The 2018 review of post-SSRI sexual dysfunction: prevalence unknown, diagnosis by exclusion, no definitive treatment
The review lists the core symptoms (genital anaesthesia, weak or pleasureless orgasm, low drive, erectile dysfunction), seven proposed mechanisms none of which is established, and the treatments tried. Mostly a list of what is not known.
Weak or heavily disputed. Treat as a question, not an answer. how we score evidence
Caveat on this rating: A narrative review that does not grade or count its sources. Seven proposed mechanisms and none established. The phototherapy 'promising results' rest on evidence the abstract does not describe. The review's purpose is partly to raise recognition, which is stated.
The state of knowledge on PSSD, summarised by urologists, and it is short.
Significant findings
Bala, Nguyen and Hellstrom define the condition: "Post-SSRI sexual dysfunction (PSSD) is a condition in which patients continue to have sexual side effects after discontinuation of SSRI use." Their first substantive sentence is the one that matters most: "The prevalence of persistent sexual side effects after discontinuing SSRIs is unknown."
The symptoms: "Common PSSD symptoms include genital anesthesia, pleasure-less or weak orgasm, decreased sex drive, erectile dysfunction, and premature ejaculation."
The proposed mechanisms, listed without a verdict: "epigenetic gene expression theory, cytochrome actions, dopamine-serotonin interactions, proopiomelanocortin and melanocortin effects, serotonin neurotoxicity, downregulation of 5-hydroxytryptamine receptor 1A, and hormonal changes in the central and peripheral nervous systems."
Diagnosis: "achieved by excluding all other etiologies of sexual dysfunction."
Treatment: "Treating PSSD is challenging, and many strategies have been suggested and tried, including serotonergic antagonists and dopaminergic agonists. There is still no definitive treatment for PSSD. Low-power laser irradiation and phototherapy have shown some promising results."
The other direction
This is a narrative review, not a systematic one, so it does not grade the studies it draws on or say how many there are. Seven mechanisms with none established is a way of saying the mechanism is unknown. The "promising" phototherapy line rests on evidence the abstract does not describe, and a reader has no way to weigh it. The review's stated aim is to raise recognition of "this underreported and distressing condition," which is an advocacy purpose as well as a scientific one, and both are legitimate to name.
What this does not show
No rate, no mechanism, no treatment: the review says each of those in its own words. It does not say the condition is common, and it does not say anyone should stop or avoid an SSRI. Its usefulness is the honesty of its gaps, which is what a person should carry into a conversation with a prescriber.
Worth asking
How would you rule out the other causes of sexual dysfunction before calling something PSSD?
Source
Post-SSRI Sexual Dysfunction: A Literature Review — Bala A, Nguyen HMT, Hellstrom WJG (2018)
Indexed peer-reviewed journal
Read the source: https://doi.org/10.1016/j.sxmr.2017.07.002
DOI: 10.1016/j.sxmr.2017.07.002
How this was scored
- Study design
- Narrative review
- Funding
- Funding not disclosed
- Published in
- Indexed peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 29, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "contested". Weak or heavily disputed. Treat as a question, not an answer. It scores 29 out of 100 on our published rubric. One caveat travels with that badge: A narrative review that does not grade or count its sources. Seven proposed mechanisms and none established. The phototherapy 'promising results' rest on evidence the abstract does not describe. The review's purpose is partly to raise recognition, which is stated. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Post-SSRI Sexual Dysfunction: A Literature Review — Bala A, Nguyen HMT, Hellstrom WJG (2018). Published in: Indexed peer-reviewed journal. DOI: 10.1016/j.sxmr.2017.07.002. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Narrative review. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.