Mild NSFW warning: this post mentions sexual side effects of medication.
SSRIs are the most common type of antidepressant (examples are Prozac/fluoxetine, Zoloft/sertraline, Paxil/paroxetine).
If you have experience with them, do you think they’re a good idea?
I came across a paper about side effects which I haven’t heard discussed before. Many people know that SSRIs have sexual effects, but apparently they also affect fertility.
This paper describes SSRIs as “gonadotoxic”, leading to effects like “decreased sperm concentration and motility, increased [DNA] fragmentation, and decreased reproductive organ weights”.
The paper does say “this effect does seem to be reversible”, so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
I would be interested to hear others’ thoughts, if you have any.
Edit: Thanks for the replies to this post, they’re interesting.
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Please don’t ask random, uninformed people on the internet about your medical treatment plan. Talk to an actual psychiatrist about your concerns.
Yeah that makes sense. But I like hearing from people in my position, who take the meds, rather than just dish them out.
In my experience doctors can be dismissive of your concerns, perhaps because they’re busy and overworked.
A major factor with antidepressants, even with ones in the same class of drugs, is that different people respond differently to different drugs. You really need to work closely with a prescribing doctor until you find what’s right for you, which is often a lengthy process. I literally can’t think of a worse place to rely on anecdotal evidence.
I have been on SSRIs for 20 years. For me they’re a good idea, but I’ve known others who have had a terrible time with them.
Sexual dysfunction is definitely a thing: how much of an issue that will be is going to be a personal decision on weighing up pros and cons. If your sex drive is low as a part of your depressive symptoms or you’re already experiencing anhedonia (inability to feel happiness/pleasure) or anorgasmia (inability to achieve orgasm) then going on SSRIs isn’t going to make that any worse. But for others the risk of missing sexual pleasure might be an unacceptable trade-off.
For anyone starting SSRIs I think it’s best to go slowly and keep in touch with your primary doctor throughout the process. There are a number of SSRIs available, and if one doesn’t work out you can try others, and hopefully land on one that works for you.
With all that said, SSRIs don’t work for everyone. It’s not unusual to feel weird or like things are getting worse when you first start them: it takes some time for the effects to settle. But if you’re having a really bad time on them, speak to your doctor about alternatives.
Thanks for this reply. To be honest I’m not so worried about the well-known sexual side effects. Instead I worry about fertility effects. The paper I mentioned in the OP says that fertility should return to normal when you come off SSRIs, so I guess that’s good. But then I came across an article mentioning a study on rats, where they apparently found impaired fertility “which persisted after the drug was stopped”.
I bet most local doctors don’t even know of these effects. They’ll know about erectile dysfunction etc, but this is something different to that.
Maybe I’m worrying too much, I don’t know. I wonder if anybody on this site has heard of these effects before.
I don’t know anything about its effect on fertility. I know people who have conceived while on SSRIs, but that’s purely anecdotal.
It’s going to be a judgement call on your part. SSRIs have been in use for long enough that I would expect there’s a big pool of data around fertility rates, even if it’s not had much analysis done on it. Also, rat models are useful but need to be understood in their context. One study in rats is not overwhelming evidence.
though it only coincidentally related SSRIs fucked me up in a different way (which still affected my libido tbf). i didn’t even get to a month of treatment before i decided to quit - they were supposed to help with my anxiety, but instead of helping they made it significantly worse, to the point where i felt as if i was spending my time edging a panic attack at all times of the day. At first i thought i was just getting worse normally, but then i noticed i felt better in the evenings (i was taking them in the mornings). i just couldn’t keep going it was awful
there’s plenty of people for whom SSRIs are life changers, but sadly i’m not in that group
If you are bipolar and unmedicated for it, they will make it worse by increasing instability
nah it was just general light anxiety, and strong situational anxiety. both stemming semi-directly from adhd
Coupled with an excellent therapist, literally saved my life when I was struggling with depression. And my fertility has not been too hampered, if you know what I mean. It can surely have bad side effects for some people, but for others it is life-changing.
If you have experience with them, do you think they’re a good idea?
If they help with treating one’s illness, absolutely.
The paper does say “this effect does seem to be reversible”, so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
Correct on both points. There are a number of medications that have similar effects and similarly have good profiles for reversal (including TRT).
It’s something that warrants more study, yes, but the risk vs benefit is a very good balance. If further study shows teratogenic effects, it should be widely communicated and handled appropriately. However, there are many lives saved.
If you’re worried by being prescribed them, noone can tell you what’s right for you and your doctor but, I’d probably not pay it any mind. They’re not super scary things and don’t say anything bad about you.
I didn’t like SSRIs. I found the effects for me to be very, very marginal, and the side effects–weight gain, sexual dysfunction–to be very unpleasant. The Zyprexa I was given (an atypical antipsychotic, I believe) was even worse for weight gain and sexual dysfunction. I preferred bupropion, which had neither side effect. The effects were still very marginal, IMO.
A lot of people have a REALLY hard time getting off SSRIs if they it doesn’t work, if the side effects are too serious, etc. Some people report ‘brain zaps’, and serious withdrawal. Like, really bad. It can take months for the withdrawal symptoms to ease or go away completely.
If it’s for depression, I’d look into TCMS. It’s probably more expensive up front, but supposedly you can have significant improvement in 50 or fewer sessions.
According to the book “Anatomy of an Epidemic” SSRIs (antidepressants) improve patient symptoms slightly in the short term compared to those who are not medicated. However, in the long term:
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They do not solve the problem of anxiety/depression at the symptomatic level.
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They hinder the patient’s recovery and turn them into a chronic depressive or anxious individual.
In my experience, since I started taking SSRIs, I have been having more panic attacks, even though initially, about 5 years ago, they seemed to improve my symptoms of social anxiety and sadness.
Check this out: https://robertwhitakerbooks.com/anatomy-of-an-epidemic/antidepressantsdepression/
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I think the main benefit of drugs is making new states of mind known, so they can later be sought organically.
One of my teachers said it’s like climbing a mountain in a rainstorm, and then suddenly there’s a flash of lightning and you see the whole mountain for a moment.
SSRIs and other antidepressants are good for people who’ve forgotten what it’s like to be at ease, who’ve been in the shit for so long that they don’t have any mental connection to a world outside of the shit any longer.
Then you just force the serotonin activity up, and this reintroduces the person to a better life. They can stay there for a while and become acquainted with it. It can give them a reason to try.
I don’t have any issues with the drugs themselves. That said, there’s serious consent issues around these medications, at least in the U.S.
Such as being overprescribed for conditions that they don’t treat well (CPTSD and PTSD for instance), having the positive effects overstated (they’re okay for mild to moderate depression, and not great for off label uses such as those just mentioned), and having the side effects downplayed (addictive is addictive, we don’t need new words like discontinuation syndrome, when withdrawal communicates clearly). SSRIs aren’t even the worst offenders on the market when it comes to this. SNRIs often have a very short half life, and a single missed dose can cause crippling withdrawal.
But how many of us have been prescribed these off label? With no indication of their addictive nature and potential withdrawal, not to mention sexual dysfunction? And for conditions that they don’t treat well to begin with? That’s not informed consent.
