Which antidepressants are linked to PSSD?
Can antidepressants outside the SSRI and SNRI groups cause PSSD? How common it is, and what nobody knows yet.
Looking for the antidepressant that did it, or the one that won’t? Ten SSRIs and SNRIs, including sertraline, citalopram, fluoxetine and venlafaxine, carry the same UK leaflet warning. Sexual problems can continue after you stop taking them.
That lasting condition is called post-SSRI sexual dysfunction (PSSD). The leaflets don’t single any of them out, and the line is the same whichever one you were given.
Cael was a healthy, sociable teenager when he was prescribed antidepressants for mild anxiety. For years he was moved from one drug to the next: Lexapro, Effexor, Zoloft, Pristiq, Seroquel and Cymbalta. He now lives with PSSD, Moral Medicine says, and nobody explained the risks to him.
Five of the six medicines Cael took are on the warning list below. The sixth, Seroquel, is an antipsychotic. If you’ve taken several, like him, you may never know which one to name. You don’t have to: one report to the medicines regulator can list them all.
So which ten carry the warning, and how common is PSSD?
Which antidepressants carry the PSSD warning?
Ten medicines carry it: six SSRIs and four SNRIs. The EU medicines regulator named all ten in its 2019 recommendation, and asked for the same words in each leaflet.
- SSRIs
- Sertraline (Lustral, Zoloft) · Citalopram (Cipramil, Celexa) · Escitalopram (Cipralex, Lexapro) · Fluoxetine (Prozac) · Paroxetine (Seroxat, Paxil) · Fluvoxamine (Faverin, Luvox)
- SNRIs
- Venlafaxine (Efexor, Effexor) · Duloxetine (Cymbalta, Yentreve) · Desvenlafaxine (Pristiq) · Milnacipran
The UK sertraline leaflet says sexual problems can happen, and “in some cases, these symptoms have continued after stopping treatment” (Lustral leaflet). The leaflet for venlafaxine uses exactly the same words. The name says SSRI, but SNRIs like venlafaxine carry the warning too.
The BBC film below is general context on antidepressant side effects in young people, worth watching if you want to hear how others raised them.
Can other antidepressants cause PSSD?
Some can, say the researchers who wrote the 2022 diagnostic criteria for PSSD. They write that it can follow any medicine that blocks the reuptake of serotonin, as SSRIs do. That includes some older antidepressants called tricyclics.
PSSD is more than sexual problems. The 2022 diagnostic criteria describe genitals that can feel “like they were exposed to an anesthetic”, often with emotional numbing, problems with cognition and changes in other senses.
The same paper mentions reports of something similar after mirtazapine. It says there isn’t enough data yet to know whether that’s the same condition.
The regulator’s 2019 review also looked at vortioxetine and clomipramine, a tricyclic. It didn’t ask for the warning on either, and the document doesn’t say why.
How common is PSSD?
Nobody has measured how often it happens after any of these medicines. Estimates run from fewer than 1 in 100 to about half, says a 2024 paper. The low figure came from health records and counted only men. The high one came from a small survey of former users, found through adverts and flyers.
The paper’s authors explain why there’s no real number. A trial set up to measure it would be unethical, because it could harm the people taking part. Doctors don’t routinely ask whether sexual side effects have gone after someone stops. And embarrassment can stop people raising it.
Dr Josef Witt-Doerring is a psychiatrist. Watch his film for a doctor’s plain explanation of what PSSD is, and why, in his view, so few patients are warned about it. It’s background, not evidence for the numbers above.
What can I do?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly.
If something has changed, write it down before your appointment. List every medicine, with doses and dates: “Sertraline 50 mg from January 2023, last tablet March 2024.” Bring the leaflet line too.
Questions to take to your GP
You could open with: "My leaflet says sexual problems can continue after stopping. I think that's happened to me."
- Could anything else explain these changes?
- Can you record that symptoms continued after I stopped?
- Will you report it, or should I do it myself?
Many people say it took time to be taken seriously. Bring the leaflet line. You can report it without a doctor agreeing.
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.
- Use the right words. If symptoms continued after stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208). It’s the right term after an SNRI too.
Our reporting guide walks you through it
If you’re struggling with your mental health, Samaritans are free on 116 123, at any hour.
What else do people ask?
Is one antidepressant more likely to cause PSSD? The leaflets don’t say so. The 2019 recommendation gave all ten the same words, and nobody has measured how often PSSD follows any of them. So nobody can rank them. The choice of medicine belongs with you and your prescriber.
Can PSSD start after stopping? Yes. The 2022 criteria say PSSD sometimes only appears once the medicine is stopped, usually within a couple of weeks. To fit the criteria, the problems have to last at least three months after the last dose.
Is it only antidepressants? No. The same criteria cover any medicine that blocks serotonin reuptake, including the painkiller tramadol. The paper also describes related conditions after finasteride, used for hair loss, and isotretinoin, used for acne. Patients know them as post-finasteride syndrome and post-Accutane syndrome.
Cael was moved through six medicines. If your story looks like his, write every one down with its dates, and put them all in one report.
Sources
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee (PRAC). PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting. EMA/PRAC/265212/2019, section 1.3 (SNRIs and SSRIs: persistent sexual dysfunction after drug withdrawal), adopted 16 May 2019. Names citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline (SSRIs) and desvenlafaxine, duloxetine, milnacipran and venlafaxine (SNRIs). Footnote 6: clomipramine and vortioxetine were part of the assessment but not included in the change.
- Viatris Products Limited. Lustral (sertraline) package leaflet, section 2, “Sexual problems”. Last revised December 2025. Electronic medicines compendium.
- Viatris Products Limited. Efexor XL (venlafaxine) package leaflet, section 2, “Sexual problems”. Last revised October 2025. Electronic medicines compendium.
- Healy D, Mangin D. Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiol Psychiatr Sci 2024;33:e40 (an editorial). The estimates it discusses run from 0.46% (Ben-Sheetrit and colleagues, 2023: a 19-year review of health records that excluded women) to 52.6% (Lüning, 2019: a survey of 76 former antidepressant users recruited through online adverts and flyers).
- 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.
- Videos: Moral Medicine, Cael’s story (18 August 2025); BBC News, Antidepressants: should we talk about side-effects? (11 August 2023); Dr Josef Witt-Doerring, The #1 worst side effect from antidepressants (19 August 2026).
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