13 May 2020
Statement from Alan Cassels on Sexual Dysfunction caused by Antidepressants
Alan Cassels has studied pharmaceutical policy for 26 years in a career spanning a range of roles, both in research (as principal investigator, project director, and analyst for dozens of provincial and national drug policy research programs) and medical journalism (contributing stories to CBC radio’s IDEAS program, Reader’s Digest, the Canadian Medical Association Journal and others). He has authored four books and has lectured on evidence-based health and drug information to actuarial science, journalism, law, medical, nursing, pharmacy, and political science programs in Canada, Australia, France and the United States. He is currently employed at UBC’s Therapeutics Initiative but the opinions expressed below are his own and he is not speaking on behalf of the Therapeutics Initiative.
Purpose of this document
This statement asserts what I believe are indisputable facts about SSRI and SNRI antidepressants and a condition known as PSSD (Post- SSRI Sexual Dysfunction). This condition can be extremely debilitating for some, is mostly unrecognized by prescribers, and is sometimes irreversible. Those who suffer PSSD may never regain their normal sexual function, arousal or orgasm even after stopping their antidepressant. Accumulating research and experience over the past 20 years, clearly show a pattern that SSRIs and SNRIs disrupt sexual function, even sometimes in those who have only a brief exposure to the drug. The professional product labelling for SSRIs and SNRIs is inadequate and fails to inform prescribers and potential patients that PSSD can be life-altering, damaging to intimate relationships and the cause of immense stress in the lives of ordinary people.
I am writing because I have met and interviewed people who believe they are suffering from PSSD, and have digested the growing body of literature on the topic. I believe a great harm is being caused in the general population, specifically those who are sexually damaged by widely-prescribed antidepressants and that many patients are never apprised of this potential adverse effect when they start on an antidepressant. Physicians are not warning patients, nor are regulators warning physicians. Recently recognized as a syndrome in Europe, regulators in the US and Canada have yet to acknowledge that PSSD is real. I prepared this document in the hope that this will change, and before starting an antidepressant, citizens will be fully informed of the potential life-altering dangers of PSSD and other harms related to SSRI/ SNRI antidepressants.
1. Rates of SSRI and SNRI use: According to the American Psychological Association almost 13% of the US population over the age of 12 take antidepressants. The numbers are higher for women (16.5% vs 8.6% for men) and the use of these drugs have grown by 64% between 1999 and 2014. An OECD study from 2017 reported that Canada has the sixth highest prescribing of antidepressants among the world’s 30 most developed countries. A conservative estimate is that one in ten people, still in their sexually active years, are taking antidepressants. One study on Canadian youth found that between 2012 and 2016 the rate of antidepressant prescribing grew by 36%, mostly attributed to new diagnoses of anxiety and depressive disorders. It is important to note that Health Canada does not authorize the prescribing of antidepressants to people under 18 years old because the drugs are ineffective in young people and increase the risk of suicide.
2. Petition on PSSD: Psychiatrist Dr. David Healy, probably the world’s authority on PSSD and one of the few researchers who has collected and analyzed reports of PSSD (see RXisk.org) published a petition with more than 20 peer-reviewed experts on PSSD in the International Journal of Risk and Safety in Medicine. This April 23, 2018 petition to the US FDA had one simple request: please mandate the use of proper warnings of the dangers of all selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) products and their links to PSSD. In particular they asked the regulators to “inform that the use of and withdrawal from SSRIs and SNRIs can result in genital anesthesia, pleasureless or weak orgasm, delayed or absent orgasm, loss of libido, erectile dysfunction, decreased vaginal lubrication, reduced nipple sensitivity, flaccid glans penis during erection, reduced response to sexual stimuli, and decreased capacity to experience sexual pleasure.”
3. Research on PSSD: Case reports, human and animal studies, as well as post-market reports dating back at least to the 1960s confirm a link between sexual dysfunction and antidepressants. A January 2020 report by Dr. Healy traces the modern history of sexual dysfunction linked to antidepressants.
4. Regulators weigh in: On June 11, the European Medicines Agency formally declared that it was recognizing Post-SSRI Sexual Dysfunction (PSSD) as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants. This generated a range of media attention (found here) but raised little attention in North America.
5. Personal stories of PSSD sufferers: I have personally interviewed two PSSD sufferers on Vancouver Island, a woman in her 20’s and a man in his early 30’s who assert that they are suffering from PSSD related to their antidepressants. Their stories are harrowing, and moving—two young people who have basically lost their sexual interest and desire likely due to damaging effects of SSRIs. They had met in a growing online community of people discussing their experiences with PSSD. Both are part of a larger movement trying to bring public attention to the sexual damage that can come with consuming these drugs. The story of this 23-year old woman who, eyes brimming with tears as she explains how she has been damaged was heartfelt and incredibly moving. Having to face fears that she may never find love, romance, or ultimately happiness because of the absolute deadening of her sexual self, is heartbreaking. Yet I believe the stories of her and others are not unique, and is backed by the research and reports from physicians like David Healy that are accumulating on PSSD.
6. Raising awareness: The facts indisputably show that SSRI and SNRI antidepressants often cause sexual dysfunction in both men and women. I believe that for the sake of prescribers and patients our regulators need to act immediately to implement an effective warning system that can reduce the potentially catastrophic impact on the sexual lives of our citizens which arrives in the form of a prescription.
Respectfully,
Alan K. E. Cassels
423 Stannard Avenue
Victoria, BC. V8S 3M6
Cassels@uvic.ca