Vitality Unleashed: The Functional Medicine Podcast

Hidden Dangers: SSRIs and Men's Sexual Health

• Dr. Kumar from LifeWellMD.com • Season 1 • Episode 139

Share episode

Send us a text

Powerful medications like SSRIs offer vital relief for millions battling depression and anxiety, but what happens when the treatment itself creates new problems? This eye-opening exploration dives into the hidden costs of antidepressant medications—specifically their profound impact on men's sexual health.

Drawing from extensive clinical research, we reveal how common sexual side effects truly are, affecting up to 80% of patients taking these medications. Beyond temporary issues lies a more concerning reality: Post-SSRI Sexual Dysfunction (PSSD), where sexual problems persist for months, years, or even decades after stopping medication. We break down the science behind this condition, explaining how serotonin systems can become "stuck in overdrive," potentially causing actual nerve damage and creating a profound disconnection between brain and body.

The numbers tell a striking story. Men prescribed serotonergic antidepressants face a threefold increased risk of erectile dysfunction, with approximately 1 in 216 developing persistent PSSD—a dramatic increase from baseline rates. Yet despite medication labels including these warnings, many healthcare providers aren't consistently sharing this information before prescribing. This "informed accountability gap" leaves patients unprepared for potential long-term consequences.

We also explore the dangers of combining serotonergic substances—whether prescription medications, recreational drugs, or even seemingly harmless supplements like St. John's Wort—which can lead to potentially life-threatening Serotonin Syndrome. Through it all, we offer hope with evidence-based strategies for those experiencing sexual dysfunction, from targeted exercise and nutritional support to psychological approaches that restore the crucial brain-body connection.

Knowledge is power when navigating these complex health decisions. Take control of your well-being by asking the right questions, understanding all potential risks, and working with healthcare providers who prioritize comprehensive, personalized care for both mental and sexual health.

Disclaimer:
The information provided in this podcast is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making changes to your supplement regimen or health routine. Individual needs and reactions vary, so it’s important to make informed decisions with the guidance of your physician.

Connect with Us:
If you enjoyed today’s episode, be sure to subscribe, leave us a review, and share it with someone who might benefit. For more insights and updates, visit our website at Lifewellmd.com.

Stay Informed, Stay Healthy:
Remember, informed choices lead to better health. Until next time, be well and take care of yourself.

Speaker 1:

Welcome back to the Deep Dive. Today we're pulling back the curtain on a topic that affects millions but far too often is discussed in hushed tones, if you know at all.

Speaker 2:

Yeah, we're talking about the unexpected impact of widely prescribed medications on men's sexual health.

Speaker 1:

Exactly. You might think you know the basics, but our deep dive into recent clinical reviews and research papers has unearthed some well truly eye-opening insights that challenge common assumptions. Our mission today is really to bring to light crucial information about antidepressant medications, specifically selective serotonin reuptake inhibitors, or SSRIs. Right, we're going to explore their lesser-known yet significant side effects, including erectile dysfunction and a more persistent condition called post-SSRI sexual dysfunction, or PSSD.

Speaker 2:

Crucial stuff.

Speaker 1:

Ultimately, we want to equip you with the knowledge to have informed conversations with your health care providers. This is information every man should be aware of, helping you navigate your wellness journey with well greater clarity and confidence.

Speaker 2:

And what's truly striking from the outset is just how prevalent these medications are in our society. I mean, consider this yeah Statistics show that one in six people over 16 experience symptoms of common psychiatric disorders like anxiety or depression.

Speaker 1:

One in six Wow.

Speaker 2:

And in the UK alone over 8 million people are prescribed antidepressants. So when you look at those numbers it becomes critically important to understand the full spectrum of effects these powerful drugs can have.

Speaker 1:

Way beyond what's typically discussed in, say, a quick doctor's visit.

Speaker 2:

Exactly Far beyond that.

Speaker 1:

Absolutely so. Ok, let's start by unpacking the initial, more common sexual side effects. Many people are prescribed SSRIs for a whole range of conditions right Depression, anxiety, ocd, ptsd.

Speaker 2:

A wide range? Yes.

Speaker 1:

And for many these drugs are genuinely life-changing, offering much-needed relief. But our sources consistently highlight a significant risk, described as very common to common.

Speaker 2:

Affecting more than 1 in 10 patients.

Speaker 1:

More than 1 in 10. And that risk is sexual side effects.

Speaker 2:

That's right. For men, this can show up as reduced libido, just a general lack of desire and, specifically, erectile dysfunction.

Speaker 1:

But it's not just men, is it?

Speaker 2:

No, not at all. The research also notes anorgasmia and vaginal dryness for women.

Speaker 1:

And the crucial point here, as the research really emphasizes, is that these aren't just minor inconveniences you can easily brush off.

Speaker 2:

No, definitely not. These can be profoundly distressing. They impact relationships, self-esteem, overall quality of life.

Speaker 1:

It really raises a fundamental question, then, doesn't it about how we weigh the benefits of medication against the broader picture of someone's well-being?

Speaker 2:

It does. Improving mental health is paramount, of course, and we can't just overlook crucial quality of life issues like sexual function Right. The research indicates that a substantial portion of patients I mean some studies put it as high as 80 percent experience some form of sexual dysfunction with SSRIs 80 percent.

Speaker 1:

That's incredibly high.

Speaker 2:

It is, and what's concerning is that this often leads them to just discontinue therapy.

Speaker 1:

Which, ironically, can then hinder their recovery from the very depression or anxiety they were trying to treat in the first place.

Speaker 2:

Precisely. It presents a really difficult catch-22 for so many people.

Speaker 1:

It sounds like a real dilemma for both patients and clinicians. And what's even more concerning is the next layer of this discussion, because, while most people, and maybe even some doctors, assume these sexual side effects just disappear once you stop the medication.

Speaker 2:

That's the common assumption, yeah.

Speaker 1:

A growing body of research is shining a spotlight on something called post-SSRI sexual dysfunction, or PSSD. So, for those who might not be familiar, what does PSSD actually mean and what makes it such a critical issue?

Speaker 2:

That's a vital question. Pssd is where sexual side effects can persist long after the medication has been withdrawn.

Speaker 1:

Persist, so not just for a little while.

Speaker 2:

No, we're not talking days or weeks here. These symptoms can last for months, years or even decades in some reported cases.

Speaker 1:

Decades wow.

Speaker 2:

Yeah, decades, in some reported cases Decades, wow yeah. This concept of enduring sexual dysfunction fundamentally challenges that common assumption that drug effects are purely temporary.

Speaker 1:

So it's not just lingering effects, it's something else.

Speaker 2:

It seems so. I mean the British National Formulary itself, which is a highly authoritative medical resource, warns that symptoms of sexual dysfunction may persist after treatment has stopped.

Speaker 1:

And they specifically mention common SSRIs.

Speaker 2:

They do. Drugs like sertraline, fluoxetine, paroxetine and citalopram are explicitly named, so this isn't just anecdotal concern. It's a recognized, yet tragically under-discussed risk, even by official medical bodies.

Speaker 1:

So imagine the experience you stop a medication, you're hoping to get back to normal, but you're still experiencing symptoms like genital numbing, maybe a complete inability to orgasm or significantly delayed orgasms, and this persistent suppression of libido.

Speaker 2:

It's a profound and often baffling experience for those affected.

Speaker 1:

The sources define a pretty consistent set of PSSD symptoms, often including what's called general anesthesia, that feeling of numbness or dullness, along with anorgasmia, ejaculatory dysfunctions and a dramatically decreased libido.

Speaker 2:

And what patients most frequently report is this kind of triad general anesthesia, lack of libido and this deeply unsettling disconnection between their brain and their genitals.

Speaker 1:

A disconnection that sounds more than just psychological.

Speaker 2:

It seems to be the pathophysiology. The how it happens is still being researched, but theories suggest that the enduring serotonin stimulation might lead to chronic serotonin-mediated tonic inhibition.

Speaker 1:

Okay, what does that mean in simpler terms?

Speaker 2:

Essentially, it's like the serotonin system gets stuck in overdrive. Even after the drug is gone, it creates this chronic inhibitory effect. Think of it as a signal constantly saying no to the body's natural sexual responses and this could even lead to neurotoxicity, potentially causing actual axonal damage in peripheral nerves.

Speaker 1:

New nerve damage.

Speaker 2:

Potentially yes, which might result in what we call neurogenic ED erectile dysfunction, stemming directly from nerve issues. So it's not just a lingering chemical effect. It might involve actual changes at a cellular and neurological level.

Speaker 1:

That really highlights the seriousness and persistence of the condition.

Speaker 2:

It does, and this profound impact on quality of life is precisely why we need to bring this to light.

Speaker 1:

That's a sobering thought that the so OK. What does this all mean for you, the listener, in terms of actual risk? How common is this PSSD?

Speaker 2:

Well, a recent quite extensive 19-year retrospective study looked at over 12,000 men aged 21 to 49.

Speaker 1:

OK.

Speaker 2:

And it revealed some stark figures. They found that men treated with these serotonergic antidepressants had more than the threefold increased risk of receiving treatment for ED compared to controls.

Speaker 1:

Threefold. That alone is significant.

Speaker 2:

Very, but more critically, this study offered a first assessment of the risk for irreversible PSSD.

Speaker 1:

Irreversible. And what did they find?

Speaker 2:

The findings suggest a small but incredibly impactful risk. Pssd developed in 1 in 216 patients. That's about 0.46% 1 in 216.

Speaker 1:

OK, 0.46%. How does that compare to the general population?

Speaker 2:

Well, to give you some context, in the general male population in that age group, 2149, the prevalence of this type of sexual dysfunction was estimated at about 4.3 per 100,000.

Speaker 1:

So much lower.

Speaker 2:

Much, much lower. So while 0.46% might seem small on a population level, for the individual affected it's a profound, often irreversible change. It could alter their life for decades.

Speaker 1:

It's not just a minor side effect, then it's a potential long-term disability.

Speaker 2:

Exactly, and that's an insight that truly needs to sink in.

Speaker 1:

This brings us straight to a crucial ethical discussion, doesn't it? Informed consent.

Speaker 2:

Absolutely. The doctrine of informed consent underpins all health care. You, as the patient, need to understand your condition, your prognosis, your treatment options and, critically, their advantages and their disadvantages.

Speaker 1:

And given that even antidepressant medication labels carry a warning that PSSD is a possible long-lasting consequence.

Speaker 2:

Right, not just temporary.

Speaker 1:

The General Medical Council advises that any risk of serious harm, however unlikely, should usually be disclosed.

Speaker 2:

But the research strongly suggests there's an informed accountability gap.

Speaker 1:

An informed accountability gap. What does that mean in practice?

Speaker 2:

It means this information isn't consistently being shared in clinical practice. Clinicians have a duty to ensure patients understand these risks, but it seems that's not always happening.

Speaker 1:

Which highlights why you, the listener, should feel empowered to ask questions. Don't wait to be asked.

Speaker 2:

Precisely, research shows patients often feel embarrassed to bring up sexual problems. They prefer the healthcare professional to initiate the conversation.

Speaker 1:

But, given the potential for lasting effects, these sources make a strong case for you to speak up.

Speaker 2:

Given the potential for lasting effects, these sources make a strong case for you to speak up, and it's also incredibly important to discuss your sexual function before starting an SSRI.

Speaker 1:

To establish a baseline.

Speaker 2:

Exactly Knowing your baseline is key so you can distinguish between, say, symptoms of depression itself and potential side effects of the treatment if they arise later.

Speaker 1:

That makes sense. Now, beyond PSSD, which is this persistent issue, there's another risk. It's more acute but potentially life-threatening Serotonin syndrome. Can you tell us more about this?

Speaker 2:

Yes, serotonin syndrome is rare, thankfully, but it's a severe consequence that can occur when multiple serotonergic drugs are used together.

Speaker 1:

So drugs that affect serotonin levels.

Speaker 2:

Correct. Using too many or combining them inappropriately can lead to an overactivation of serotonin receptors in the brain. Think of it like a serotonin overload.

Speaker 1:

And what are the symptoms? How would someone know?

Speaker 2:

Symptoms can range from mild things like diarrhea, restlessness, sweating, to severe and potentially fatal Wow. Yes, Severe symptoms can include muscle twitching, high blood pressure, a rapid heart rate, fever and even seizures. It's a true medical emergency that requires immediate attention.

Speaker 1:

That sounds incredibly serious, and what I found particularly fascinating in the research was the discussion around how other substances can dramatically increase this risk. It's not just about prescription drugs mixing, is it?

Speaker 2:

Absolutely not. This is where comprehensive patient history becomes so critical. Many stimulant recreational drugs things like cocaine, mdma, ecstasy, crystal meth significantly increase serotonin release. Combining those with an antidepressant can exponentially increase the risk of serotonin syndrome.

Speaker 1:

And it's not just illegal drugs either.

Speaker 2:

No, what many people don't realize is that even common over-the-counter herbal remedies like St John's wort are serotonergic agents.

Speaker 1:

St John's wort. People often take that for mood.

Speaker 2:

They do and they often assume natural means safe to combine with other medications. But that's a dangerous misconception here. St John's wort can cause severe interactions with SSRIs.

Speaker 1:

That's a vital piece of information. It truly underscores the absolute necessity for a comprehensive medical history.

Speaker 2:

Absolutely. Your doctor needs to know about everything recreational drug use, over-the-counter supplements, herbal remedies.

Speaker 1:

Even if you aren't currently using them.

Speaker 2:

Yes, your doctor should counsel you on the risks for any future use as well, so you can make informed choices down the line.

Speaker 1:

Because the consequences of not having that conversation can be dire. When it comes to serotonin syndrome, prevention truly is the best, maybe the only approach.

Speaker 2:

That's right.

Speaker 1:

Okay, this deep dive has definitely focused on some serious challenges and it can feel a bit overwhelming.

Speaker 2:

It can.

Speaker 1:

But what can you, as a man navigating these waters, actually do? Is there any good news here?

Speaker 2:

Yes, there is. The good news is that research is actively exploring multimodal approaches to manage sexual dysfunction, including PSSD.

Speaker 1:

Multimodal meaning several things at once. Exactly.

Speaker 2:

While there's no single cure for PSSD right now, these studies offer pathways for improvement and, importantly, hope for restoring that vital brain-genital connection that so many patients report losing.

Speaker 1:

Okay, so can you walk us through some of the actionable insights from these studies? What kind of things help?

Speaker 2:

Certainly, it's really about taking a holistic approach. For example, one study explored a strategy for PSSD that included several key interventions and they saw significant improvements.

Speaker 1:

Like what.

Speaker 2:

Well, first, regular physical activity. We're talking 40 minutes of moderate to vigorous aerobic exercise, maybe four or five times a week.

Speaker 1:

And that helps with ED specifically.

Speaker 2:

It can profoundly impact erectile function, yes, but it also improves self-concept and can even positively influence testosterone levels. It's not just about general fitness.

Speaker 1:

Okay, what else?

Speaker 2:

Nutritional support Supplementation with L-arginine about three grams per day, and L-carnitine, two grams per day, should promise.

Speaker 1:

Why those specifically?

Speaker 2:

L-arginine is a nitric oxide donor, which is crucial for healthy erectile function. Alt-carnitine supports energy production, reduces fatigue and provides important antioxidant effects. So they're targeted.

Speaker 1:

Got it. Are there medication options too?

Speaker 2:

Yes, pharmacological options if appropriate and always under strict medical guidance. Medications like PDE5 inhibitors many listeners will know these, as drugs like sildenafil or tadalafil, viagra or Cialis can be used to treat the ED symptom.

Speaker 1:

Okay.

Speaker 2:

And for low libido or delayed orgasm. Another drug called buspirone is an option that healthcare providers might consider.

Speaker 1:

And beyond pills and supplements.

Speaker 2:

Absolutely. Behavioral interventions are key. Things like mindfulness training can be incredibly helpful in reducing anxiety and improving that mind-body connection which often feels fractured in PSSD.

Speaker 1:

Makes sense.

Speaker 2:

Cognitive behavioral therapy, or CBT, can address negative thoughts or low self-esteem related to sexual function, and sex therapy, which can definitely include partners, focuses on education, improving communication and, importantly, shifting the focus to pleasurable experiences rather than just performance.

Speaker 1:

You know, if we connect this to the bigger picture, these approaches really emphasize a holistic view of health.

Speaker 2:

They do.

Speaker 1:

Addressing not just symptoms but the interplay of physical, psychological and social factors. It's about empowering you with multiple tools for your health journey.

Speaker 2:

And, importantly, for restoring that crucial brain-genital connection that patients often report losing.

Speaker 1:

Yeah, this kind of comprehensive, personalized strategy really prioritizes your overall wellness, that's the goal. So, wrapping this up, what does this all mean for you listening? I think the key takeaway from this deep dive is pretty clear. Antidepressants are powerful, important medications, but their sexual side effects, particularly the risk of persistent PSSD and that acute danger of serotonin syndrome, are significant and often under-discussed.

Speaker 1:

They really are danger of serotonin syndrome are significant and often under-discussed. They really are. You have a right to be fully informed about these risks, especially given that, for PSSD, prevention is currently the only established treatment. There's no easy fix after the fact.

Speaker 2:

That's a critical point Prevention through informed choice.

Speaker 1:

So understanding your pre-existing sexual function, openly discussing all medications and lifestyle choices recreational drugs supplements everything and being proactive in conversations with your health care provider are absolutely crucial steps.

Speaker 2:

Don't be afraid to ask the tough questions.

Speaker 1:

Exactly this deep dive has aimed to equip you with the knowledge to have those vital conversations, especially regarding these well hidden dangers.

Speaker 2:

And it really highlights the profound importance of personalized, comprehensive care in managing both mental and sexual health.

Speaker 1:

It's not just about prescribing a pill.

Speaker 2:

Not at all. It's about understanding the individual, their unique risks, their life circumstances and exploring all pathways to holistic well-being.

Speaker 1:

That integrated approach is essential for men to truly thrive and navigate these complex health decisions.

Speaker 2:

Couldn't agree more.

Speaker 1:

So if you're a man who wants to understand how these hidden dangers might impact you, or if you're seeking guidance on optimizing your health and longevity through actionable tips and a comprehensive approach, remember that support is available.

Speaker 2:

Yes.

Speaker 1:

Dr Kumar and the team at LifeWellMDcom specialize in health, wellness and longevity, helping individuals start their wellness journey today.

Speaker 2:

They offer that kind of personalized, comprehensive care we've been talking about.

Speaker 1:

Exactly For that kind of care and a comprehensive approach to your health. We encourage you to call them at 561-210-9999.

Speaker 2:

That number again is 561-210-9999.

Speaker 1:

Thank you for joining us on this deep dive. We really hope this knowledge empowers you to take control of your health.

Speaker 2:

Stay informed.

Speaker 1:

Until next time, stay curious, stay informed and keep asking those important questions.