PSSD or "Post SSRI Sexual Dysfunction" = loss of libido, ejaculatory/orgasmic anhedonia, inability to achieve orgasm, erectile dyfunction in men and lack of lubrication in women, complete loss of excitement regardless of stimuli, complete genital anesthesia...
Look into SSRIsex, a yahoo group that provides support for exactly the condition you describe.
Do not look to the Advanced BL board to bring you an explanation.
Stories from this group have elucidated the extent of damage that SSRIs can do to human sexuality, as well as the trend towards at least partial recovery. Many examples of full recovery exist.
I found this group during my research on MDMA toxicity, which in my case involved a rather severe form of sexual anhedonia.
It it difficult to describe to other people just how frustrating it is!
Because sexuality is a higher brain function - it is an essential consequence of healthy neurological function.
The absence of libido and reward means the absence of humanity itself....
How do you explain this to others?
The people in SSRIsex will understand.
Many doctors have told members to go back on SSRIs, and those that do normally suffer a worsening of their condition.
They are often told that their complaints are simply a sign of 'depression' - with some doctors completely dismissing the condition itself!
Ironically there are many other symptoms exhibited by this group that overlap with MDMA toxicity.
Such as difficulty concentrating, BRAIN ZAPS, inability to look people in the face, tinnitus, head-pressure, severe anxiety (inc. social)...
Many of them face suicidal thoughts as well.
What is going on here?
SSRIs and MDMA both target the Prefrontal Cortex.
By increasing serotonin in the PFC a marked improvement in mood/social function is achieved.
This region is also the home of the more vulnerable serotonin nerves - the first to be lost to neurotoxicity and the last to recover during abstinence.
By the way, serotonin exists predominantly in the intestines - the 'serum' that 'tones' the smooth muscle surrounding the GI.
In the brain it plays a role in a wide variety of functions, often inhibiting the firing of neurons and transmission of neurotransmitters.
It has powerful effects upon small blood vessels in the brain, the release of dopamine and acetylcholine...
It is the great moderator of the brain.
Prefrontal Serotonin innervation is known to be critical to sexual function - other types of damage to these pathways has been shown to cause severe sexual dysfunction.
SSRIs cause down-regulation of cortical SERT, especially in the distant PFC.
They also cause release of prolactin by the pituitary gland - which is directly associated with the efficacy of treatment.
Peak prolactin response can take 5 weeks or more in SSRI patients, while MDMA achieves a RAPID response in 90 minutes!
Is the cause of sexual dysfunction solely due to the destruction of prefrontal SERT?
And if so, why does this not occur to all patients?
It turns out that some form of sexual dysfunction is extremely common among SSRI users.
Initial research that was tailored to the wishes of pharmaceutical companies failed to reveal the truth.
Later studies required doctors to ASK patients about sexual symptoms rather than waiting on the information to be volunteered.
More importantly the studies followed patients for MORE than a short 6 weeks.
The outcome?
60-80% of SSRI users experience sexual side-effects including many of those on the list at the beginning of my post.
However...
For the majority of patients these side-effects do not persist beyond use of the medication.
Upon discontinuation sexual function returns to normal, or at least patients do not complain of persistent problems.
But a portion of patients do continue to experience anhedonia - not just of sexual nature but in regards to ALL life experiences.
What is odd is to hear some of them report complete lack of ALL sensation in their genitalia, including testicles and even the anus....and thighs...and even the bottom of hands and feet!
There is clearly more than depression happening in these people.
The perception of physical sensation is actually altered.
I can relate - I spent a few months feeling like my dick wasn't even there!
I could feel urination, but nothing beyond that.
And although some libido still existed, it was very unreal to be in the presence of naked women.
And orgasm was a source of infinite frustration and anger.
I would transition from experiencing mild enjoyment in sex to feeling absolutely NOTHING during orgasm.
It was like the light switch had been flipped off.
Enraging...
Why this happens is not understood, like most things in neurology.
But I was able to garner a basic understanding.
Stimulation of 5HT-1a receptors induces a prolactin release in the pituitary gland.
Prolactin is a hormone associated with breast-feeding and is released in massive amounts during child-birth.
In men, prolactin function is mysterious - but it is certainly released during orgasm.
Oxytocin is subsequently released by the pituitary and is associated with bonding, but prolactin plays the more important role in this discussion.
Here is a link to a great chart showing the rise of prolactin during orgasm.
http://psyed.org/r/ns/nsp/prolactin.jpg
Dopamine peaks just as orgasm begins, then it begins to fall quickly.
Prolactin surges forth - and remains elevated for long periods of time (up to several weeks).
It is clearly associated with a drop in sexual desire, especially in men.
Erections are much more difficult to achieve after orgasm - with most men requiring a rest period.
I believe that prolactin does more than shut down sexual desire.
I believe at the moment of orgasm the surge of dopamine is 'flushed' out by prolactin - a response to prefrontal 5HT-1a stimulation.
The highest regions of the brain are activated during orgasm, especially in men.
PET studies bear this out - showing an impressive display of blood and glucose consumption in the prefrontal region during climax.
In men, orgasm is a full-fledged neurological event.
The Prefrontal Cortex is more interconnected with the rest of the brain than ANY other part of the cortex.
One fiber tract connects it directly to a deep limbic structure known as the Nucleus Acumbens.
This is the pleasure center of the brain - the dopamine highway.
Every single drug of abuse targets NA dopamine release.
As orgasm approaches, more and more prefrontal serotonin receptors are being activated.
Local glucose, blood, and acetylcholine levels increase.
When the peak is finally reached, dopamine can no longer be contained.
The PFC goes MAD with activity.
The Nucleus Acumbens experiences a massive surge of dopamine - as if the brain was trying to hold it back all along.
And the pituitary gland squeezes out a dose of prolactin into the bloodstream.
As this hormone enters the pathways in the Nucleus Acumbens, dopamine receptors are down-regulated.
I speculate that prolactin actually pushes dopamine into the NA from other regions of the brain.
I believe its role is to restore chemical balance in the brain as well as enhance the experience of orgasm.
Without prolactin, perhaps the peak of dopamine would never reach the height that it does.
My evidence?
Look at the chart again - the highest peak of dopamine occurs JUST as prolactin begins its upward climb.
Besides, sex on MDMA feels like one long continuous orgasm!
And prolactin is what MDMA is ALL ABOUT.
So are SSRIs.
Both can enhance, and damage sexuality.
And it is all about those precious and vulnerable prefrontal serotonin nerves.
The wires that connect your intestines to your mind...
So you have 'down-regulated' your serotonin receptors in the PFC and perhaps other cortical areas.
Damn.
Is that the real problem?
On its own, not quite.
The true diagnosis for MOST of the PSSD victims is this - hyperprolactinemia.
This is simply an indication of continuous elevated levels of prolactin released by the pituitary.
Many doctors do not even get to this point with their patients.
They blame psychological problems or overlook the test results entirely.
After all, prolactin levels fluctuate considerably in 'normal' people.
Just tightening your belt can elevate your prolactin (no joke)...
So interpreting prolactin plasma levels in a blood test represent a challenge to medical personnel.
If the results are determined to be in the 'high' range, the first suspect is a brain tumor - which is known to cause prolactin elevation.
Non-cancerous pituiarty growths known as adenomas are relatively common - but those that release hormones or grow past a certain size are considered for treatment.
Once tumors are ruled out, the doctor shakes his/her head and pronounces: "I don't have a fucking clue."
This is simply because we don't have a good theory on how the brain really works.
If we did, then every general practitioner would know that SSRIs damage Prefrontal SERT and this directly causes pituitary malfunction in some patients.
Here is where my theorizing enters the picture again.
Since prolactin release occurs in response to 5HT-1a receptor activation, shouldn't the loss of PFC SERT cause a drop in prolactin?
As many have pointed out, relationships are never linear in regards to brain function.
What I believe is happening is that the damage to PFC SERT causes a major INCREASE in sub-PFC serotonin transmission.
The Raphe Nuclei in the brain stem is still pumping out continuous amounts of this intestine contracting chemical into the whole brain.
Because the highest region is now disconnected from the network of nerves, others SERTs experience a relatively greater supply of serotonin.
That means that prolactin release is not only caused by 1a activation in the PFC, but in other regions as well.
And 1a receptors are being continuously bombarded with excess serotonin - for weeks or months or YEARS on end.
All because of 'anti-depressant' treatment.
Lexapro is cited by many SSRIsex members as the cause of their ultimate sexual dysfunction - several claimed that other SSRIs had less effect but switching to lexapro caused a genital 'coma' to occur.
So you have hyperprolactinemia.
Caused by prefrontal SERT loss and subsequent hyper-stimulation of sub-prefrontal 1a receptors.
Remember the role of prolactin
during orgasm?
It causes a surge in pleasure (according to me) and then SHUTS OFF sexual desire (according to everyone).
Well, your endocrine system (pituitary) is
stuck in this mode.
You are living every moment of every day with the chemical equivalent of just having had an orgasm.
Your brain thinks you just came and all sexuality needs to be shut down.
Here is where things get a little scary.
Remember that prolactin 'down-regulates' dopamine receptors in the Nucleus Acumbens (your critical reward center)?
This is how it stops dopamine production and restores balance...
Well, hyperprolactinemia is hypothesized to cause permanent changes to dopamine receptor density in the NA - according to the epigenetic theory for PSSD.
Epigenetics literally means that the activity of genes is altered - that these receptors can be permanently turned off.
Scary - believe me, I know.
And some former SSRI users, a small cohort, will actually experience LONG-term and
permanent loss of libido, erection/lubrication, and all sensation or pleasure during orgasm.
Some of the men require penile injections to obtain erections even after a DECADE of abstinence from the drug.
There is even a story of a woman who experienced completely painless childbirth!
Now that I have completely scared the shit out of you, allow me to offer you some strong encouragement.
Even in the community of online PSSD suffers, there seems to be a trend towards recovery.
Think about this...
The percentage of people suffering PSSD (likely all from hyperprolactinemia) is unknown.
But personal accounts reveal that sexual function slowly returns over a period of months/years for many.
I was always surprised as to the overlap of symptoms, and recovery time, with MDMA users.
In both cases, the 12-24 month timeline seems critical.
It appears that a great number of the SSRIsex members recover sexual function within the first year.
Beyond the second year, there are stories of people that recover spontaneously.
However - past five years I could not find one.
A member once told me that a man who had been on Prozac for many years spent two DECADES without sexual function.
Then in his 60s regained his ability to get hard.
His wife couldn't get enough...
The point is that most people DO experience recovery.
And often those with truly persistent conditions still have some limited enjoyment in sex.
You will often hear reports of sudden and unexpected 'decent' orgasms - fleeting reminders of what they once had.
Mysterious...
The wires that connect the intestines to the highest regions of the brain are critical to your sexual function - and your personality.
Many aspects of executive function are tied to the PFC and former MDMA users are often found to have selective executive function deficits.
All readers be warned - anti-depressants and MDMA can steal more than just your sexuality from you.
They can damage your soul.
I am almost two years recovered from Serotonin Syndrome.
My ability to achieve erection was never harmed, which separates me from many SSRI victims.
But my libido, response to stimuli, and quality of orgasm were all SERIOUSLY injured by using MDMA.
I have had windows when my orgasms felt amazing - but in general my reward from climax has very slowly reached an acceptable level.
Even now my ability to concentrate on stimuli can be difficult and sometimes I must initiate sex prior to feeling libido at all.
But I consider myself fortunate, because I have encountered those who are not.
I have failed to mention the numerous other SEVERE emotional and bodily dysfunctions I experienced during my initial first month of recovery...
Persistent agitation including akithesia and RLS, complete insomnia, swelling of lymph nodes in the lower abdomen including tenderness, absolute intolerance of food including major weight loss, absent or seldom urination, lack of ability to feel nausea, absence of normal bodily odor, crippling HPPD that caused the world to look pale and distant, severe head-pressure, chest pain, not to mention severe anxiety - approaching and exceeding levels typical of PTSD.
(Yes, I felt like I had been through war and seen atrocities that destroyed my soul)
It is truly incredible what damaging the PFC can do to a person.
When the recent shooting in Aurora, Colorado took place, several members of SSRIsex commented - "Which one was he taking?"
Why would this be?
Because loss of sexuality is secondary to loss of humanity.
When your endocrine system malfunctions to the point of feeling no desire or reward AT ALL, then committing violent crimes seems easily within reach. To a mind this demented it might be worth killing simply for the sake of a few moments of feeling normal emotion again.
I can relate - the disconnection from reality in the initial stages of recovery was SO crippling that I suddenly knew why some people kill themselves, and others. I can only imagine how much worse it is with SSRIs like Lexapro.
Many of the violent shootings that have taken place are speculated to have involved anti-depressants.
From Columbine to Fort Hood to Aurora.
Whether or not these speculations are accurate, there are MANY stories of suicide in former SSRI users.
And these are not typical suicides - they are extremely violent.
A quick search on Youtube will reveal some of the horror stories.
Although most people who use anti-depressants do not commit suicide or murder, and may not even experience persistent sexual dysfunction....there is CLEAR evidence that cortical SERT density is reduced in the long-term and perhaps permanently.
And the majority of patients exhibit a WORSE neuro-endocrine profile after treatment with SSRIs versus prior!
Many doctors simply conclude these patients need life-long treatment...
Scary shit.
I'm not a typical big-Pharma complainer.
Whilst they are making
billions of dollars on drugs that damage the connection between the body and mind of countless millions...
They are also helping some people that truly and desperately need something.
Perhaps there are a percentage of people that belong on long-term or even life-long treatment with drugs that target the PFC.
Perhaps we will learn enough about brain function to one day develop superior drugs that can truly improve life without such substantial risk profiles.
Meanwhile they have learned that lithium improves prolactin response to treatment-resistant depression.
And this is my recommendation to the OP.
Look into lithium.
It might just improve your pituitary function.
And there is evidence that it modulates gene expression, possibly protecting some of your precious NA dopamine receptors!
Just make sure you involve a doctor and are monitored....
Aside from this the ONLY treatment that is known is time.
And exercise.
That's right - working out can make a big difference in your recovery timeline.
It grows new brain cells, especially serotonin nerves.
But only repeated exercise will bring persistent relief.
And don't expect any miracles.
If your use of Lexpro was brief, then you should have HIGH hopes.
And if you are not experiencing other problems that I have described, such as difficulty sleeping, brain zaps, trouble concentrating...over stimulation by sugar/caffeine...thoughts of emptiness and suicide...
Then you have a very good chance at a quick recovery.
I used to lay in the shower wishing and praying I would feel normal again one day.
I would shed tears for myself as if attending my own funeral - every single day.
I literally mourned the loss of self.
Is this happening to you?
If not, your prefrontal damage is not extensive.
You are going to be OK.
It just takes some time.
And while taking dopamine agonists might temporarily improve function, they will NOT substitute for recovery.
You know what regrows serotonin receptors?
BDNF - an activity based growth factor (protein released in the brain due to exercise)
St. Johns Wort - complicated and poorly understood
And most of all....CORTISOL
The stress hormone actually causes up-regulation of 5HT receptors.
Very very very slooooooooowly.
Think in terms of brain development.
Not days - but months at the minimum.
There is no treatment, not yet.
Time to exercise constantly, eat healthy, and endure.
This is a waiting game....welcome to the club.
I wish you the best.
I hope that somebody reading will stop somebody from using SSRIs or MDMA recklessly.
Both deserve mad respect.
FBC
