The PSSD crash: what to expect and what helps
Is it withdrawal or PSSD, and how long will it last? What a crash can feel like, ways through the first weeks, and what to tell your GP.
Did sex, feelings or cognition get worse after you stopped or cut down an antidepressant? You are not imagining it. When post-SSRI sexual dysfunction (PSSD) symptoms appear or worsen like this, it is called the “crash”.
It can last after stopping, and nobody can yet say for how long. Criteria proposed in 2022 describe exactly this pattern. The problem “may only appear when the drug is stopped”, or a mild one “may worsen on stopping”.
The UK leaflet for Cipralex (escitalopram) says sexual problems have, in some cases, “continued after stopping treatment”.
So what does a crash feel like, and what helps in the first weeks?
What does a PSSD crash feel like?
PSSD is much more than a sex problem, even though the name says so. Its core is a lasting change in genital sensation, often numbness. The 2022 criteria also list emotional numbing, feeling detached from yourself, and problems with cognition.
People describe it in plain words:
- Touch feels numb, or orgasm comes with little or no pleasure.
- Desire drops away, sometimes almost overnight.
- Feelings go flat. Music, friends and good news don’t land the way they did.
- Concentration slips. Reading, remembering and finding words get harder.
- Sleep breaks up, which makes everything else heavier.
Not everyone has all of these, and the mix can change from week to week.
Is it withdrawal or PSSD, and how long will it last?
At first it can be hard to tell, and that’s normal. The NHS says withdrawal symptoms “usually begin within a few days” of coming off antidepressants “and last for a few weeks”. It adds that they “can be severe for some people, start weeks or months later, and last for months or longer”.
Withdrawal often brings dizziness, “brain zaps”, sweating and headaches. PSSD centres on changes in genital sensation, emotions and cognition that stay.
The 2022 criteria say that once problems last three months after stopping, PSSD is more likely. You don’t need to wait three months to see your GP or to report it.
Nobody has measured how long a crash lasts, or how often it eases. The 2022 criteria say these conditions “can remain for months, years or indefinitely” after stopping, and set no upper limit.
That is hard to read. Some people do report improvement. Our article on whether full recovery from PSSD is possible looks at what people report.
Watch: a psychiatrist on PSSD
If you’re new to this and want to hear a doctor take it seriously, start here. Professor Joanna Moncrieff, a psychiatrist at UCL, talks about PSSD and how aware doctors are of it. It’s general background, not evidence about crashes.
How can I get through the first weeks?
Start with the basics that make bad weeks lighter. None of these treat PSSD, but people say they help them cope.
- Protect your sleep. A calm routine, earplugs or quiet sounds can help. Our guide to sleep after a PSSD crash has more.
- Tell one person. A friend or relative who just listens can take some of the weight. You don’t have to explain everything.
- Keep a short diary. Note what changed and when. It helps your GP, and it helps you see change over time.
- Talk to people who’ve been there. Our WhatsApp peer support groups connect you with others who know what a crash is like.
If you feel you can’t go on, call Samaritans on 116 123, any time, for free.
What should I tell my GP?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly, and if you’re still cutting down, ask about doing it slowly.
Bring a short record:
- Your medicine: “Sertraline 50 mg from January 2023, last tablet March 2024.”
- What changed: “Touch feels numb”, “I can’t feel pleasure”, “my thinking is slow”.
- When it started: while taking it, while cutting down, or after stopping.
- How things were before: “No problems before 2023.”
Three questions for your GP
- Could this be withdrawal, PSSD or something else, and how will we tell?
- What can we check to rule out other causes?
- When should I come back if nothing changes?
You could start with: "Since I stopped my antidepressant, things have changed and they haven't come back. The leaflet says this can happen."
Many people say it took time to be taken seriously. Bring the leaflet line. You can report it without a doctor agreeing.
Rosie, president of the PSSD Network, talks about her own PSSD in her interview on our site. In this extract she describes what it’s like to live with it.
Report it: it helps everyone
A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US. Our Yellow Card guide for PSSD shows each step.
- Use the right words. If symptoms continued after stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208).
Our reporting guide walks you through it
What else do people ask?
Can a crash happen weeks after the last tablet? Yes, it can. The 2022 criteria say “a delay can sometimes occur” between the last dose and the start of the problem. Write down the date of your last tablet and when you first noticed changes. That timeline matters to your GP and to your report.
Can PSSD start without any sexual symptoms first? For many people the first thing they notice is emotional flatness or cognitive problems. The criteria list these alongside the genital changes. Tell your GP about all of them, not only the sexual ones, because together they make the pattern clearer.
Should I go back on the medicine? That’s a decision for you and your prescriber. Nobody has shown that restarting reverses PSSD. Talk it through with your doctor before you change anything, and don’t stop or start suddenly.
If today is a bad day, pick one thing: write your timeline, or message our community. Our PSSD page is there when you want the bigger picture.
Sources
- Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed criteria developed through expert agreement. Section 3: “An enduring change in somatic (tactile) or erogenous (sexual) genital sensation after treatment stops”; ancillary non-sexual symptoms “emotional numbing”, “depersonalization”, “cognitive impairment”. Onset: “an enduring sexual dysfunction may only appear when the drug is stopped”, “a mild dysfunction on treatment may worsen on stopping”, “a delay can sometimes occur between the last dose of the drug and the onset of dysfunction”. On duration: “can remain for months, years or indefinitely”; “once dysfunction lasts for three months, it is more likely to be PSSD”; no upper limit is set on duration.
- Lundbeck Limited. Cipralex (escitalopram) patient information leaflet, electronic Medicines Compendium. Section 2: “In some cases, these symptoms have continued after stopping treatment.” Section 3: the dose “is gradually reduced over a number of weeks”.
- NHS. Antidepressants: withdrawal symptoms “usually begin within a few days of starting to come off antidepressants and last for a few weeks”; “They can be severe for some people, start weeks or months later, and last for months or longer.”
- GOV.UK. Report a problem with a medicine or medical device.
- PSSD Network, Professor Joanna Moncrieff discusses Post-SSRI Sexual Dysfunction, June 2026. General context, not evidence about crashes.
- Moral Medicine, Interview with PSSD Network President Rosie, 9 July 2024.
Sources checked on 22 October 2026. AI-assisted writing and review, not clinical review.
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