A pharmacist has issued a warning after the Medicines and Healthcare products Regulatory Agency (MHRA) updated patient information for people taking certain antidepressants, including sertraline, fluoxetine and citalopram. The update includes clearer information that sexual side effects can sometimes continue after people stop taking these medications.
What the MHRA update covers
Palvinder Deol, Superintendent Pharmacist at Happy Pharmacy, said: "The Medicines and Healthcare products Regulatory Agency (MHRA) announced new antidepressant safety warnings including clearer information that sexual side effects can sometimes continue after people stop taking certain medications. Common antidepressants such as sertraline can affect your sex drive or change how you experience sexual sensation, and for some people, these problems can continue even after treatment has ended."
Deol added: "We still don't know exactly how common these lasting symptoms are, but antidepressants can be an important part of treating mental health conditions, so people shouldn't suddenly stop taking them because of the warning. Anyone who's noticed changes in their sexual health, whether they're still taking antidepressants or have already stopped, should speak to their GP or pharmacist."
Sexual side effects are well known with certain antidepressants, particularly medicines such as sertraline, fluoxetine and citalopram. People may find they are not as interested in sex as they used to be, struggle to become aroused, or find it harder to reach orgasm. Some also notice that sexual touch does not feel the same or that they have lost some sensation.
Understanding PSSD
Post-SSRI sexual dysfunction, or PSSD, is a term used to describe certain sexual problems that continue after someone has stopped taking an antidepressant. Normally, side effects would be expected to improve once the medicine is no longer being taken, but that does not always happen. Some people have reported changes that continue for months or even longer after treatment ends.
The MHRA's latest safety update covers commonly prescribed antidepressants, including sertraline, fluoxetine, citalopram, escitalopram, paroxetine and fluvoxamine. These are known as SSRIs and are widely used to treat depression and anxiety. Other antidepressants, including venlafaxine and duloxetine, are also relevant to the review, although that does not mean every medicine carries exactly the same risk of persistent sexual problems.
Deol said: "The MHRA's updated warning makes it clearer that these lasting problems can happen, although we still don't know exactly how common they are or why some people experience them. That doesn't mean everyone taking antidepressants will have sexual side effects, or that those who do will struggle with them long term. The important thing is knowing that persistent symptoms are possible, rather than assuming they'll always disappear once treatment stops."
Considering other causes
If sexual problems continue after stopping antidepressants, it does not automatically mean someone has PSSD. Deol said: "If you've noticed changes after stopping medication, it's reasonable to wonder whether the two are connected, but it's important to look at what else might be going on before assuming you have PSSD. Depression and anxiety can affect your sex life even when you're not taking medication."
Hormonal changes, menopause, diabetes, other prescription medicines and certain health conditions can also play a part. Stress, poor sleep and relationship difficulties may make things worse. A GP will usually want to know when the problems started, whether they were noticed while taking antidepressants, and what has happened since stopping. They may also ask about mental health, other medications and any changes in physical health, and can arrange tests or refer for further assessment if needed.
What to do if you are affected
Deol advises that people whose antidepressant is helping their mental health but affecting their sex life should speak up rather than put up with it in silence. A prescriber might look at whether the dose could be adjusted, whether a different antidepressant might suit better, or whether there is a treatment that could help with a particular sexual problem.
People should not start skipping tablets, cutting their dose or stopping suddenly to see whether their sex drive improves. Coming off antidepressants too quickly can cause withdrawal symptoms such as dizziness, nausea, anxiety, sleep problems and unpleasant sensations that some people describe as electric shocks. It could also cause the depression or anxiety being treated to come back.
For those who stopped taking antidepressants months or years ago but still have sexual difficulties, Deol says it is still worth speaking to a doctor. There is not currently a treatment proven to reliably reverse PSSD, and researchers are still trying to understand why it happens. People can report suspected side effects through the MHRA's Yellow Card scheme, even if they are no longer taking the medication.
The MHRA is also making warnings about suicidal thoughts and behaviours more prominent in antidepressant information leaflets. Some people may experience new or worsening thoughts of self-harm, particularly when they first start treatment or after their dose changes. The updated information includes clearer boxed warnings and a new patient information card. Deol encourages people to ask their prescriber what changes to look out for and to seek urgent help if they develop new or worsening suicidal thoughts, contacting NHS 111, their local mental health crisis service, or calling 999 or going to A&E if in immediate danger.
