Anhedonia appears to be a core symptom of Post-SSRI Sexual Dysfunction (PSSD), a condition where sexual and emotional side effects from antidepressants persist even after the medication is stopped. While anhedonia refers to the general inability to feel pleasure, in PSSD this often includes a specific lack of pleasure or satisfaction from orgasm, known as orgasmic anhedonia. PSSD can also cause broader emotional and cognitive blunting, with some patients describing a feeling of disconnection from life. 

The link between PSSD and anhedonia

PSSD appears to be caused by lasting neurobiological changes from SSRI use, and research suggests a connection between this and the symptoms of anhedonia. 

  • Dopamine and reward pathways: SSRIs increase serotonin levels, which can suppress dopamine, a neurotransmitter critical to the brain’s reward system. This suppression may not fully reverse after stopping the medication. Anhedonia is thought to stem from a dysfunction in these dopamine reward pathways.
  • Serotonin-dopamine interaction: Research indicates that the high levels of serotonin while on an SSRI can inhibit dopamine release, which is necessary for the hedonic, or pleasure, response. The dual dysfunction of these systems is believed to be central to both PSSD and anhedonia.
  • Emotional blunting: In addition to sexual and orgasmic anhedonia, many PSSD sufferers report a more generalized emotional blunting. This can include a loss of feelings of warmth or connection and an inability to feel enjoyment from activities that were previously pleasurable. 

Differentiating PSSD from depression

It is important for clinicians to distinguish PSSD from sexual dysfunction that is a symptom of ongoing depression, as the treatment approaches are different. A key feature of PSSD is genital anesthesia, or a loss of sensation, which is not typically associated with depression-related sexual issues. The diagnosis of PSSD is clinical and relies on a patient’s history and symptoms, especially the persistence of sexual dysfunction after the medication has been discontinued. 

Current understanding and outlook

  • Limited recognition: Despite being formally recognized by the European medical agency in 2019, PSSD remains underrecognized by many medical professionals. Many patients report feeling dismissed, which adds to the distress of the condition.
  • Treatment challenges: No definitive treatment for PSSD has been established, and management often focuses on symptom relief. Some treatments have been explored, but results have been inconsistent.
  • Devastating impact: The persistent and unresolved nature of PSSD can have a devastating impact on a person’s quality of life, leading to significant emotional distress, relationship problems, and a severe loss of function

If you think you may have Post-SSRI Sexual Dysfunction (PSSD), contact me through this link or call me at (602) 492-6507.