Post-SSRI sexual dysfunction (PSSD)

Post-SSRI sexual dysfunction (PSSD) is a condition caused by SSRI and SNRI antidepressants. It can start during treatment or only after stopping, and can affect sexual function, emotions, cognition and the senses. Its defining sign is a lasting change in genital feeling.

SSRIs (selective serotonin reuptake inhibitors) are the most widely used type of antidepressant, the NHS says. SNRIs (serotonin and noradrenaline reuptake inhibitors) work in a similar way. Both help many people.

Sexual side effects during treatment are common and usually lift after stopping. PSSD is different: a lasting condition that can also begin after stopping.

PSSD is one of three related conditions, with PFS (after finasteride) and PAS (after isotretinoin). The 2022 criteria cover all three.

The 2022 diagnostic criteria

There is no blood test or scan for PSSD. In 2022, 37 doctors and researchers from ten countries agreed diagnostic criteria for it.

• Required: you took a medicine that blocks serotonin reuptake, such as an SSRI or SNRI.
• Required: the feeling in your genitals changed, and stayed changed after you stopped. Touch may feel numb, or register but no longer feel sexual.
• Supporting: lasting loss of sexual desire, erection problems, orgasms that are absent or give less pleasure, and problems that have lasted 3 months or more.
• Ruled out: the same problems before the drug, or another illness, medicine or substance that explains them.

Three months after stopping, the authors’ consensus is that “it is more likely to be PSSD”. A current mental health diagnosis does not rule it out.

The criteria are an expert consensus, not official guidance. They were built from cases reported to RxISK.org, a drug safety website linked to three of the authors. More in PSSD diagnosis criteria.

Names and codes

The medicines involved

In 2019 the European Medicines Agency asked for a warning on ten medicines: six SSRIs and four SNRIs.

Being on this list does not mean a medicine will do this to you. Do not stop or change a medicine without your prescriber. More in which antidepressants are linked to PSSD.

The symptom list comes from the 2022 criteria. Only the change in genital feeling is required. Symptoms can start on the medicine or only after it is stopped.

The criteria require it because these changes “seem distinctive to PSSD” and can be “hidden beneath” low desire. Any change not fully back to normal counts.

Emotional and genital numbing “commonly go together”, the criteria note. More on emotional blunting, genital numbness after antidepressants and PSSD in women.

PSSD has been reported in men and women, from teenagers to people in their sixties, after short and long courses.

Nobody knows how often PSSD happens. Its incidence “is unknown”, the criteria’s authors write, and a 2023 systematic review of 19 studies and case reports could not find a reliable estimate.

Reported is not the same as measured

Reports to the Yellow Card scheme, the FDA or RxISK show that something happens. They cannot show how often, because most reactions are never reported. The MHRA has published the estimate that “only 10% of serious reactions” are reported.

Why there is no rate

Healy and Mangin, two of the criteria’s authors, gave these reasons in 2024:

• A trial designed to find PSSD would be unethical.
• Common questionnaires skip genital sensation, and company studies rarely follow people after stopping.
• People rarely mention it unless asked, and the link is rarely recorded.

The two studies that tried

Neither study gives a rate for all antidepressant users. In our view, a long study asking about genital feeling, emotions and cognition before, during and after treatment would close the gap.

UK and EU regulators have added a warning to SSRI and SNRI labels, and one US label carries it. None has issued clinical guidance on recognising PSSD.

A label warning is not the same as clinical guidance. In England, NICE’s depression guideline lists “long-term effects on sexual function” as a risk of long-term use. It does not mention problems that continue after stopping.

In our view, this leaves a gap: the label warns of PSSD, but no official body tells doctors how to recognise it. More in what the MHRA, EMA and FDA say about PSSD.

Research on PSSD is small. Most of it describes cases, very little follows people over time, and we found no controlled trial of a treatment.

Nobody knows why it lasts, and no explanation has been confirmed in people. Proposals include lasting changes in how genes are switched on and off (epigenetic change) and in neurosteroids, steroids made in the brain and nerves.

There is no test for PSSD. A doctor diagnoses it from your history, using the 2022 criteria. Those criteria are not official guidance, and your doctor may not have come across them.

Some clinics can test touch in the penis, but for sexual feeling “there are no available tests”, the criteria note. Normal blood results do not rule PSSD out. They help rule out other causes.

Ruling out other causes

Depression itself can affect sex. A 2012 review of six studies found it raised the risk of sexual problems by about 50 to 70%. That is a relative figure: the review gives no starting rate.

Withdrawal is told apart by time. The UK escitalopram label says withdrawal symptoms usually clear within two weeks. In some people they “may be prolonged (2-3 months or more)”.

Numbness is different. “No mental health disorder causes anaesthesia of the genitals,” Healy and Mangin write. Borderline hormone levels are sometimes found in PSSD, but the criteria say they “may be a consequence of the conditions rather than a cause”.

What to bring to your doctor

• A printed copy of the 2022 criteria, which are free to read.
• The medicine, the dose and roughly when you took it.
• When the changes began, and whether that was on the drug or after stopping.
• What changed: in genital feeling, emotions, cognition or the senses.
• What things were like before you took it.
• Other medicines, past and present, especially finasteride or isotretinoin.

Ask for it to be recorded in your notes. NHS records have had a code for it since October 2024. If you are still on the medicine, the criteria say “a provisional diagnosis might be warranted”. You do not need to stop it to be assessed.

How PSSD is diagnosed covers each step in more detail.

There is no approved treatment for PSSD. Attempts described in research have “yet to lead to any established treatments”, Healy and Mangin wrote in 2024.

In September 2026 we found no treatment trial for it registered on ClinicalTrials.gov. Research is still at the laboratory stage. The Milano Project, which SIDEfxHUB raises money for, is studying what SSRIs change in the brain and nerves.

Is PSSD permanent?

It can be. PSSD “can remain for months, years or indefinitely”, the criteria’s authors write, and some reports describe more than 20 years. David Healy has written that some people recover to a degree over several years. How many recover fully “has never been properly investigated”.

Is full recovery from PSSD possible? and do SSRI sexual side effects ever go away? look at recovery in more detail.

How to judge a treatment offer

You may come across treatments offered online or in private clinics. We do not recommend any. These questions help you and your doctor weigh an offer:

• Has it been tested in a controlled trial in people with PSSD, and where was that published?
• What are its risks, and is it licensed for this use?
• Does it promise recovery? No one can honestly promise that.
• Would it mean stopping or changing another medicine?
• What does it cost, and who is selling it?

If you try something, tell your doctor. You can report side effects of the treatment itself, too.

SIDEfxHUB is a UK patient charity (registered charity 1203385) for people living with PFS, PSSD and PAS. We fund research, push for these conditions to be recognised, and support patients.

• The community. Our community follows people over months and years. Its members chose to join, so it cannot say how common PSSD is. It can show how symptoms change over time, which research has hardly looked at.
• Research. We raise money for the Milano Project at the University of Milan, which studies what finasteride and SSRIs change in the body. It is led by Professor Roberto Melcangi.

Every source below was checked on 26 September 2026.