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Comment by sillysaurusx | Hacker News Reader

I take Sidenafil for this which works for me, but I guess for other people it might be less effective.

Since we’re being honest, the only effects I’ve noticed are going soft after 20 minutes or so, and more difficulty finishing. Sidenafil helps with the former. As for the latter, it isn’t every time, and I don’t mind it much, but everyone’s different.

I think it’s important to address this issue head on though. The horror stories of sexual dysfunction were one reason I put off trying antidepressants. But (a) you’ll see the effects coming on gradually, (b) it’s not permanent, and (c) for me it wasn’t nearly as intense as people made it seem.

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The whole point I'm making is that it is permanent. That's the whole issue I'm talking about here. It doesn't go away. Ever.

If yours goes away when you stop taking SSRIs, then you aren't suffering PSSD (post SSRI sexual dysfunction) in the first place.

Interesting. I hadn’t heard of PSSD.

From https://annals-general-psychiatry.biomedcentral.com/articles...

> A 19-year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase-5 inhibitors prescriptions. 12,302 males aged 21–49 met the following criteria: non-smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or substance use.

> SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8–4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3–4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000.

4.3 per 100k is lower than the US murder rate (6.8 per 100k). You’re right that it’s a consideration, but it seems pretty rare.

It's saying the overall prevalence in the population from which the study group was drawn was 4.3 per 100k. The study cohort (young men who took SAs during the study time frame) was less than 1000 people, of whom 4 exhibited PSSD. So incidence within the studied group was around 100x the general population prevalence.

Fair, thanks.

> Out of the 866 subjects of the study group, four subjects (0.46%) met full case criteria for PSSD (see Fig. 1B). These subjects were 32, 34, 37, and 42 years-old. They used antidepressants with at least a partial serotonergic mechanism (escitalopram, paroxetine, imipramine, or nortriptyline) for 4–8 months before initiating treatment for erectile dysfunction with PDE-5 inhibitors (all used tadalafil and vardenafil, but not sildenafil). They continued to have erectile dysfunction after drug discontinuation as evidenced by 3.6–14.8 months of PDE-5 inhibitor treatment at the end of the study period. The prevalence of PSSD in males of ages 21–49 years of the population of the CHS Tel-Aviv district is 4.3 per 100,000 (4 in 92,476).

4 in 866 is pretty good odds, but everyone has different risk profiles. I’ll be sure to mention it next time Prozac comes up.

But… shouldn’t we compare with depressed people who don’t take SSRIs? Could this be a side effect of depression rather than the drug?

The people in question were depressed and not on SSRIs - they had libidos.

I got to watch in real time as my libido evaporated, immediately desisted the pills and yet...

Bullshit it's that low.

I say this as someone who kept his SSRI induced asexuality to himself for 20 years; I was ashamed and humiliated.

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