Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases
Healy, David; Le Noury, Joanna; Mangin, Dee
International Journal of Risk & Safety in Medicine · 29(3-4):125-1342018
In plain terms
The authors collected 300 reports, sent to a drug-safety website they run, from people in 37 countries whose sexual problems lasted after they stopped certain antidepressants, the acne drug isotretinoin, or the hair-loss and prostate drugs finasteride and dutasteride. People in all three groups described similar problems: genital numbness, orgasms that felt weak or brought little pleasure, low sex drive and, in men, erection problems. For about 1 in 5, the problems started or got much worse only after stopping the drug, and 17 people said they had lasted 10 years or more.
What it doesn’t show: It can't show how often this happens or prove that the drugs caused it: these are reports people chose to send in, with no comparison group and no medical check described, and only 25 came from men who had taken finasteride or dutasteride.
Summary (paraphrased)
Drawing on reports submitted to the RxISK.org adverse-event site, the authors assembled 300 cases of persistent sexual difficulty from 37 countries after treatment with serotonin reuptake inhibiting antidepressants, finasteride-type drugs, or isotretinoin. Genital anesthesia, weak or pleasureless orgasm, loss of libido, and impotence appeared across all three drug groups, while some features (such as new-onset premature ejaculation and persistent genital arousal) were unique to the antidepressant cases. The authors concluded that the data pointed to one or more legacy (tardive) syndromes, said a next step was to establish whether there was a single syndrome, and noted that secondary harms included relationship breakdown and reduced quality of life. They called for diagnostic coding that recognizes these enduring conditions.
Evidence
Extracted from the full text; page numbers refer to the paper. The library’s own notes are labelled as such.
- Design
- Case seriesCase series of patient reports to an online adverse-event reporting site (RxISK.org), selected and coded by the authors
- Setting
- RxISK.org reports from 17 June 2012 to 17 December 2015 and 26 April 2016 to 21 August 2017 (3,033 reports in all); reporters from 37 countries
- Population
- People reporting sexual dysfunction that persisted after stopping a serotonin reuptake inhibitor (SRI), a 5α-reductase inhibitor (5α-RI) or isotretinoin; 245 men and 55 women, aged 15–66 (age given by 295). The authors excluded 51 reports (2 unconvincing, 5 duplicates, 10 possible confounders, 14 ambiguous, 20 too little detail), and set aside 8 linked to antipsychotics or catecholamine reuptake inhibitors.
- Size
- 300 · 300 cases: 221 after SRIs (171 men, 50 women), 54 after isotretinoin (49 men, 5 women), 25 after 5α-RIs (24 finasteride, 1 dutasteride; all men). Group totals summed from Table 1; they match the denominators of Tables 3a–3b.
- Exposure
- 14 drugs: 11 SRIs (escitalopram, citalopram, paroxetine, sertraline, fluoxetine, venlafaxine, duloxetine, fluvoxamine, vortioxetine, clomipramine, desvenlafaxine), isotretinoin, finasteride, dutasteride. Treatment length, given for 226, ranged from a single dose to over 16 years; 19 took the drug for under two weeks.
- Compared with
- None; drug groups described side by side
- Outcome
- Features of enduring sexual dysfunction as described in structured and free-text reports; Naranjo causality score (0–4 more information needed, 5–8 likely link, 9+ strong possibility); impact on relationships and work.
- Follow-up
- None; single reports. Some reported problems lasting 10 or more years after stopping
Key results
- Men (245): erectile dysfunction 216 (88.2%), loss of libido 193 (78.8%), genital anaesthesia 113 (46.1%), pleasureless or weak orgasm 80 (32.7%). Genital anaesthesia by group: SRIs 84 of 171 (49.1%), isotretinoin 18 of 49 (36.7%), 5α-RIs 11 of 25 (44.0%) · p. 128, Table 3a
- Women (55): loss of libido 41 (74.5%), genital anaesthesia 33 (60.0%), difficulty achieving orgasm 32 (58.2%), emotional blunting 14 (25.5%) · p. 129, Table 3b
- Men on 5α-RIs (25) more often reported watery ejaculate 8 (32.0%), testicular atrophy 8 (32.0%), reduced penis size 7 (28.0%) and penile or testicular pain 5 (20.0%) than the other groups; new premature ejaculation (17 men) and persistent genital arousal disorder (6; 2 men, 4 women) were reported only after SRIs · pp. 128–129, Tables 3a–3b
- Dysfunction appeared, or became much worse, only after stopping in 41 SRI cases (18.6%), 9 isotretinoin cases (16.7%) and 7 5α-RI cases (28.0%) · p. 129
- 17 reported the condition lasting at least 10 years after stopping (8 isotretinoin, 8 SRIs, 1 finasteride), 5 of them over 20 years; 25 reported a relationship breakup (9 marriages) and 90 said their work was affected (12 lost jobs) · p. 129
- Mean Naranjo causality scores were 8.9 (SRIs), 8.8 (5α-RIs) and 8.5 (isotretinoin); the authors consider these underestimates because the algorithm is not designed for lasting effects · pp. 126–127
Limitations the authors note
- Articles on enduring sexual dysfunction run on RxISK.org since 2013 likely encouraged reporting
- The Naranjo and similar algorithms are not geared to lasting effects, so causality scores are likely underestimates
- The reporting facility was unavailable for an extended period (December 2015 to April 2016)
- Not every report mentions genital anaesthesia, though the authors say every PSSD patient who contacted them directly has had it
- How often PSSD occurs is unknown
- Online communities' focus (for example on neurosteroids in PFS) may shape which features are reported and obscure shared ones; structured interviews are needed to test whether there is a single syndrome
- Earlier treatments, such as tetracycline-type antibiotics, were not explored
Also worth weighing (library’s note)
- Self-selected, self-reported online reports; no clinical examination or independent verification is described, and the counts are not rates
- The authors set up the reporting site and chose which reports to include; the number of reports found before exclusions is not given
- No comparison group of people who took the same drugs without lasting problems
- The 5α-RI group is small (25 men), so its percentages rest on few reports (32.0% is 8 men)
- Symptoms come from what reporters chose to describe, not a fixed checklist, so a missing symptom does not mean it was absent; denominators for fatigue (9%), muscle weakness (3%), brain fog (19%) and memory impairment (11%) are not given
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sectors Interests: All three authors are linked to RxISK.org (the reporting site used); none declared consultancy or other links to groups with an interest in the results
What it can support (library’s note): That people report a similar pattern of lasting sexual problems, especially genital numbness, weak or pleasureless orgasm, low libido and erection problems, after SRIs, 5α-reductase inhibitors and isotretinoin. It cannot show how common this is, establish causation, or show that it is one syndrome rather than several.
Why it’s in the corpus
A landmark cross-drug case series (221 serotonin reuptake inhibitor, 54 isotretinoin and 25 5α-reductase inhibitor cases) showing overlapping features of enduring sexual dysfunction across the three drug classes; the authors leave open whether this is one shared syndrome or several. Foundational citation for the corpus's cross-drug axis.
Some fields on this page come from the release’s Markdown edition, which carries text the JSON edition omits.
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