Antidepressants and Sexual Side Effects

The grim reality

The post on April 8^th pointed to potential links between antidepressant use, long-term sexual side effects and the sudden surge in transgender diagnoses. Are there connections and, if so, what could they be? For decades, sexual side effects of the drugs were dismissed as imaginary, minor, transient, or due to the depression but that’s completely false. We now have a name for the problem, Post-SSRI Sexual Disorder or PSSD, which is a start. The European Medicines Agency [1] requires antidepressants to include specific warnings on the product information leaflets that they can cause “symptoms of sexual dysfunction (which can continue) after stopping treatment.”

Soon after that post, I received a lengthy email from a member of a group of PSSD sufferers in the UK, PSSD Network.org. It included quite a few references on the subject which show how real, persistent and devastating this problem is. On their site, they have stories from sufferers from around the world which all say much as this one does:

I also feel betrayed by the medical establishment, as I was given no warning that the long-term sexual symptoms and emotional numbness could persist after discontinuing the drug. I would have never taken Citalopram if I had been informed of the risk of developing PSSD. Every day is a struggle for me, and I feel like I am merely existing and surviving, unable to derive any enjoyment from life with this condition. I have no idea if I will ever recover or if I will have to live in this horrible state for the rest of my life. Living with PSSD can be described as a form of prolonged mental torture, where you can't interact and function in the world as you're supposed to.

Mental torture. Torture is what the victim experiences, not what the perpetrator intends. As for not being given the information, that’s absolutely true. Despite any propaganda from psychiatric organisations, patients are simply not given information to make a reasoned choice. All too often, if they complain of side effects, they’re told to stop being silly, or given more drugs for yet another diagnosis based on the side effects. Dr Josef Witt-Doering, an Australian psychiatrist working in New York, is perfectly blunt: Psychiatrists, he says, commonly lie about drug side effects. I don’t know how many actually lie but we know for a fact that, from the most senior positions down, they are perfectly happy to repeat things which sound good when a few minutes’ investigation would show they are false, but they choose not to investigate.

We saw this a few years ago when the president of the Royal College of Psychiatrists in the UK and the chairman of their college committee on drugs stated that withdrawal effects from antidepressants were minor and lasted only a week or two. After considerable pressure, including complaints to the college, she very reluctantly issued a revised statement saying withdrawal effects are not minor and last much longer than a few weeks. There was no excuse for her ignorance, especially as it damages patients, but the reason is simple: they don’t want to know about drug withdrawals. They want to believe their own narrative that depression is a genetic disease of the brain which is quickly and safely treated with their happy pills because, left untreated, it causes suicide and brain damage. That’s their story, but it’s false, a false narrative.

Despite anything Mr RF Kennedy Jr may believe, mainstream medicine doesn’t have many false narratives, but psychiatry certainly does. They are built into its structure and we know how and why. Claim No. 1, of course, is that they actually know what they’re doing, they have a scientific model which governs their practice, their teaching and their research. There’s a bit of debate over whether the model is a reductionist biological model called the biomedical model, or whether it’s a dualist model called the biopsychosocial model. That fact that these two approaches are incompatible hasn’t registered yet but, more to the point, nor has the fact that neither of them exists as anything more than a vague hope. In every sense of the term, each of them is a false narrative but if you can get any psychiatrist to admit that, please let me know as I’ve been trying for 30 years and haven’t got anything other than abuse.

Claim No. 2 is that everything psychiatrists do, from locking people up to drugging and shocking them against their will, is fully justified by their “evidence-based science of mental disorder.” Again, this is a fantasy as, absent a model of mental disorder, there is no way of knowing what the evidence amounts to: the model tells us what facts are relevant and what should be ignored. If there is no model guiding the collection of evidence, then it’s collected according to prejudice. For example, the sexual side effects of antidepressants: psychiatrists simply don’t believe these drugs have that effect. As far as they’re concerned, impotence, loss of libido or anorgasmia are caused by depression itself, because that’s what their “model” tells them. What the complaining patient needs is more antidepressants, not less. Their narrative tells them to dump the complaint of loss of sexuality in the “insignificant” bin and punish the patient for moaning over nothing (known as “Somatisation Disorder”).

Same goes for akathisia, which is Greek for “unable to sit” because that’s what it is: a serious and exceedingly unpleasant side effect of most psychiatric drugs that won’t let you sit. People suffering from akathisia have an intense sensation that they have to move. They pace up and down, stamp, twitch, jerk, wave their arms and are often unable to get to sleep because of it. It’s more common with certain classes of drugs: years ago, it was known as “the Stelazine stomp,” but also very common with injectables. I believe akathisia is a significant factor in sudden, inexplicable suicides and/or homicides in people recently started on psychiatric drugs. However, it is common for psychiatrists to dismiss this complaint on the basis there’s no evidence for it but that’s because they don’t do the research [2]. When you consider how long these drugs have been around, how many people are forced to take them, how patients describe akathisia as torture, and above all, how little research there is, you could be excused for thinking psychiatrists don’t want to know about it. They are comfortable with their narrative and don’t want any inconvenient facts getting in the way. Is that science? Absolutely not.

The question then arises: How does this happen? How come important matters such as side effects aren’t studied, or evidence of severe adverse effects is suppressed [3]? Part of the problem is the frantic rush to get drugs on the market in the first place, which means that they haven’t been studied long enough to find long term side effects. A typical drug trial is 8 weeks, whereas people are often taking them for 25 years. Another factor is that the technology to study them properly wasn’t available 35-40 years ago. For example, with permanent changes such as loss of sexuality, it is now known that SSRI drugs cause major changes in a class of hormones that are either produced in or affect parts of the brain involved in sexual interest and behaviour [4]. The effects are also seen in laboratory animals, so it can’t be dismissed as Somatisation Disorder. None of this was known when these drugs were developed in the early to mid 1980s.

Similarly, there is now good evidence to indicate that SSRI and SNRI antidepressants can cause irreversible changes to the patient’s genetic material. This is not a direct effect on DNA, as with drugs that cause cancers, but an indirect effect on how the DNA is packaged in the cell which affects how it is expressed. Because of the incredible complexity of the way DNA is wrapped and bundled in the cell, it is now known that the bundles can become tangled due to drug-induced cross-linkages, known as epigenetic links. As a result, the normal production of proteins is blocked. If the protein that gets blocked is part of the array of hormones involved in sexuality, then serious side effects can develop. Because there is no way known of reversing these changes, they are likely to be permanent. Is there any firm evidence for this? Yes, there is. A group studied the effect of the common antidepressant drug citalopram on gene expression in human cells for only 30 days. They concluded:

The study validates our hypothesis that pharmaceutical drugs can have off-target epigenetic effects and reveals affected networks and pathways. We view this study as a first step towards understanding the long-term epigenetic consequences of prescription drugs on human health [3].

They pointed out that where drug mixtures are used, so-called ‘polypharmacy’ which is absolutely normal in psychiatry, such changes would become much more likely but would be unpredictable. So at this stage, it looks as though PSSD is not due to depression but to the drugs. There is a clear theoretical pathway which needs to be studied in more detail and, until that happens, patients need to be given full information on the sexual risks so they can make an informed decision. When that happens, the rate of acceptance of antidepressants plummets by about 95%.

That’s all very interesting and scary, so why doesn’t it get more air time? It’s not popular with psychiatrists, that’s why. The push to get people taking hallucinogenic drugs for a range of unrelated mental disorders powers ahead but serious side effects are ignored. Isn’t that what the ethical psychiatric publishing industry is for, to publish a balance of the good news and the bad? Sure, and if you believe that, there’s a very nice bridge in Sydney Harbour I could sell you because the psychiatric publishing industry is back in the news for just that. Mr Kennedy (again) has accused prestigious medical journals in the US of “lying” about Mr Trump’s response to the pandemic and has installed a lawyer in the Department of Justice to go after them. U.S. Attorney Edward Martin sent letters to a number of medical journals, including the prestigious New England Journal of Medicine, asking them to respond pronto to these questions:

How do you assess your responsibilities to protect the public from misinformation?

How do you clearly articulate to the public when you have certain viewpoints that are influenced by your ongoing relations with supporters, funders, advertisers, and others?

Do you accept articles or essays from competing viewpoints?

How do you assess the role played by government officials and funding organizations like the National Institutes of Health in the development of submitted articles?

How do you handle allegations that authors of works in your journals may have misled their readers?

On the face of it, these are absolutely standard questions for any scientific journal and, in normal times, would attract a boilerplate response to stifle any further questions: Of course we’re responsible; our positions aren’t influenced by advertisers, funders, etc; and we always publish competing viewpoints yahdy yah. But these are not normal times so a couple of indignant editorials have appeared in The Lancet, which was established in London in 1823, just a few years after the NEJM in Boston. The first, on February 8^th, was titled American chaos: standing up for health and medicine, alongside a photo of Mr Trump, which was perhaps not their most diplomatic move. They concluded this: “… is no time for panic … The Lancet will be a focal point of accountability over the next 4 years, monitoring and reviewing the actions of the US Government and the consequences of its decisions for health.” I’m sure Mr Trump is quaking in his boots. If that wasn’t enough, they fired another shot on April 26^th, just after Mr Martin’s letters were reaching their targets. This one, Supporting medical science in the USA, concluded:

Science and medicine in the USA are being violently dismembered while the world watches. While the risks to civil servants and academics’ livelihoods are real and understandably frightening, bullies are only emboldened by acquiescence or indifference.

All true but, for all its impact, their shot probably fell in the Irish Sea. Not to be outdone, the British Journal of Psychiatry (BJP) nailed their colours to their mast with an editorial written by no less than 22 heavies: Truthful communication of mental science: pledge to our patients and profession. They bemoaned the diversion of research funds as well as the niggling restrictions on reporting sex, ethnicity, etc. of patients in research studies. They pledged not to be intimidated by these antiscientific moves:

… we as journal editors … will continue to strive for the highest scientific standards …we will continue to:

(a) communicate research that has been conducted ethically and report findings that are scientifically accurate and clinically meaningful;

(b) publish science that reflects reality and advances knowledge based on inclusion of those who are disadvantaged;

(c) uphold our high standards of scientific publishing and maintain the integrity of our research record.

Two of the authors were Prof. G Malhi, of Sydney University, former editor of the Australian and New Zealand Journal of Psychiatry (ANZJP) and now editor of BJP, and Prof. S Kisely, of University of Queensland and now editor of ANZJP. We came across them a few weeks ago in connection with an editorial they published jointly in ANZJP which I covered on April 8^th. Very briefly, some years ago, the RANZCP published “guidelines on management of mood disorders” which didn’t mention psychotherapy, thereby annoying a sizeable number of the membership. They forced a special meeting of the college which, to keep the peace, contracted with a psychoanalytic institute in London, the Anna Freud Centre, to provide a review of psychotherapy. Their report was duly circulated to the members but, in turn, it annoyed the authors of the original guidelines, two of whom used their status as editors to publish an editorial arguing that the review was no good. They concluded with a stamp of their little feet: “In the 21st century, facts should be established through rigorous scientific enquiry, not popular vote” [6, p7]. This, as I pointed out in a letter to the editor, is complete rubbish. Every entry in the DSM is decided by a vote in its labyrinthine committees, and the biopsychosocial model (which they endorse) was adopted (by a committee vote) without any enquiry, rigorous or otherwise. Needless to say, my letter criticising the editors was rejected with no reason given.

Now the plot thickens. In a surprising turn, the current president of the RANZCP, a Dr Elizabeth Moore of Canberra (the same one who refuses to provide any details of her “science-based” biopsychosocial model) stated in her recent newsletter (April 24^th) that the editors should not have published their editorial:

I emphasise my disappointment with the publication of this editorial as it directly contravened advice provided to all members regarding the embargoed nature of the review. The Board is aware of the impact that the editorial has had on College committees, members and the Anna Freud Centre, and will be addressing these concerns at the next Board meeting.

Normally, this sort of catfight is kept out of sight so she was obviously very annoyed. I’d say there’s a lot more to this than we ordinary members will ever know, and 99% of it is personal just because there’s no science involved. So what, you say, sounds like business as usual in the psychiatry sandpit. Well, on the one hand, we have the assembled editors of medical journals squealing that nobody should be allowed to question them as their ethics are beyond reproach, and yet, breaching protocol in the process, two of them publish frank falsehoods and then make sure nobody sees that they have knowingly published bullshit. And I agree, that is definitely business as usual in the psychiatric publishing industry which is why I have long argued it should be closed and replaced with an entirely different online system, using a process similar to blockchains, but that’s another matter.

So I asked earlier how does it happen that psychiatry gets away with spreading false narratives? The answer is perfectly clear. The people who set the pace in psychiatry, the movers and shakers and powers-that-be, have always drawn the clearest of lines between psychiatry as medical psychology and other helping disciplines such as psychology, social work, religious pastoral support, etc. In order to be accepted as medical, they had to get rid of the scornful label of “trick cyclists” by emphasising their status as a “biological science.” However, since they don’t have a biological model of mental disorder, or any model, they realised they don’t have a scientific leg to stand on, so they made one up (take your pick of biomedical or biopsychosocial), touted it far and wide and then made sure nobody questions it.

In this project, the editors of the world’s 300 or so psychiatric journals play a pivotal role. As members of a very tight and exclusive international fraternity, editors act as keepers of the gate, sorting, as they say, the wheat from the chaff and making sure only the chaff is published. Twenty years ago, John Ioannidis, one of the most widely cited medical researchers, published an article with the pointed title: “Why most published research findings are false” [7]. Similarly, Richard Smith, long-time associate editor of the BMJ, punched his former employers in the face with an essay: “Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies” [8]. I rest my case.

Bear in mind that scientific publishing is one of the most profitable industries in the world, with a return on equity (ROE) of anything up to 36% (see this lengthy but very interesting article on science publishing, which describes the role of one Robert Maxwell, father of Ghislaine, the imprisoned girlfriend of Jeffrey Epstein) and we have all the features of yet another “conspiracy of the like-minded.” As for their valiant protestations of editorial rectitude, “Methinks the lady doth protest too much.” Like-minded they certainly are but in view of the amazing cock-up over publishing embargoed material (imagine the shit fight if I tried that stunt), we really have to ask how bright these people are. Don’t ask them because, like Herr Drumpf, they’re all convinced they’re “very stable geniuses.” That’s what happens when exclusive control of publishing, a central pillar of the scientific process, is handed to a self-selected and closed inner circle of people committed to a single viewpoint and who bitterly resent being questioned. Anybody who isn’t committed or has sticky questions to ask just doesn’t get a look in.

References:

1. EMA/PRAC/265212/2019, June 11^th 2019. Kainiunas A et al (2021). The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review. Neuropsych Dis Treatment. Published online Dec. 3, 2021. https://doi.org/10.2147/NDT.S337785

2. Le Noury J et al (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ; At: https://www.bmj.com/content/351/bmj.h4320

3. Giatti S et al (2021) Effects of paroxetine treatment and its withdrawal on neurosteroidogenesis. Psychoneuroendocrinology 132 (2021) 105364. https://doi.org/10.1016/j.psyneuen.2021.105364

4. Kanherkar RR et al (2018). The Effect of Citalopram on Genome-Wide DNA Methylation of Human Cells. Int. J Genomics. https://doi.org/10.1155/2018/8929057

5. Kisely S, Malhi G (2025): Concerns over the process and outcomes of the review by the RANZCP into long-term psychodynamic psychotherapy. Aust NZ J Psychiat. Published online Dec 24, 2024; https://doi.org/10.1177/00048674241308371.

6. Ioannidis JPA (2005) Why most published research findings are false. PLoS Med 2(8): e124 https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124.

7. Smith R (2005) Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2(5): e138. DOI: 10.1371/journal.pmed.0020138

Disclosure: I am an associate editor at Ethical Human Psychology and Psychiatry.

The whole of this material is copyright but can be quoted or retransmitted provided the author is acknowledged.