live as a cyclical creature. Modernity has no space for it and it makes it so terribly confusing for people. :-(
Yes, we need more work being done like this. Women deserve to know their body (and it's signs of health and ill-health in the menstrual cycle) before pumping a bunch of drugs into it, clouding any baseline of normalcy.
People are so quick to slap labels on themselves. I used to be an active member of the big asexual forum, AVEN, back in the day -- late 2000s, because despite being in my early twenties I didn't have a sex drive and was searching for information. Then I lost a bunch of weight in a short window of time, got really active, and my hormones woke up. The modern body is so distorted from the weird lifestyles we live, the questionable chemicals in our food, etc, but the mainstream opinion is to declare that rampant mental issues and identity issues, etc are all perfectly normal. It's bizarre and damaging.
I was on AVEN as well! Spent several formative teen years thinking I was ace only for my libido to finally show up at 19/20. Luckily I didn't experience any significant identity crisis over it but I imagine these days there could be social blowback for acknowledging the existence of late bloomers.
THANK YOU for writing this!! I'm in my 60s, but I was on both antidepressants and birth control pills when I was younger, and I can tell you the side effects are nothing to ignore. With one antidepressant (SSRI) I gained an "instant" 30 pounds, which took me DECADES to lose, and I SMILED (literally smiled!) through my mother's funeral because I had no feelings. I was a robot. Another SSRI (Zoloft) had me sitting at my computer at work, drooling, while I was supposed to be supervising 50 employees. I told the doctor I would rather be in pain than drooling at my desk! I called myself a Zoloft Zombie. I won't even go into what the birth control pills did to my body. I am now 100% drug-free and very happy (and very against Big Pharma, but that's a comment for another day).
I started taking an SSRI when I was 16. To this day, I am fairly convinced that there was no choice for me but to receive medical treatment, due to the severity of my anxiety. I was entirely debilitated, cowering, struggling to make it out of bed or communicate.
I think that the boom in these prescriptions is a trend we have seen often before with psychotropic drugs. They are necessary for some, but then become culturally normative and are over requested and subsequently overprescribed. All medicine requires a cost-benefit analysis. I took SSRIs and was able to get out of bed again. I probably was not going to have sex with my crippling anxiety...if anything they have empowered my sexuality as a possibility. But, I recognize there are thousands where that won't be the case, and thus, people should be extremely thoughtful in weighing their options. I think that my parents rightly determined that medical treatment was worth the risk for me...but my experience is not one that can be generalized.
Dang. Your comment makes one think... HARD. I was a wreck during adolescence, maybe even before. Depression and anxiety and ADD. Apparently I appeared pretty normal, or so I heard at a class reunion. It's a miracle I didn't whack myself. But it all passed, mostly, at around age 21, coincident with a dramatic religious conversion. Maturity and marriage came late for me, but it finished the job. I'm my teen years I would have gobbled up meds had they been on offer. As it turned out, I'm glad they weren't. Thanks for sharing your story!
I agree that this is an important issue and I think it's likely that many self-identified cases of asexuality have medical origin, especially in SSRI treatment. But there's some needless conflation here between the kind of sexual dysfunction that occurs during and shortly after SSRI treatment, which is incredibly common, and the kind of sexual dysfunction that persists long after treatment is discontinued, which is rare. Only the latter is post-SRRI sexual dysfunction (PSSD); the overwhelming majority of cases of SSRI-induced sexual dysfunction will be found in people who are still taking the medications. I know you clarified the rates of each at the beginning of the piece, but sentences like "So my fear is this: you might not be asexual. You might be suffering from PSSD" elide the distinction. This isn't the only piece that I've read recently where I've worried that readers will come away from it thinking that a single dose of Zoloft has a good chance of leading to lifelong sexual struggle, or that having sexual problems while you're on SSRIs means they will never go away, when neither is the case. It's important for people to have realistic senses of these odds so that they can make appropriate risk-benefit determinations for themselves.
It would be nice if people *could* weigh up the pros vs cons of using an SSRI. Sadly this is impossible as noone has bothered to find out the prevalence of PSSD, a full 30yrs after regulators started to receive reports. I am a woman chemically castrated by an SSRI given for PMS a decade ago. I spoke to a psychiatrist who told me that PSSD didn't exist. After the MHRA recognised this side effect he said that it was 'rare'. This is exactly the same thing that happened with protracted withdrawal: at first noone believed the patients, then it was 'rare' and only know are we finally seeing it as the disaster it is.
Your concerns should lie with the fact that regulators 'missed' it, Drs still aren't aware, there's no informed consent, little research and no cure. Journalists drawing attention to this scandal may be the only way out of this mess.
I'm sorry this happened to you. It's true that this is very under-researched, and that professionals can be dismissive of issues they don't understand, including this one. I experienced that myself with respect to SSRI withdrawal (although there were definitely clinicians who were ahead of the curve on that one, and knew, based on patient experiences, that the official line was bunk). I didn't orgasm until I was nearly 30 as a result of SS/SNRIs, so I understand that dimension of it as well. I had a friend in high school who had a different kind of sequela from a short-term treatment with an SSRI--electric shock sensations that came and went periodically, and lasted for many years. Another class of psych drug did significant harm to me, and some clinicians still act like it's not within the realm of possibility for the drug to actually do the opposite of what it says on the tin to some people. I also have worried for a long time that developmental trajectories of many kinds might be altered by psychiatric medications in childhood and adolescence, which is an issue researchers either have little interest is or have decided is too difficult to parse experimentally. In either case it's a dereliction of responsibility--what we don't know can hurt us, but if it's next to impossible to prove it won't hurt anybody's bottom line.
I am concerned about all these issues and express them where I think it appropriate. But I can be concerned about more than one thing at a time. It's still the case that PSSD is not nearly as prevalent as garden variety SSRI-induced sexual dysfunction. If it were, it could not possibly have been missed for this long. There would be veritable hordes of people with it. Regardless what the medical organizations say, individual practitioners would have noticed. Something like 1 in 8 people take an antidepressant presently, many more have taken them at some point in time (I didn't find data on lifetime prevalence but considering incidence is pushing 15% I'd wager it's in the neighborhood of neighborhood of 1 in 5), and the vast majority of those prescriptions are for SSRIs and SNRIs. PSSD cases would be more than two orders of magnitude larger than the estimate provided by the study Freya cites (which has a methodology that I think undercounts cases, but still, there would have been a much stronger signal in that data if it were anywhere near as common). Even if we don't have stellar data, when the difference is bound to be that significant, conflating the two likelihoods is more than a little misleading.
I truly think I understand where you are coming from. But many people benefit from treatment with SSRIs, and exaggeration of the risks, intentional or not, stands to harm them. In any case, I hope that more research is put into this issue, so that people can make more informed treatment choices, and so that people who have been harmed by SSRIs as you have can hopefully find relief from the damage that's been done.
Thank you so much for adding this balance to the discussion. I completely understand where people are coming from and these concerns are real. There should be better education for GPs and patients on these issues, without ignoring the fact that there are indeed "rotten apples" among psychiatrists. There should also be more research into the long-term effects of these drugs. Still, some statistics are misrepresented (not even saying this was intention) because they don't say what the author probably thinks they say. Other aspects are likely blown out of proportion. As usual with such discussions (see parallels to ADHD), there are still many people who would benefit from SSRIs but are not taking them or don't even have access to them.
Yeah, this is probably partially a reason. On the other hand, I think we might also look at the fact that our society, in general, is veryyy over-sexualized. Even normal, everyday ads seem to have an element of “sexiness” to them. Social media is full of influencers urging girls to be provocative. And it seems like kids are dating younger and younger and getting into sexual situations they should not be in.
I’m not advocating for no sex ed, fyi… I just think we need to take a good look at what we as a society are showing young people about sexuality. This and the medications may very well be working in tandem, too. Who knows. But there’s a lot that needs to change.
I was on antidepressants for 4 years in college, and although there may have been unintended side effects regarding sexuality (I will have to give this more thought) I am also 100% sure without medication at that period I would have failed out of school and not had the courage to get regular counseling and make a lot of necessary life changes that allowed me to eventually get off the medication. It leveled the playing field so I wasn't starting from way back at the 1 yard line. I think doctors need to be more proactive talking with patients about this, but I hope your piece doesn't scare folks away from getting help if they need it. Suicide is a huge issue in America and in my mind is the one "side effect" of depression you can never rebound from...
My wife has been SSRI's for a few years now, and the effects have been really defeating. Sex drive has gone to zero, gained a huge amount of weight. Went from an energetic, lively, stressed out, overwhelmed woman full of anxiety and optimism and turned her into an asexual, lethargic, stressed out, apathetic, anxiety-ridden hoarder.
The worst part is the open-ended was of it all. This is a forever drug. You are on it for life. There's no point at which you are "cured" and can wean off.
Utterly pernicious. The people responsible for drugging entire generations of young women will have a lot to answer for in the next life.
'This is a forever drug. You are on it for life. There's no point at which you are "cured" and can wean off.'
Some doctors are of that opinion, but the good ones will help a patient discontinue and find other ways to manage anxiety/depression, if that's what the patient wants. It's tricky though because even well-intentioned doctors often don't understand how to taper SSRI doses slowly, and will interpret withdrawal symptoms as a depression relapse.
I totally agree that too many young people (and people in general) are on SSRIs and similar medications. Many reasons why it's happening—financial incentives, cultural shifts in how we view human distress, etc—and it's a complicated issue. It is also true that sexual dysfunction of one sort or another while taking SSRIs is common and absolutely underappreciated by psychiatrists.
However, I think it is important to separate sexual dysfunction while taking SSRIs (a common and a well-known phenomenon, and one that has some remedies) with post-SSRIs sexual dysfunction. Mainly because PSSD is a relatively new and still poorly understood thing with some big unanswered questions, eg a plausible mechanism for that kind of effect. I've still never met someone who had really long-term post SSRI dysfunction that wasn't easily explainable by other glaring causes. The longest I've heard reliable reports of PSSD lasting is around one or two months at most (again, this is just the people I've seen and talked to). The point is that if it is real, it is thankfully rare.
Generally, though, I absolutely agree that we should be cautious about the side effects of these meds, especially when given to children, although I suspect the link between SSRIs and anything resembling permanent "chemical castration" is probably a stretch. Could be wrong, but that's my sense.
It's also interesting to think about the following scenario: let's say PSSD is rigorously established to be real, beyond a reasonable doubt. I could easily see large numbers of false positive PSSD cases from those who tend to glom onto the currently in vogue diagnosis, whether it is multiple personalities, anorexia, gender stuff, etc. The intersection of this side effect with culture (i.e. sex, and lack thereof) could easily make this a big cultural or even political issue.
Anyway, enjoyed you work as always. Seems I'm less concerned about widespread catastrophic consequences than you are perhaps, but I do agree it is a very big problem.
(Also, your reference to Sarafem reminded me of a fun game I played with a co-resident a while back. Create a fantasy novel narrative but everyones' name is a psych med. eg: We received instructions from the three Elvish princesses, Sarafem, Saphris, and Seroquel. We were to cross the plains of Nardil and head north until we reached the Zenzedi temple. There we would speak with the ancient Sorcerer Atarax, who could provide us with his “Abilify” spell, which would grant us increased strength and fortitude for the battles ahead. We would pass near the Geodon canyon, eventually reaching the port city of Pamelor, you get the idea)
'If it's real'? Did you know that in 2019 the EMA recognised that SSRIs cause 'enduring sexual side effects'? Do you think they got it wrong? What are the 'glaring causes' that you feel others are missing?
I don't think they got it wrong, but I think it is too early to say much with certainty because we don't understand the phenomenon well enough. Glaring causes include a combination of: using other medications that can cause sexual side effects, continued drug use, ongoing psychiatric problems, poor relationship quality, demoralization, lack of prospects, strong history of somatization, etc. The point is not that PSSD doesn't exist, but that we should be prudent and careful in investigating it, without jumping to conclusions prematurely.
And you think that genital numbness, the key symptom of PSSD, could be caused by the above? It's interesting to me that Drs seem to be so skeptical about PSSD, but I suppose psychiatrists always have the option of diagnosing a harmed patient with another disorder. I've seen psychiatrists on Twitter argue that a) they've never seen a case of PSSD, yet b) they know which psychological conditions the patient *really* might have wrong with them and that Drs who *think* they might be seeing PSSD cases are probably mistaken. A mainstream psychiatrist covers this situation really well here: https://www.psychiatrymargins.com/p/can-we-please-stop-bullshitting-patients In any case, we may soon have objective evidence of the harms caused by PSSD. In this interview, a radiologist discusses his research into PSSD, showing that young men with PSSD have penile fibrosis. I look forward to this paper being published. I wonder how psychiatrists will react to this research https://www.youtube.com/watch?v=TiJ94cqa9II&t=6s
I agree psychiatrists should not be unthinkingly dismissive about this issue: patient concerns are patient concerns, and we need to take them seriously. I think the biggest question mark is a plausible mechanism of action. But hey, biology is complicated and we may very well find something we didn't expect. It happens all the time. I'm mostly cautioning against prematurely endorsing the view without sufficient evidence. (re: genital numbness, I've never met a patient who has had prolonged post-SSRI desensitization or anything like that, so I would just be speculating on that point)
Online 'asexuals' make a distinction between romantic attraction and sexual attraction, and contend that both exist on a spectrum. There are people who want to be in a romantic relationship with cuddling and commitment and the like, but don't like the idea of sex at all, and then people who say they only experience sexual attraction with people they have a strong emotional bond to, etc.
"People who only experience sexual attraction with people they have a strong emotional bond to" are also known as "women".
It always boggles my mind that sex-positive feminists were so keen to champion "having sex like a man" that they ended up reinventing the wheel with "demisexuality", which they then treated as a rare and therefore cherished category rather than the default pattern of female sexual attraction.
There's an entire page on facebook called "They're Discovering Christian Morality" devoted to capturing moments when modernists propose great new ideas based on their bitter experience......that are really just the same moral codes that traditional religions have codified for millennia.
I just want to advise anyone who reads this post and decides to come off their SSRI to //do so gradually//. Seriously, don't go cold turkey.
Personally, I've found a tricyclic far preferable for dealing with my OCD after many, many years of being on SSRI. But if you make a similar move, do so with medical supervision and not just overnight.
I continue to be appalled at the extent of the medication of children - and especially the number of young women on multiple long-term prescriptions, including the pill, anti-depressants, anti-anxiety medication and painkillers. Then there are the medications for ADHD etc. Parents and young people seem to be quite content with this - just grateful for an answer to a problem, without any curiosity about the roots of their distress or what they might be doing to themselves in the long run.
I think there is a cultural problem where women are often on the over-receiving end of medication; its partially because women are more trusting than men of the mental health system and more likely to reach out to a therapist and partially a continuation of a Victorian trend that tended to diagnose every emotionally angsty teenager with hysteria.
I am sure there are some who give it deep thought - there are also many who don't, who are only too pleased to be offered a pill to pop. I was referring to the latter in my comment. I have frequently heard teenagers discussing relative doses, with those on the highest doses having the most kudos in school. This concerns me very much.
When I read this , I remembered an episode on House more than 10 years ago about an asexual couple. Back then it was still possible to say that there may be a medical cause. Of course I had to google it now and boy oh boy. The asexual community is not happy about that episode.
If you're watching House and thinking to yourself that Dr House is a good role model whose behaviour and beliefs you should emulate, you're doing it wrong.
I am not emulating his behavior and beliefs, I also don't use it to diagnose myself or those around me, it's just a show I watched a while ago for entertainment. I was just commenting on the way some people reacted to it with "House" let asexual community down and such. Also, it is quite telling that an episode like that would most likely not be aired nowadays.
I was always curious as to why so many of my peers identified as "ace." Being a late bloomer couldn't be the explanation for ALL of them. Many of us didn't watch porn, oddly enough. But given that depression was so rampant among us, I wouldn't be surprised if they were on medication.
And the amount of girls and women on antidepressants because...... they are on hormonal contraceptives(!!!) Seems like that decades-long experiment of messing with female hormones kinda sucked and came with the worst trickle-down effects (which then needed to be treated with other drugs.)
I wish there was more awareness about this. Hormonal birth control can have a huge impact on mental and physical health but it seems like not a lot of women know this.
Doctors are quicker to hand out birth control than candy. Little to no counseling on the side effects.
my wife and I have been together since she was 18 and I have watched libido essentially disappear and it rather dropped off a cliff actually by the time she was 21... by that time I think that she was on birth control pills for about five years. it has really been a sore spot in our 24 year relationship with many years of arguing until I eventually just gave up that things would ever change. parents of young ladies you need to avoid BC pills at all costs, it is poison for many.
Haley this is so true and very sad. We didn't grow up aware of our cycles or had role models as such and therefore it is very easy for girls (or mums) with the best of intentions to put girls early on on the pill not aware of the psychological effects. I am trying to bring awareness to this double bind here (https://theclab.substack.com/) but it is tricky because, as you touched on in your response, many girls have no awareness of how it feels to live as a cyclical creature. Modernity has no space for it and it makes it so terribly confusing for people. :-(
Yes, we need more work being done like this. Women deserve to know their body (and it's signs of health and ill-health in the menstrual cycle) before pumping a bunch of drugs into it, clouding any baseline of normalcy.
I agree. Sad that many women don’t have the opportunity to first know what’s normal before - as you said - clouding any baseline of normalcy. 😞
Double profits. Pharma got so close to government, and now both cause a problem, then offer the solution for it.
This is worth an article in itself. Thanks for sharing it!
People are so quick to slap labels on themselves. I used to be an active member of the big asexual forum, AVEN, back in the day -- late 2000s, because despite being in my early twenties I didn't have a sex drive and was searching for information. Then I lost a bunch of weight in a short window of time, got really active, and my hormones woke up. The modern body is so distorted from the weird lifestyles we live, the questionable chemicals in our food, etc, but the mainstream opinion is to declare that rampant mental issues and identity issues, etc are all perfectly normal. It's bizarre and damaging.
I was on AVEN as well! Spent several formative teen years thinking I was ace only for my libido to finally show up at 19/20. Luckily I didn't experience any significant identity crisis over it but I imagine these days there could be social blowback for acknowledging the existence of late bloomers.
THANK YOU for writing this!! I'm in my 60s, but I was on both antidepressants and birth control pills when I was younger, and I can tell you the side effects are nothing to ignore. With one antidepressant (SSRI) I gained an "instant" 30 pounds, which took me DECADES to lose, and I SMILED (literally smiled!) through my mother's funeral because I had no feelings. I was a robot. Another SSRI (Zoloft) had me sitting at my computer at work, drooling, while I was supposed to be supervising 50 employees. I told the doctor I would rather be in pain than drooling at my desk! I called myself a Zoloft Zombie. I won't even go into what the birth control pills did to my body. I am now 100% drug-free and very happy (and very against Big Pharma, but that's a comment for another day).
Damn, your comment makes me want to break down and cry. AND SCREAM.
I started taking an SSRI when I was 16. To this day, I am fairly convinced that there was no choice for me but to receive medical treatment, due to the severity of my anxiety. I was entirely debilitated, cowering, struggling to make it out of bed or communicate.
I think that the boom in these prescriptions is a trend we have seen often before with psychotropic drugs. They are necessary for some, but then become culturally normative and are over requested and subsequently overprescribed. All medicine requires a cost-benefit analysis. I took SSRIs and was able to get out of bed again. I probably was not going to have sex with my crippling anxiety...if anything they have empowered my sexuality as a possibility. But, I recognize there are thousands where that won't be the case, and thus, people should be extremely thoughtful in weighing their options. I think that my parents rightly determined that medical treatment was worth the risk for me...but my experience is not one that can be generalized.
Dang. Your comment makes one think... HARD. I was a wreck during adolescence, maybe even before. Depression and anxiety and ADD. Apparently I appeared pretty normal, or so I heard at a class reunion. It's a miracle I didn't whack myself. But it all passed, mostly, at around age 21, coincident with a dramatic religious conversion. Maturity and marriage came late for me, but it finished the job. I'm my teen years I would have gobbled up meds had they been on offer. As it turned out, I'm glad they weren't. Thanks for sharing your story!
I agree that this is an important issue and I think it's likely that many self-identified cases of asexuality have medical origin, especially in SSRI treatment. But there's some needless conflation here between the kind of sexual dysfunction that occurs during and shortly after SSRI treatment, which is incredibly common, and the kind of sexual dysfunction that persists long after treatment is discontinued, which is rare. Only the latter is post-SRRI sexual dysfunction (PSSD); the overwhelming majority of cases of SSRI-induced sexual dysfunction will be found in people who are still taking the medications. I know you clarified the rates of each at the beginning of the piece, but sentences like "So my fear is this: you might not be asexual. You might be suffering from PSSD" elide the distinction. This isn't the only piece that I've read recently where I've worried that readers will come away from it thinking that a single dose of Zoloft has a good chance of leading to lifelong sexual struggle, or that having sexual problems while you're on SSRIs means they will never go away, when neither is the case. It's important for people to have realistic senses of these odds so that they can make appropriate risk-benefit determinations for themselves.
It would be nice if people *could* weigh up the pros vs cons of using an SSRI. Sadly this is impossible as noone has bothered to find out the prevalence of PSSD, a full 30yrs after regulators started to receive reports. I am a woman chemically castrated by an SSRI given for PMS a decade ago. I spoke to a psychiatrist who told me that PSSD didn't exist. After the MHRA recognised this side effect he said that it was 'rare'. This is exactly the same thing that happened with protracted withdrawal: at first noone believed the patients, then it was 'rare' and only know are we finally seeing it as the disaster it is.
Your concerns should lie with the fact that regulators 'missed' it, Drs still aren't aware, there's no informed consent, little research and no cure. Journalists drawing attention to this scandal may be the only way out of this mess.
I'm sorry this happened to you. It's true that this is very under-researched, and that professionals can be dismissive of issues they don't understand, including this one. I experienced that myself with respect to SSRI withdrawal (although there were definitely clinicians who were ahead of the curve on that one, and knew, based on patient experiences, that the official line was bunk). I didn't orgasm until I was nearly 30 as a result of SS/SNRIs, so I understand that dimension of it as well. I had a friend in high school who had a different kind of sequela from a short-term treatment with an SSRI--electric shock sensations that came and went periodically, and lasted for many years. Another class of psych drug did significant harm to me, and some clinicians still act like it's not within the realm of possibility for the drug to actually do the opposite of what it says on the tin to some people. I also have worried for a long time that developmental trajectories of many kinds might be altered by psychiatric medications in childhood and adolescence, which is an issue researchers either have little interest is or have decided is too difficult to parse experimentally. In either case it's a dereliction of responsibility--what we don't know can hurt us, but if it's next to impossible to prove it won't hurt anybody's bottom line.
I am concerned about all these issues and express them where I think it appropriate. But I can be concerned about more than one thing at a time. It's still the case that PSSD is not nearly as prevalent as garden variety SSRI-induced sexual dysfunction. If it were, it could not possibly have been missed for this long. There would be veritable hordes of people with it. Regardless what the medical organizations say, individual practitioners would have noticed. Something like 1 in 8 people take an antidepressant presently, many more have taken them at some point in time (I didn't find data on lifetime prevalence but considering incidence is pushing 15% I'd wager it's in the neighborhood of neighborhood of 1 in 5), and the vast majority of those prescriptions are for SSRIs and SNRIs. PSSD cases would be more than two orders of magnitude larger than the estimate provided by the study Freya cites (which has a methodology that I think undercounts cases, but still, there would have been a much stronger signal in that data if it were anywhere near as common). Even if we don't have stellar data, when the difference is bound to be that significant, conflating the two likelihoods is more than a little misleading.
I truly think I understand where you are coming from. But many people benefit from treatment with SSRIs, and exaggeration of the risks, intentional or not, stands to harm them. In any case, I hope that more research is put into this issue, so that people can make more informed treatment choices, and so that people who have been harmed by SSRIs as you have can hopefully find relief from the damage that's been done.
Thank you so much for adding this balance to the discussion. I completely understand where people are coming from and these concerns are real. There should be better education for GPs and patients on these issues, without ignoring the fact that there are indeed "rotten apples" among psychiatrists. There should also be more research into the long-term effects of these drugs. Still, some statistics are misrepresented (not even saying this was intention) because they don't say what the author probably thinks they say. Other aspects are likely blown out of proportion. As usual with such discussions (see parallels to ADHD), there are still many people who would benefit from SSRIs but are not taking them or don't even have access to them.
You did it again: such an interesting, well researched, and powerfully written essay! 💥
Thank you so much!
True observation. This one was A+.
Yeah, this is probably partially a reason. On the other hand, I think we might also look at the fact that our society, in general, is veryyy over-sexualized. Even normal, everyday ads seem to have an element of “sexiness” to them. Social media is full of influencers urging girls to be provocative. And it seems like kids are dating younger and younger and getting into sexual situations they should not be in.
I’m not advocating for no sex ed, fyi… I just think we need to take a good look at what we as a society are showing young people about sexuality. This and the medications may very well be working in tandem, too. Who knows. But there’s a lot that needs to change.
I was on antidepressants for 4 years in college, and although there may have been unintended side effects regarding sexuality (I will have to give this more thought) I am also 100% sure without medication at that period I would have failed out of school and not had the courage to get regular counseling and make a lot of necessary life changes that allowed me to eventually get off the medication. It leveled the playing field so I wasn't starting from way back at the 1 yard line. I think doctors need to be more proactive talking with patients about this, but I hope your piece doesn't scare folks away from getting help if they need it. Suicide is a huge issue in America and in my mind is the one "side effect" of depression you can never rebound from...
My wife has been SSRI's for a few years now, and the effects have been really defeating. Sex drive has gone to zero, gained a huge amount of weight. Went from an energetic, lively, stressed out, overwhelmed woman full of anxiety and optimism and turned her into an asexual, lethargic, stressed out, apathetic, anxiety-ridden hoarder.
The worst part is the open-ended was of it all. This is a forever drug. You are on it for life. There's no point at which you are "cured" and can wean off.
Utterly pernicious. The people responsible for drugging entire generations of young women will have a lot to answer for in the next life.
'This is a forever drug. You are on it for life. There's no point at which you are "cured" and can wean off.'
Some doctors are of that opinion, but the good ones will help a patient discontinue and find other ways to manage anxiety/depression, if that's what the patient wants. It's tricky though because even well-intentioned doctors often don't understand how to taper SSRI doses slowly, and will interpret withdrawal symptoms as a depression relapse.
Some resources here: https://www.madinamerica.com/drugs-withdrawal-home/
Honest question, if it hasn't treated her stress but has sapped her vivacity, why is she still taking it?
I totally agree that too many young people (and people in general) are on SSRIs and similar medications. Many reasons why it's happening—financial incentives, cultural shifts in how we view human distress, etc—and it's a complicated issue. It is also true that sexual dysfunction of one sort or another while taking SSRIs is common and absolutely underappreciated by psychiatrists.
However, I think it is important to separate sexual dysfunction while taking SSRIs (a common and a well-known phenomenon, and one that has some remedies) with post-SSRIs sexual dysfunction. Mainly because PSSD is a relatively new and still poorly understood thing with some big unanswered questions, eg a plausible mechanism for that kind of effect. I've still never met someone who had really long-term post SSRI dysfunction that wasn't easily explainable by other glaring causes. The longest I've heard reliable reports of PSSD lasting is around one or two months at most (again, this is just the people I've seen and talked to). The point is that if it is real, it is thankfully rare.
Generally, though, I absolutely agree that we should be cautious about the side effects of these meds, especially when given to children, although I suspect the link between SSRIs and anything resembling permanent "chemical castration" is probably a stretch. Could be wrong, but that's my sense.
It's also interesting to think about the following scenario: let's say PSSD is rigorously established to be real, beyond a reasonable doubt. I could easily see large numbers of false positive PSSD cases from those who tend to glom onto the currently in vogue diagnosis, whether it is multiple personalities, anorexia, gender stuff, etc. The intersection of this side effect with culture (i.e. sex, and lack thereof) could easily make this a big cultural or even political issue.
Anyway, enjoyed you work as always. Seems I'm less concerned about widespread catastrophic consequences than you are perhaps, but I do agree it is a very big problem.
(Also, your reference to Sarafem reminded me of a fun game I played with a co-resident a while back. Create a fantasy novel narrative but everyones' name is a psych med. eg: We received instructions from the three Elvish princesses, Sarafem, Saphris, and Seroquel. We were to cross the plains of Nardil and head north until we reached the Zenzedi temple. There we would speak with the ancient Sorcerer Atarax, who could provide us with his “Abilify” spell, which would grant us increased strength and fortitude for the battles ahead. We would pass near the Geodon canyon, eventually reaching the port city of Pamelor, you get the idea)
'If it's real'? Did you know that in 2019 the EMA recognised that SSRIs cause 'enduring sexual side effects'? Do you think they got it wrong? What are the 'glaring causes' that you feel others are missing?
I don't think they got it wrong, but I think it is too early to say much with certainty because we don't understand the phenomenon well enough. Glaring causes include a combination of: using other medications that can cause sexual side effects, continued drug use, ongoing psychiatric problems, poor relationship quality, demoralization, lack of prospects, strong history of somatization, etc. The point is not that PSSD doesn't exist, but that we should be prudent and careful in investigating it, without jumping to conclusions prematurely.
And you think that genital numbness, the key symptom of PSSD, could be caused by the above? It's interesting to me that Drs seem to be so skeptical about PSSD, but I suppose psychiatrists always have the option of diagnosing a harmed patient with another disorder. I've seen psychiatrists on Twitter argue that a) they've never seen a case of PSSD, yet b) they know which psychological conditions the patient *really* might have wrong with them and that Drs who *think* they might be seeing PSSD cases are probably mistaken. A mainstream psychiatrist covers this situation really well here: https://www.psychiatrymargins.com/p/can-we-please-stop-bullshitting-patients In any case, we may soon have objective evidence of the harms caused by PSSD. In this interview, a radiologist discusses his research into PSSD, showing that young men with PSSD have penile fibrosis. I look forward to this paper being published. I wonder how psychiatrists will react to this research https://www.youtube.com/watch?v=TiJ94cqa9II&t=6s
I agree psychiatrists should not be unthinkingly dismissive about this issue: patient concerns are patient concerns, and we need to take them seriously. I think the biggest question mark is a plausible mechanism of action. But hey, biology is complicated and we may very well find something we didn't expect. It happens all the time. I'm mostly cautioning against prematurely endorsing the view without sufficient evidence. (re: genital numbness, I've never met a patient who has had prolonged post-SSRI desensitization or anything like that, so I would just be speculating on that point)
Good points tactfully argued, thanks.
I was on various antidepressants for years. Definitely an issue. And the insurance dictated doctors Blame The Patients!
It’s been well over ten years since I was on any & still rather numb.
Wow had no idea about this, asexual dating apps isn't that an oxymoron?
Online 'asexuals' make a distinction between romantic attraction and sexual attraction, and contend that both exist on a spectrum. There are people who want to be in a romantic relationship with cuddling and commitment and the like, but don't like the idea of sex at all, and then people who say they only experience sexual attraction with people they have a strong emotional bond to, etc.
"People who only experience sexual attraction with people they have a strong emotional bond to" are also known as "women".
It always boggles my mind that sex-positive feminists were so keen to champion "having sex like a man" that they ended up reinventing the wheel with "demisexuality", which they then treated as a rare and therefore cherished category rather than the default pattern of female sexual attraction.
There's an entire page on facebook called "They're Discovering Christian Morality" devoted to capturing moments when modernists propose great new ideas based on their bitter experience......that are really just the same moral codes that traditional religions have codified for millennia.
"If God did not exist it would be necessary to invent Him."
He is remarkably similar to the Austro-Hungarian empire in that regard.
I just want to advise anyone who reads this post and decides to come off their SSRI to //do so gradually//. Seriously, don't go cold turkey.
Personally, I've found a tricyclic far preferable for dealing with my OCD after many, many years of being on SSRI. But if you make a similar move, do so with medical supervision and not just overnight.
I continue to be appalled at the extent of the medication of children - and especially the number of young women on multiple long-term prescriptions, including the pill, anti-depressants, anti-anxiety medication and painkillers. Then there are the medications for ADHD etc. Parents and young people seem to be quite content with this - just grateful for an answer to a problem, without any curiosity about the roots of their distress or what they might be doing to themselves in the long run.
I think there is a cultural problem where women are often on the over-receiving end of medication; its partially because women are more trusting than men of the mental health system and more likely to reach out to a therapist and partially a continuation of a Victorian trend that tended to diagnose every emotionally angsty teenager with hysteria.
You are making a huge leap to say that people take mood altering medications with no deep thought. It is a huge decision taken very seriously.
I am sure there are some who give it deep thought - there are also many who don't, who are only too pleased to be offered a pill to pop. I was referring to the latter in my comment. I have frequently heard teenagers discussing relative doses, with those on the highest doses having the most kudos in school. This concerns me very much.
When I read this , I remembered an episode on House more than 10 years ago about an asexual couple. Back then it was still possible to say that there may be a medical cause. Of course I had to google it now and boy oh boy. The asexual community is not happy about that episode.
If you're watching House and thinking to yourself that Dr House is a good role model whose behaviour and beliefs you should emulate, you're doing it wrong.
I am not emulating his behavior and beliefs, I also don't use it to diagnose myself or those around me, it's just a show I watched a while ago for entertainment. I was just commenting on the way some people reacted to it with "House" let asexual community down and such. Also, it is quite telling that an episode like that would most likely not be aired nowadays.
I was always curious as to why so many of my peers identified as "ace." Being a late bloomer couldn't be the explanation for ALL of them. Many of us didn't watch porn, oddly enough. But given that depression was so rampant among us, I wouldn't be surprised if they were on medication.
If it was a whole peer group, social contagion is also a plausible explanation. Kids at that age are desperate to conform.