Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

David Healy¹, Audrey Bahrick², Maarten Bak^{3

4}, Angelo Barbato⁵, Rocco Salvatore Calabrò⁶, Barbara M Chubak⁷, Fiammetta Cosci^{3

8

9}, Antonei B Csoka¹⁰, Barbara D'Avanzo⁵, Silvia Diviccaro¹¹, Silvia Giatti¹¹, Irwin Goldstein^{12

13}, Heiko Graf¹⁴, Wayne J G Hellstrom¹⁵, Michael S Irwig^{16

17}, Emmanuele A Jannini¹⁸, Paddy K C Janssen^{19

20}, Mohit Khera²¹, Manoj Therayil Kumar²², Joanna Le Noury²³, Michał Lew-Starowicz²⁴, David E J Linden²⁵, Celine Lüning²⁶, Dee Mangin¹, Roberto Cosimo Melcangi¹¹, Omar Walid Muquebil Ali Al Shaban Rodríguez²⁷, Jalesh N Panicker^{28

29}, Arianna Patacchini⁸, Amy M Pearlman³⁰, Caroline F Pukall³¹, Sanjana Raj³², Yacov Reisman³³, Rachel S Rubin³⁴, Rudy Schreiber³⁵, Stuart Shipko³⁶, Barbora Vašečková³⁷, Ahad Waraich¹³

Affiliations

¹ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
² University Counseling Service, University of Iowa, Iowa City, IA, USA.
³ Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
⁴ FACT, Mondriaan Mental Health, Maastricht/Heerlen, The Netherlands.
⁵ Unit for Quality of Care and Rights Promotion in Mental Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
⁶ IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
⁷ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Health Sciences, University of Florence, Florence, Italy.
⁹ Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.
¹⁰ Department of Anatomy, Howard University College of Medicine, Washington, DC, USA.
¹¹ Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
¹² Alvarado Hospital, San Diego, CA, USA.
¹³ San Diego Sexual Medicine, San Diego, CA, USA.
¹⁴ Department of Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
¹⁵ Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
¹⁶ Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁷ Harvard Medical School, Boston, MA, USA.
¹⁸ Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
¹⁹ Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
²⁰ Department of Hospital Pharmacy, VieCuri Medical Center, Venlo, The Netherlands.
²¹ Department of Urology, Baylor School of Medicine, Houston, TX, USA.
²² Institute for Mind and Brain, Kerala, India.
²³ North Wales Department of Psychological Medicine, Bangor, Wales, UK.
²⁴ Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland.
²⁵ Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
²⁶ Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany.
²⁷ Psychiatry Service, Hospital Universitario San Agustín, Avilés, Asturias, Spain.
²⁸ Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
²⁹ Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
³⁰ Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
³¹ Department of Psychology, Queen's University, Kingston, ON, Canada.
³² Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.
³³ Flare-Health, Amstelveen, The Netherlands.
³⁴ Department of Urology, Georgetown University School of Medicine, Washington, DC, USA.
³⁵ Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
³⁶ Private Practice, Pasadena, CA, USA.
³⁷ Psychiatric Clinic, Slovak Medical University and University Hospital, Bratislava, Slovakia.

PMID: 34719438
PMCID: PMC8925105
DOI: 10.3233/JRS-210023

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

David Healy et al. Int J Risk Saf Med. 2022.

. 2022;33(1):65-76.

doi: 10.3233/JRS-210023.

Authors

Affiliations

¹ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
² University Counseling Service, University of Iowa, Iowa City, IA, USA.
³ Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
⁴ FACT, Mondriaan Mental Health, Maastricht/Heerlen, The Netherlands.
⁵ Unit for Quality of Care and Rights Promotion in Mental Health, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
⁶ IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
⁷ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁸ Department of Health Sciences, University of Florence, Florence, Italy.
⁹ Clinical Pharmacopsychology Laboratory, University of Florence, Florence, Italy.
¹⁰ Department of Anatomy, Howard University College of Medicine, Washington, DC, USA.
¹¹ Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
¹² Alvarado Hospital, San Diego, CA, USA.
¹³ San Diego Sexual Medicine, San Diego, CA, USA.
¹⁴ Department of Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
¹⁵ Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
¹⁶ Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁷ Harvard Medical School, Boston, MA, USA.
¹⁸ Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
¹⁹ Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
²⁰ Department of Hospital Pharmacy, VieCuri Medical Center, Venlo, The Netherlands.
²¹ Department of Urology, Baylor School of Medicine, Houston, TX, USA.
²² Institute for Mind and Brain, Kerala, India.
²³ North Wales Department of Psychological Medicine, Bangor, Wales, UK.
²⁴ Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland.
²⁵ Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
²⁶ Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany.
²⁷ Psychiatry Service, Hospital Universitario San Agustín, Avilés, Asturias, Spain.
²⁸ Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
²⁹ Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
³⁰ Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
³¹ Department of Psychology, Queen's University, Kingston, ON, Canada.
³² Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.
³³ Flare-Health, Amstelveen, The Netherlands.
³⁴ Department of Urology, Georgetown University School of Medicine, Washington, DC, USA.
³⁵ Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
³⁶ Private Practice, Pasadena, CA, USA.
³⁷ Psychiatric Clinic, Slovak Medical University and University Hospital, Bratislava, Slovakia.

PMID: 34719438
PMCID: PMC8925105
DOI: 10.3233/JRS-210023

Abstract

Background: A set of enduring conditions have been reported in the literature involving persistent sexual dysfunction after discontinuation of serotonin reuptake inhibiting antidepressants, 5 alpha-reductase inhibitors and isotretinoin.

Objective: To develop diagnostic criteria for post-SSRI sexual dysfunction (PSSD), persistent genital arousal disorder (PGAD) following serotonin reuptake inhibitors, post-finasteride syndrome (PFS) and post-retinoid sexual dysfunction (PRSD).

Methods: The original draft was designed using data from two published case series (Hogan et al., 2014 and Healy et al., 2018), which represent the largest public collections of data on these enduring conditions. It was further developed with the involvement of a multidisciplinary panel of experts.

Results: A set of criteria were agreed upon for each of the above conditions. Features of PSSD, PFS and PRSD commonly include decreased genital and orgasmic sensation, decreased sexual desire and erectile dysfunction. Ancillary non-sexual symptoms vary depending on the specific condition but can include emotional blunting and cognitive impairment. PGAD presents with an almost mirror image of unwanted sensations of genital arousal or irritability in the absence of sexual desire. A new term, post-SSRI asexuality, is introduced to describe a dampening of sexual interest and pleasure resulting from a pre-natal or pre-teen exposure to a serotonin reuptake inhibitor.

Conclusions: These criteria will help in both clinical and research settings. As with all criteria, they will likely need modification in the light of developments.

Keywords: Post-SSRI sexual dysfunction; antidepressants; finasteride; isotretinoin; selective serotonin reuptake inhibitors.

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References

1. 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):125–34. - PMC - PubMed
1. Leiblum SR, Nathan SG. Persistent sexual arousal syndrome. A newly discovered pattern of female sexuality. J Sex Marital Ther. 2001;27(4):365–80. - PubMed
1. Csoka AB, Shipko S. Persistent sexual side effects after SSRI discontinuation. Psychother Psychosom. 2006;75(3):187–8. - PubMed
1. Bahrick AS. Post SSRI sexual dysfunction. American Society for the Advancement of Pharmacotherapy Tablet. 2006;7(3):2–3, 10–11.
1. Irwig MS, Kolukula S. Persistent sexual side effects of finasteride for male pattern hair loss. J Sex Med. 2011;8(6):1747–53. - PubMed

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Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

Affiliations

Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin

Authors

Affiliations

Abstract

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials