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PSSD (Post-SSRI Sexual Dysfunction): Symptoms, Recognition, and What Is Known

What PSSD is, its symptoms, what regulators say, what is still unknown, and how to talk with your prescriber.
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Medically Reviewed by Dr John Motl MD

PSSD at a glance

Don’t stop an antidepressant suddenly to avoid or fix sexual side effects. Talk with your prescriber first. If you feel hopeless or have thoughts of suicide, call or text 988.

What it is
Post-SSRI sexual dysfunction: sexual problems that start during or after antidepressant treatment and continue after the drug is stopped
Main symptoms
Genital numbness, weak or pleasureless orgasm, low sex drive, erection problems
Other symptoms
Some people also report emotional numbing
Drugs involved
SSRIs and SNRIs, such as sertraline, escitalopram, paroxetine, fluoxetine, venlafaxine, and duloxetine
Recognition
Europe (2019) and Canada (2021) updated labels to say symptoms may continue after stopping
How common
Unknown; believed to be rare, with only one small population estimate
Treatment
No proven treatment yet; research is limited
Best step
Ask about sexual side effects before starting, and plan any change with your prescriber
PSSD symptomsIs PSSD recognized?Talking to a prescriberQuestions to ask
Table of contents (13)

What is PSSD (post-SSRI sexual dysfunction)?

PSSD, or post-SSRI sexual dysfunction, is the name for sexual problems that continue after someone stops taking an SSRI or SNRI antidepressant. The most common symptoms are genital numbness, weak or pleasureless orgasm, low sex drive, and erection problems.7,10

Sexual side effects during antidepressant treatment are common and well known.13,14 For most people, they fade after the medication is stopped. PSSD describes the smaller group of people whose symptoms do not go away.10,17 European and Canadian regulators have added this possibility to antidepressant labels, describing it as long-lasting sexual dysfunction that can continue after treatment ends.1,2,3

PSSD is real to the people who live with it, and it deserves to be taken seriously. At the same time, the research is young. We don’t yet know how often it happens, why it happens to some people and not others, or how to treat it.10,12,16 This article sticks to what the evidence shows and says so plainly when it doesn’t.

Want medical support while you taper? Learn how our residential medication tapering program in Sedona works, or call (888) 907-7075.

PSSD symptoms

Short answer: the hallmark symptoms are genital numbness, orgasms that feel weak or bring little pleasure, loss of sex drive, and erectile dysfunction. Some people also describe emotional flatness.7,10,12

In a published series of 300 cases from 37 countries, the most common features were genital numbness (anesthesia), pleasureless or weak orgasm, loss of libido, and impotence.7 One review describes a reduced ability to feel sexual pleasure as the most frequent feature.11

Sexual symptoms reported in reviews:

  • Genital numbness: reduced or changed feeling in the genitals, often the first thing people notice7,8,10
  • Orgasm changes: orgasms that are weak, delayed, or bring little or no pleasure7,10,12
  • Low sex drive: reduced or absent desire7,10
  • Erectile dysfunction: trouble getting or keeping an erection7,10
  • Ejaculation problems: including premature ejaculation in some reports10

Non-sexual symptoms some people report:

  • Emotional numbing or blunted feelings8,12
  • Loss of pleasure in general (anhedonia) and apathy12

Many of these symptoms can also come from depression, anxiety, hormones, other medicines, or physical health problems. That is why a careful medical review matters before anyone settles on a cause.8,10

How is PSSD diagnosed?

There is no lab test for PSSD. In 2022, a group of clinicians and researchers proposed diagnostic criteria.8 Under these criteria, two things are required:

  • Past treatment with a serotonin reuptake inhibitor
  • A lasting change in genital feeling or sexual sensation after the drug is stopped

Supporting features include lasting low desire, erectile dysfunction, and weak or absent orgasm, with symptoms continuing for at least 3 months after stopping. The criteria also require ruling out sexual problems that existed before the drug and other medical causes, medicines, or substances that could explain the symptoms.8

These are proposed research criteria. PSSD is not listed as a separate diagnosis in the main psychiatric or medical coding systems, so doctors diagnose it by ruling out other causes.7,10,12

Is PSSD recognized by the FDA, EMA, and Health Canada?

Short answer: Europe and Canada have updated antidepressant labels to say sexual problems can continue after stopping. The FDA has not added a warning about this to U.S. labels as of October 2026.1,2,3,4,6

Regulator What it did Key wording
European Medicines Agency (EMA), 2019 Asked makers of SSRIs and SNRIs to update product information after reviewing case reports, research, and company data “There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs/SNRI.”1,2
Health Canada, 2021 Reviewed 58 case reports and found 43 possibly linked to past use. It “could not confirm, nor rule out, a causal link,” but asked for label updates Prescribers should tell patients about “the potential risk of long lasting (possibly weeks to years) sexual dysfunction despite discontinuation.”3
U.S. FDA Current SSRI and SNRI labels warn about sexual side effects during treatment, but carry no warning that they can persist. A 2018 citizen petition asking for one is still pending The Prozac label’s adverse reactions section notes sexual symptoms “occasionally persist after discontinuation of fluoxetine treatment.”4,5,6

U.S. labels for drugs such as Zoloft now ask prescribers to “inquire about sexual function prior to initiation” and to ask specifically about changes during treatment, because people often don’t bring them up.4 In March 2026, the FDA held a listening session with petitioners on several SSRI and SNRI petitions, including the 2018 PSSD petition. The FDA said it made no decisions at that meeting and will post its responses when complete.6

In the UK, the NHS now tells patients that sexual problems “may carry on after stopping antidepressants” for some people, and the Royal College of Psychiatrists describes persistent sexual side effects as rare.17,18

Which drugs can cause PSSD?

Short answer: the regulatory warnings cover SSRIs and SNRIs. Reports involve many different drugs in these groups, and there is not enough evidence to say one is clearly safer than another for PSSD.1,3,7

Drugs In the label reviews?
SSRIs: citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft) Yes, Europe 2019 and Canada 20211,3
SNRIs: desvenlafaxine (Pristiq), duloxetine (Cymbalta), milnacipran, venlafaxine (Effexor) Yes, Europe 2019 and Canada 20211,3
Vortioxetine (Trintellix), vilazodone, levomilnacipran Canada 2021 only; Europe assessed vortioxetine but did not require the update1,3
Trazodone, mirtazapine (Remeron), bupropion (Wellbutrin) Not part of these reviews1

Can trazodone or amitriptyline cause PSSD? These drugs were not part of the European or Canadian label reviews.1,3 That does not prove they can’t be involved. It means there is too little evidence to say. If you take one of them and notice sexual changes, raise it with your prescriber.

The 300-case series included people who had taken 14 different drugs, not only antidepressants. Similar lasting sexual symptoms have been reported after the hair-loss drug finasteride and the acne drug isotretinoin.7

How common is PSSD?

Short answer: nobody knows for sure. It is believed to be rare, and the only population estimate comes from a small study of men.9,16,18

Sexual side effects during treatment are much more common. In one large study of 1,022 outpatients, 59% reported sexual problems on antidepressants.14 A review found rates from about 26% to 80% across different antidepressants, though study methods varied a lot.13

For PSSD itself, a 2023 study followed more than 12,000 healthy men aged 21 to 49 in an Israeli health system over 19 years. Of 866 men who took a serotonergic antidepressant, 4 met the study’s definition of PSSD, about 1 in 216.9

That number needs care. It covers only young, healthy men. It used prescriptions for erection drugs as a stand-in for sexual dysfunction, and it rests on just 4 cases. The authors say it may underestimate the true figure.9 There is no verified estimate for women. A 2026 review concluded that current evidence does not support precise prevalence claims.16

In the Netherlands, the national pharmacovigilance center analyzed 86 reports of sexual problems that continued after stopping an SSRI. In the longest case, symptoms had lasted 23 years.15

Worried about side effects from your antidepressant? Talk with our team about medically supervised tapering and what a residential stay looks like.

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What is and isn’t known about PSSD

Short answer: regulators accept that lasting sexual problems after SSRIs and SNRIs have been reported. The cause, how often it happens, and how to treat it are still unknown.3,12,16

What we know What we don’t know yet
Sexual side effects during SSRI and SNRI treatment are common13,14 Why symptoms continue in some people and not others12,16
Some people report symptoms that last months or years after stopping3,15 How often this happens, especially in women9,16
European and Canadian labels now mention this risk1,3 Whether dose, length of use, or the specific drug changes the risk16
Genital numbness is a core feature in proposed criteria8 The biological mechanism; several theories exist, none proven12,16
No treatment has shown clear benefit in studies10,15 Whether, or how often, symptoms improve over time

Most of what is known comes from case reports, patient surveys, and drug safety databases. These sources are good at spotting a problem but can’t show how common it is or prove cause and effect.3,16 Larger, better-designed studies are needed.

Is there a treatment for PSSD?

Short answer: not yet. Reviews agree there is no proven treatment for PSSD, and treatments tried so far have not had clear results.10,12,15

Various drugs and therapies have been tried in individual cases, but none has been tested well enough to recommend.12,16 The 2022 criteria paper notes that testosterone has not reliably helped and that erection drugs often seem less effective than usual.8 Be cautious about anyone who promises quick or certain results.

What can help right now:

  • A thorough medical workup. Hormone levels, other medications, blood sugar, blood pressure, and pelvic health can all affect sexual function. Finding and treating another cause matters even if PSSD is also part of the picture.8,10
  • Mental health support. Living with PSSD can be isolating and distressing. Counseling with someone who takes the condition seriously can help.
  • Specialist care. A urologist, gynecologist, or sexual medicine specialist can check for other treatable problems.
  • Reporting it. In the U.S., you or your doctor can report side effects to FDA MedWatch at 1-800-FDA-1088. Reports help regulators see patterns.4

Nutrition, sleep, exercise, and overall physical health support well-being in general. They are not a proven treatment for PSSD, and we don’t present them as one.

How to talk to your prescriber about PSSD

Short answer: be specific about what changed and when it started, bring notes, and ask what else could be causing it. U.S. labels already ask prescribers to ask about sexual function, so you are not raising an off-topic issue.4

Sexual symptoms can feel awkward to bring up. Many people never mention them, which is one reason they go unrecorded.4 These steps can make the visit easier:

  • Write a short timeline. Note when you started the drug, any dose changes, when you stopped, and when each symptom began.4,8
  • Use plain words. For example: “Since starting sertraline, I have numbness in my genitals and orgasms feel weak. It hasn’t improved since I stopped 4 months ago.”
  • Ask about other causes. Ask whether hormone tests, a medication review, or a specialist referral make sense.8,10
  • Bring the labels. If your prescriber hasn’t heard of PSSD, the EMA wording and the Health Canada review are short and easy to share.1,3
  • Ask about mood too. Low mood can lower desire, and PSSD can affect mood. Both deserve attention.

If you are still taking the medication, don’t stop it suddenly to fix the problem. Stopping an antidepressant quickly can cause withdrawal symptoms or a return of depression or anxiety. Any change should be planned with your prescriber.4,17

Questions to ask before starting or stopping an antidepressant

Short answer: before starting, ask how likely sexual side effects are and what the options are. Before stopping, ask for a gradual, supervised plan and how sexual symptoms will be followed.4,13

Antidepressants can help many people, and the decision to take one belongs to you and your prescriber. Knowing about sexual side effects up front lets you make that decision with full information.

Before starting:

  • How often does this drug cause sexual side effects?
  • Are there options with a lower rate of sexual side effects that would fit my situation? In one review, bupropion, mirtazapine, and a few others were not linked to more sexual problems than placebo.13
  • Would therapy or other non-drug approaches be a reasonable first step for me?
  • What should I do if I notice genital numbness or other sexual changes?
  • Can we record my current sexual function now so we can compare later?4

Before stopping:

  • How should we reduce the dose, and how slowly?
  • What withdrawal symptoms should I watch for, and who do I call?
  • If sexual symptoms continue after I stop, how will we follow up?
  • What is the plan if depression or anxiety comes back?

Read our guide on how to come off antidepressants safely for more on planning a taper.

When to get help right away

Living with lasting sexual dysfunction can bring grief, shame, relationship strain, and hopelessness. If you feel this way, you deserve support now.

  • Call or text 988 for the Suicide and Crisis Lifeline, free, confidential, and open 24/7. You can also chat at 988lifeline.org.19
  • Call 911 or go to the nearest emergency room if you or someone else is in immediate danger.

How Alternative to Meds Center can help

Alternative to Meds Center is a residential treatment center in Sedona, Arizona, with nearly 20 years of experience helping people taper psychiatric medications. We do not offer a treatment for PSSD, and no one can honestly promise to reverse it. What we offer is careful, supervised help for people who have decided with their prescriber to reduce or come off an antidepressant.

Each resident gets lab testing and a medical assessment on arrival. Our medical team plans each dose step, using half tablets or liquid preparations as needed, and adjusts the pace as you respond. The program also includes neurotransmitter support, whole-food nutrition, counseling, and dual diagnosis care for depression and anxiety. These supports work alongside medical care, not in place of it.

Our Medical Director describes how the team runs a taper:

“Our medical and nursing teams collaborate closely to monitor each client’s tapering plan, assess progress, and make adjustments as clinically indicated. The team regularly evaluates symptoms, sleep patterns, mood, and overall well-being to support a safe and individualized process.”
Kimberli Galloway, PMHNP-BC, Medical Director

See where you’d stayTour our Sedona residence →Hear from clientsReal recovery stories →

Learn more about antidepressant withdrawal, antidepressant tapering, and antidepressants and sexual health risks.

Talk to our admissions team. Ask about a supervised antidepressant taper, what a stay looks like, and insurance. Family members are welcome to call.

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PSSD FAQs

What does PSSD stand for?
PSSD stands for post-SSRI sexual dysfunction. It describes sexual problems, such as genital numbness, weak orgasm, and low desire, that continue after stopping an SSRI or SNRI antidepressant.7,10
Is PSSD real?
Regulators in Europe and Canada have accepted that long-lasting sexual dysfunction after stopping SSRIs and SNRIs has been reported, and they updated drug labels.1,3 Health Canada said it could not confirm or rule out a causal link.3 Much remains unknown, but people’s symptoms deserve to be taken seriously.
Can Lexapro cause PSSD?
Escitalopram (Lexapro) is one of the SSRIs covered by the 2019 European label update, which says sexual symptoms have been reported to continue after stopping.1,2 There is no reliable data on how often this happens with any single drug.16
Can trazodone cause PSSD?
Trazodone was not part of the European or Canadian reviews, which focused on SSRIs and SNRIs.1,3 There is too little evidence to say whether it can cause lasting sexual problems. Tell your prescriber about any sexual changes on any medication.
Can duloxetine (Cymbalta) cause PSSD?
Duloxetine is an SNRI and is covered by the 2019 European label update.1 Its U.S. label warns about sexual side effects during treatment but does not mention persistence after stopping. See our article on Cymbalta side effects.
How long does PSSD last?
It varies and isn’t well studied. The proposed criteria use at least 3 months after stopping. Canadian labeling describes it as possibly lasting weeks to years, and one Dutch report described symptoms lasting 23 years.3,8,15
Can PSSD be treated?
There is no proven treatment at this time.10,15 A medical workup can find other treatable causes of sexual problems, and counseling can help with the stress of living with it. Be wary of anyone who promises quick or certain results.
Which antidepressants have the fewest sexual side effects?
In one review, bupropion, mirtazapine, agomelatine, moclobemide, and nefazodone were not linked to more sexual side effects than placebo, while SSRIs and SNRIs were.13 Whether any of these is right for you depends on your health and history, so talk it through with your prescriber.
Should I stop my antidepressant if I have sexual side effects?
Don’t stop suddenly. Talk with your prescriber about options, which may include changing the dose or the medication. If you decide to stop, a gradual, supervised plan lowers the risk of withdrawal symptoms and relapse.4,17

Sources:

1. European Medicines Agency, Pharmacovigilance Risk Assessment Committee. PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting (signal: persistent sexual dysfunction after drug withdrawal, EPITT no 19277). EMA/PRAC/265212/2019. June 11, 2019. [cited 2026 Oct 20]

2. European Medicines Agency. New product information wording: extracts from PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting. EMA/PRAC/265221/2019. [cited 2026 Oct 20]

3. Health Canada. Summary Safety Review: SSRIs and SNRIs, assessing the potential risk of sexual dysfunction despite treatment discontinuation. January 6, 2021. [cited 2026 Oct 20]

4. Pfizer. Zoloft (sertraline) prescribing information, section 5.11 Sexual Dysfunction. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

5. Eli Lilly and Company. Prozac (fluoxetine) prescribing information, sections 5.17 and 6.1. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

6. Healy D. Citizen petition: Sexual side effects of SSRIs and SNRIs. Int J Risk Saf Med. 2018;29(3-4):135-147. doi:10.3233/JRS-180745. PMID: 29733031. Petition docket FDA-2018-P-1846, including the FDA listening session memo of April 24, 2026. [cited 2026 Oct 20]

7. Healy D, Le Noury J, Mangin D. Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med. 2018;29(3-4):125-134. doi:10.3233/JRS-180744. PMID: 29733030. [cited 2026 Oct 20]

8. Healy D, Bahrick A, Bak M, et al. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med. 2022;33(1):65-76. doi:10.3233/JRS-210023. PMID: 34719438. [cited 2026 Oct 20]

9. Ben-Sheetrit J, Hermon Y, Birkenfeld S, Gutman Y, Csoka AB, Toren P. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry. 2023;22(1):15. doi:10.1186/s12991-023-00447-0. PMID: 37085865. [cited 2026 Oct 20]

10. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev. 2018;6(1):29-34. doi:10.1016/j.sxmr.2017.07.002. PMID: 28778697. [cited 2026 Oct 20]

11. Reisman Y. Sexual Consequences of Post-SSRI Syndrome. Sex Med Rev. 2017;5(4):429-433. doi:10.1016/j.sxmr.2017.05.002. PMID: 28642048. [cited 2026 Oct 20]

12. Peleg LC, Rabinovitch D, Lavie Y, et al. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev. 2022;10(1):91-98. doi:10.1016/j.sxmr.2021.07.001. PMID: 34627736. [cited 2026 Oct 20]

13. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009;29(3):259-266. doi:10.1097/JCP.0b013e3181a5233f. PMID: 19440080. [cited 2026 Oct 20]

14. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry. 2001;62 Suppl 3:10-21. PMID: 11229449. [cited 2026 Oct 20]

15. Chinchilla Alfaro K, van Hunsel F, Ekhart C. Persistent sexual dysfunction after SSRI withdrawal: a scoping review and presentation of 86 cases from the Netherlands. Expert Opin Drug Saf. 2022;21(4):553-561. doi:10.1080/14740338.2022.2007883. PMID: 34791958. [cited 2026 Oct 20]

16. Broul M, Hujová A, Liegertová M, Langmaierová K, Albrecht J. Persistent Sexual Dysfunction After SSRIs and SNRIs: A Clinical Framework for Assessment, Counseling, and Pharmacovigilance. J Sex Marital Ther. 2026:1-17. doi:10.1080/0092623X.2026.2726480. PMID: 42684852. [cited 2026 Oct 20]

17. NHS. Antidepressants. Page last reviewed 2026. [cited 2026 Oct 20]

18. Royal College of Psychiatrists. Antidepressants. [cited 2026 Oct 20]

19. 988 Suicide and Crisis Lifeline. 988lifeline.org. [cited 2026 Oct 20]


This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Never start, stop, or change a prescription medication without consulting a qualified healthcare professional who understands your medical history. If you are experiencing an immediate medical or safety emergency, call 911.