Mild NSFW warning: this post mentions sexual side effects of medication.
SSRIs are the most common type of antidepressant (examples are Prozac/fluoxetine, Zoloft/sertraline, Paxil/paroxetine).
If you have experience with them, do you think they’re a good idea?
I came across a paper about side effects which I haven’t heard discussed before. Many people know that SSRIs have sexual effects, but apparently they also affect fertility.
This paper describes SSRIs as “gonadotoxic”, leading to effects like “decreased sperm concentration and motility, increased [DNA] fragmentation, and decreased reproductive organ weights”.
The paper does say “this effect does seem to be reversible”, so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
I would be interested to hear others’ thoughts, if you have any.
Edit: Thanks for the replies to this post, they’re interesting.
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I have battled chronic clinical depression since 1989 and it is possible that I have been prescribed every SSRI ever at one point or another. Two have had pronounced sexual side effects but I cannot remember which did what any more, so I’ll forgo names altogether.
The first, and most disturbing of all, gave me instant erectile dysfunction. I was in my thirties when I started the pill. After a few days my penis was dead to the world. What is sad is that it was really working on my depression and anxiety without the dreaded twitching. ED in my thirties was a non-starter (no pun intended).
The second one I took for years and was in fact the last SSRI I took before I took myself off them entirely and started doing my own thing. On this pill I sort of had the opposite problem, but still a big problem. I could not only get an erection, I could effortlessly maintain it at full strength indefinitely. Well, hours for sure, and if I wanted it back, it was back. The negative side effect was a near complete inability to ejaculate. I could have passionate sex for hours at peak performance, but I could very rarely reach the finish line. As far as clinical effectiveness, the pill was adequate but not great. The combination of only slightly dulled symptoms, sexual trauma, and a virtually unlimited capacity to perform can lead to some very unhealthy behaviors.
Just be mindful, listen to yourself, and make sure that what you are doing works best for you. Good luck.
PS: During the time I was on the last pill I also suffered from acute and chronic insomnia. At my worst I was getting 90 minutes of light sleep in a 24 hour period. I do not mention it as a side effect of the SSRI because I think that was caused by a combination of factors. The pills could have been one of the factors though. I am not sure.
Please don’t ask random, uninformed people on the internet about your medical treatment plan. Talk to an actual psychiatrist about your concerns.
Yeah that makes sense. But I like hearing from people in my position, who take the meds, rather than just dish them out.
In my experience doctors can be dismissive of your concerns, perhaps because they’re busy and overworked.
A major factor with antidepressants, even with ones in the same class of drugs, is that different people respond differently to different drugs. You really need to work closely with a prescribing doctor until you find what’s right for you, which is often a lengthy process. I literally can’t think of a worse place to rely on anecdotal evidence.
I have been on SSRIs for 20 years. For me they’re a good idea, but I’ve known others who have had a terrible time with them.
Sexual dysfunction is definitely a thing: how much of an issue that will be is going to be a personal decision on weighing up pros and cons. If your sex drive is low as a part of your depressive symptoms or you’re already experiencing anhedonia (inability to feel happiness/pleasure) or anorgasmia (inability to achieve orgasm) then going on SSRIs isn’t going to make that any worse. But for others the risk of missing sexual pleasure might be an unacceptable trade-off.
For anyone starting SSRIs I think it’s best to go slowly and keep in touch with your primary doctor throughout the process. There are a number of SSRIs available, and if one doesn’t work out you can try others, and hopefully land on one that works for you.
With all that said, SSRIs don’t work for everyone. It’s not unusual to feel weird or like things are getting worse when you first start them: it takes some time for the effects to settle. But if you’re having a really bad time on them, speak to your doctor about alternatives.
Thanks for this reply. To be honest I’m not so worried about the well-known sexual side effects. Instead I worry about fertility effects. The paper I mentioned in the OP says that fertility should return to normal when you come off SSRIs, so I guess that’s good. But then I came across an article mentioning a study on rats, where they apparently found impaired fertility “which persisted after the drug was stopped”.
I bet most local doctors don’t even know of these effects. They’ll know about erectile dysfunction etc, but this is something different to that.
Maybe I’m worrying too much, I don’t know. I wonder if anybody on this site has heard of these effects before.
I don’t know anything about its effect on fertility. I know people who have conceived while on SSRIs, but that’s purely anecdotal.
It’s going to be a judgement call on your part. SSRIs have been in use for long enough that I would expect there’s a big pool of data around fertility rates, even if it’s not had much analysis done on it. Also, rat models are useful but need to be understood in their context. One study in rats is not overwhelming evidence.
Coupled with an excellent therapist, literally saved my life when I was struggling with depression. And my fertility has not been too hampered, if you know what I mean. It can surely have bad side effects for some people, but for others it is life-changing.
According to the book “Anatomy of an Epidemic” SSRIs (antidepressants) improve patient symptoms slightly in the short term compared to those who are not medicated. However, in the long term:
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They do not solve the problem of anxiety/depression at the symptomatic level.
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They hinder the patient’s recovery and turn them into a chronic depressive or anxious individual.
In my experience, since I started taking SSRIs, I have been having more panic attacks, even though initially, about 5 years ago, they seemed to improve my symptoms of social anxiety and sadness.
Check this out: https://robertwhitakerbooks.com/anatomy-of-an-epidemic/antidepressantsdepression/
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though it only coincidentally related SSRIs fucked me up in a different way (which still affected my libido tbf). i didn’t even get to a month of treatment before i decided to quit - they were supposed to help with my anxiety, but instead of helping they made it significantly worse, to the point where i felt as if i was spending my time edging a panic attack at all times of the day. At first i thought i was just getting worse normally, but then i noticed i felt better in the evenings (i was taking them in the mornings). i just couldn’t keep going it was awful
there’s plenty of people for whom SSRIs are life changers, but sadly i’m not in that group
If you are bipolar and unmedicated for it, they will make it worse by increasing instability
nah it was just general light anxiety, and strong situational anxiety. both stemming semi-directly from adhd
