Post-Selective Serotonin Reuptake Inhibitor Sexual Dysfunctions(PSSD): Clinical Experience with a Multimodal Approach
1Department of Sexual Medicine, Flare-Health, 1183DJ Amstelveen, The Netherlands
2School of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
3Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
DOI: 10.31083/j.jomh1808165 Vol.18,Issue 8,August 2022 pp.1-8
Submitted: 28 December 2021 Accepted: 18 March 2022
Published: 31 August 2022
Background: Post-SSRI sexual dysfunction (PSSD) is a set of heterogeneous sexual disorders, that may arise during the administration of antidepressant Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitor (SNRIs) and may persist after their discontinuation. PSSD is commonly associated with sexual problems with marked distress and poor quality of life. To date, however, no effective treatment is available. The study describes the clinical experience with a newly introduced systems sexology approach involving bio-psycho-social interventions. Methods: In this study we retrospectively analyzed (from July 2019 to July 2020) twelve PSSD male patients (mean age 31.3 ± 6.21 years old) treated according to a recently introduced approach involving system sexology and bio-psycho-social interventions. The protocol was based on a combination of lifestyle changes, nutritional supplementation, pharmacological and behavioral interventions. Results: 12 patients with high probability of PSSD were selected. Patients reported a significant improvement in all International Index of Erectile Function-15 (IIEF) domains and Orgasmometer scores from the baseline at 6 months of follow-up. Conclusions: This study described for the first time a feasible and handy treatment procedure for PSSD, framework to improve patients complains, sexual function and satisfaction, and quality of life. Future randomized, placebo-controlled clinical studies with bigger cohorts will be needed in order to better assess this efficacy and confirm our results.
PSSD; multimodal approach; SSRI
Yacov Reisman,Tommaso B. Jannini,Emmanuele A. Jannini. Post-Selective Serotonin Reuptake Inhibitor Sexual Dysfunctions(PSSD): Clinical Experience with a Multimodal Approach. Journal of Men's Health. 2022. 18(8);1-8.
 Jannini TB, Di Lorenzo G, Bianciardi E, Niolu C, Toscano M, Ciocca G, et al. Off-label uses of selective serotonin reuptake in-hibitors (SSRIs). Current Neuropharmacology. 2021. (Preprint)
 Atmaca, M. Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives. Neu-ropsychiatric Disease and Treatment. 2020; 16: 1043–1050.
 Clayton AH, Croft HA, Handiwala L. Antidepressants and sex-ual dysfunction: mechanisms and clinical implications. Post-graduate Medicine. 2014; 126: 91–99.
 Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. Journal of Clinical Psychopharmacol-ogy. 2015; 35: 273–278.
 Bolton JM, Sareen J, Reiss JP. Genital anaesthesia persisting six years after sertraline discontinuation. Journal of Sex and Marital Therapy. 2006; 32: 327–330.
 Csoka AB, Bahrick A, Mehtonen OP. Persistent sexual dys-function after discontinuation of selective serotonin reuptake in-hibitors. Journal of Sexual Medicine. 2008; 5: 227–233.
 Healy D. Antidepressants and sexual dysfunction: a history. Journal of the Royal Society of Medicine. 2020; 113: 133–135.
 Healy D, Le Noury J, Mangin D. Mangin, Enduring sexual dys-function after treatment with antidepressants, 5alpha-reductase inhibitors and isotretinoin: 300 cases. International Journal of Risk and Safety in Medicine. 2018; 29: 125–134.
 Reisman Y. Post-SSRI sexual dysfunction. British Medical Jour-nal. 2020; 368: m754.
 Giatti S, Diviccaro S, Panzica G, Melcangi RC. Post-finasteride syndrome and post-SSRI sexual dysfunction: two sides of the same coin? Endocrine. 2018; 61: 180–193.
 Keltner NL, McAfee KM, Taylor CL. Mechanisms and treat-ments of SSRI-induced sexual dysfunction. Perspectives in Psy-chiatric Care. 2002; 38: 111–116.
 Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: an fMRI Analysis. Journal of Sexual Medicine. 2017; 14: 1380–1391.
 Bijlsma EY, Chan JSW, Olivier B, Veening JG, Millan MJ, Waldinger MD, et al. Sexual side effects of serotonergic an-tidepressants: mediated by inhibition of serotonin on central dopamine release? Pharmacology, Biochemistry, and Behavior. 2014; 121: 88–101.
 Blier P, de Montigny C, Chaput Y. Modifications of the Sero-tonin System by Antidepressant Treatments: implications for the therapeutic response in major depression. Journal of Clinical Psychopharmacology. 1987; 7: 24S–35S.
 Pfaus JG. Pathways of sexual desire. Journal of Sexual Medicine. 2009; 6: 1506–1533.
 Csoka AB, Szyf M. Epigenetic side-effects of common pharma-ceuticals: a potential new field in medicine and pharmacology. Medical Hypotheses. 2009; 73: 770–780.
 Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dys-function: a Literature Review. Sexual Medicine Reviews. 2018; 6: 29–34.
 Healy D, Bahrick A, Bak M, Barbato A, Calabrò RS, Chubak BM, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. International Journal of Risk and Safety in Medicine. 2022; 33: 65–76.
 Jannini EA. SM = SM: the Interface of Systems Medicine and Sexual Medicine for Facing Non-Communicable Diseases in a Gender-Dependent Manner. Sexual Medicine Reviews. 2017; 5: 349–364.
 Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Revista Brasileira De Psiquiatria. 2013; 35: 416–431.
 Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology and Metabolism. 1999; 84: 3666–3672.
 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997; 49: 822–830.
 Limoncin E, Lotti F, Rossi M, Maseroli E, Gravina GL, Ciocca G, et al. The impact of premature ejaculation on the subjective perception of orgasmic intensity: validation and standardisation of the ‘Orgasmometer’. Andrology. 2016; 4: 921–926.
 Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical Activity to Improve Erectile Function: a Systematic Review of Intervention Studies. Sexual Medicine. 2018; 6: 75–89.
 Jiannine LM. An investigation of the relationship between phys-ical fitness, self-concept, and sexual functioning. Journal of Ed-ucation and Health Promotion. 2018; 7: 57.
 Corona G, Sansone A, Pallotti F, Ferlin A, Pivonello R, Isidori AM, et al. People smoke for nicotine, but lose sexual and re-productive health for tar: a narrative review on the effect of cigarette smoking on male sexuality and reproduction. Journal of Endocrinological Investigation. 2020; 43: 1391–1408.
 Calabrò RS, Polimeni G, Bramanti P. Current and future ther-apies of erectile dysfunction in neurological disorders. Recent Patents on CNS Drug Discovery. 2011; 6: 48–64.
 Cormio L, De Siati M, Lorusso F, Selvaggio O, Mirabella L, Sanguedolce F, et al. Oral L-citrulline supplementation im-proves erection hardness in men with mild erectile dysfunction. Urology. 2011; 77: 119–122.
 Courtois F, Carrier S, Charvier K, Guertin PA, Journel NM. The control of male sexual responses. Current Pharmaceutical De-sign. 2013; 19: 4341–4356.
 Gad MZ. Anti-aging effects of l-arginine. Journal of Advanced Research. 2010; 1: 169–177.
 Gianfrilli D, Lauretta R, Di Dato C, Graziadio C, Pozza C, De Larichaudy J, et al. Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunc-tion. Andrologia. 2012; 44: 600–604.
 Sato S, Namisaki T, Furukawa M, Saikawa S, Kawaratani H, Kaji K, et al. Effect of L-carnitine on health-related quality of life in patients with liver cirrhosis. Biomedical Reports. 2020; 13: 65.
 Jannini EA, DeRogatis LR, Chung E, Brock GB. How to Evalu-ate the Efficacy of the Phosphodiesterase Type 5 Inhibitors. Jour-nal of Sexual Medicine. 2012; 9: 26–33.
 Norden MJ. Buspirone treatment of sexual dysfunction associ-ated with selective serotonin re-uptake inhibitors. Depression. 1994; 2: 109–112.
 Bossio JA, Basson R, Driscoll M, Correia S, Brotto LA. Mindfulness-Based Group Therapy for Men with Situational Erectile Dysfunction: a Mixed-Methods Feasibility Analysis and Pilot Study. Journal of Sexual Medicine. 2018; 15: 1478–1490.
 Nobre PJ, Pinto-Gouveia J. Dysfunctional sexual beliefs as vul-nerability factors to sexual dysfunction. Journal of Sex Research. 2006; 43: 68–75.
 Johnston MG, Faulkner C. A bootstrap approach is a superior statistical method for the comparison of non‐normal data with differing variances. New Phytologist. 2021; 230: 23–26.
 Reisman Y. Sexual Consequences of Post-SSRI Syndrome. Sex-ual Medicine Reviews. 2017; 5: 429–433.
 Limoncin E, Tomassetti M, Gravina GL, Ciocca G, Carosa E, Di Sante S, et al. Premature ejaculation results in female sexual distress: standardization and validation of a new diagnostic tool for sexual distress. Journal of Urology. 2013; 189: 1830–1835.
 Allen MS, Walter EE. Health-Related Lifestyle Factors and Sexual Dysfunction: a Meta-Analysis of Population-Based Re-search. Journal of Sexual Medicine. 2018; 15: 458–475.
 Stanton AM, Handy AB, Meston CM. The Effects of Exercise on Sexual Function in Women. Sexual Medicine Reviews. 2018; 6: 548–557.
 Xu Z, Liu C, Liu S, Zhou Z. Comparison of efficacy and safety of daily oral L-arginine and PDE5Is alone or combination in treat-ing erectile dysfunction: a systematic review and meta‐analysis of randomised controlled trials. Andrologia. 2021; 53: e14007.
 Bjørklund G, Dadar M, Pen JJ, Chirumbolo S, Aaseth J. Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach. Biomedicine and Pharmacotherapy. 2019; 109: 1000–1007.
 Cavallini G, Modenini F, Vitali G, Koverech A. Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of silde-nafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology. 2005; 66: 1080–1085.
 Borrelli F, Colalto C, Delfino DV, Iriti M, Izzo AA. Herbal Di-etary Supplements for Erectile Dysfunction: a Systematic Re-view and Meta-Analysis. Drugs. 2018; 78: 643–673.
 Caruso S, Cianci S, Cariola M, Fava V, Rapisarda AMC, Cianci A. Effects of nutraceuticals on quality of life and sexual function of perimenopausal women. Journal of Endocrinological Investi-gation. 2017; 40: 27–32.
 Jalali-Chimeh F, Gholamrezaei A, Vafa M, Nasiri M, Abiri B, Darooneh T, et al. Effect of Vitamin D Therapy on Sexual Func-tion in Women with Sexual Dysfunction and Vitamin D Defi-ciency: a Randomized, Double-Blind, Placebo Controlled Clin-ical Trial. Journal of Urology. 2019; 201: 987–993.
 Calabrò RS, De Luca R, Manuli A, Portaro S, Naro A, Quattrini F. Towards Improving Post-SSRI Sexual Dysfunction by Using Nutriceuticals: Lessons from a Case Study. Journal of Sex and Marital Therapy. 2019; 45: 562–565.
 Abdel-Hamid IA, Elsaied MA, Mostafa T. The drug treatment of delayed ejaculation. Translational Andrology and Urology. 2016; 5: 576–591.
 Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, et al. Hypoactive Sexual Desire Disorder: Interna-tional Society for the Study of Women’s Sexual Health (ISS-WSH) Expert Consensus Panel Review. Mayo Clinic Proceed-ings. 2017; 92: 114–128.
 Blycker GR, Potenza MN. A mindful model of sexual health: a review and implications of the model for the treatment of in-dividuals with compulsive sexual behavior disorder. Journal of Behavioral Addictions. 2018; 7: 917–929.
 Higgins A, Nash M, Lynch AM. Antidepressant-associated sex-ual dysfunction: impact, effects, and treatment. Drug, Health-care and Patient Safety. 2010; 2: 141–150.
 Pyke RE, Clayton AH. Psychological Treatment Trials for Hy-poactive Sexual Desire Disorder: a Sexual Medicine Critique and Perspective. Journal of Sexual Medicine. 2015; 12: 2451–2458.
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