The pathophysiology of Post SSRI Sexual Dysfunction – Lessons from a case study

Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly underst...

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Bibliographic Details
Published in:	Biomedicine & pharmacotherapy Vol. 161; p. 114166
Main Authors:	Klaas, Samantha, Siva, Jessica Barbut, Bak, Maarten, Govers, Mark, Schreiber, Rudy
Format:	Journal Article
Language:	English
Published:	France Elsevier Masson SAS 01-05-2023 Elsevier
Subjects:	Antidepressants Antidepressive Agents - therapeutic use Erectile dysfunction Erectile Dysfunction - drug therapy Genital anaesthesia Humans Male Middle Aged Post-SSRI sexual dysfunction (PSSD) Selective serotonin reuptake inhibitors (SSRIs) Selective Serotonin Reuptake Inhibitors - adverse effects Serotonin and Noradrenaline Reuptake Inhibitors - adverse effects Sexual Dysfunction, Physiological - chemically induced Sexual Dysfunction, Physiological - drug therapy Selective serotonin reuptake inhibitors (SSRIs) Erectile dysfunction Post-SSRI sexual dysfunction (PSSD) Antidepressants Genital anaesthesia
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Summary:	Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated. Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options. We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient’s symptoms. The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, ‘brain zaps’, overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems. The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic – and possibly noradrenergic – mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes. [Display omitted] •A post-SSRI-sexual dysfunction case study taking a design-thinking approach.•A narrative literature review of the pathophysiology guided by the case study.•Serotonergic, noradrenergic, neurosteroid and oxytocin systems are involved.•Potential use of pharma- and nutraceutical agents, however none are FDA approved.•Complexity of case and pathophysiology emphasizes need for personalized medicine.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Review-3 content type line 23 ObjectType-Feature-5 ObjectType-Article-4 ObjectType-Report-1
ISSN:	0753-3322 1950-6007
DOI:	10.1016/j.biopha.2022.114166