The pathophysiology of Post SSRI Sexual Dysfunction – Lessons from a case study (2023)
Review
The pathophysiology of Post SSRI Sexual Dysfunction – Lessons from a case study
Samantha Klaas (a 1), Jessica Barbut Siva (a 1), Maarten Bak (b c), Mark Govers (d,) Rudy Schreiber (a)
- A post-SSRI-sexual dysfunction case study taking a design-thinking approach.
- A narrative literature review of the pathophysiology guided by the case study.
- Serotonergic, noradrenergic, neurosteroid and oxytocin systems are involved.
- Potential use of pharma- and nutraceutical agents, however none are FDA approved.
- Complexity of case and pathophysiology emphasizes need for personalized medicine.
Abstract
Background
Although Post-SSRI Sexual Dysfunction (PSSD) has finally been recognized by the European Medicines Agency as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants, this condition is still largely unknown by patients, doctors, and researchers, and hence, poorly understood, underdiagnosed, and undertreated.
Objective
Becoming familiar with the symptomatology of PSSD and understanding the underlying mechanisms and treatment options.
Method
We applied a design thinking approach to innovation to 1) provide insights into the medical condition as well as the personal needs and pains of a targeted patient; and 2) generate ideas for new solutions from the perspective of this particular patient. These insights and ideas informed a literature search on the potential pathophysiological mechanisms that could underlie the patient’s symptoms.
Results
The 55-year-old male patient developed symptoms of low libido, delayed ejaculation, erectile dysfunction, ‘brain zaps’, overactive bladder and urinary inconsistency after discontinuation of the SNRI venlafaxine. In many of these symptoms a dysregulation in serotonergic activity has been implicated, with an important role of 5-HT1A receptor downregulation and possible downstream effects on neurosteroid and oxytocin systems.
Conclusions
The clinical presentation and development of symptoms are suggestive of PSSD but need further clinical elaboration. Further knowledge of post-treatment changes in serotonergic – and possibly noradrenergic – mechanisms is required to improve our understanding of the clinical complaints and to inform appropriate treatment regimes.
Full text: https://www.sciencedirect.com/science/article/pii/S0753332222015554
- Un caso di studio di disfunzione sessuale post-SSRI con un approccio di design-thinking.
- Una revisione narrativa della letteratura sulla fisiopatologia guidata dal caso di studio.
- Sono coinvolti i sistemi serotoninergico, noradrenergico, neurosteroideo e ossitocinico.
- Potenziale uso di agenti farmaceutici e nutraceutici, ma nessuno approvato dalla FDA.
- La complessità del caso e della fisiopatologia sottolinea la necessità di una medicina personalizzata.