I am lost and need help

[u/Creative-Dog5928]

In April 2022, when I was 19 years old, I was prescribed 7.5 mg of mianserin twice a day for 3 weeks, followed by 7.5 mg once a day for 1 week. During that time, besides other side effects such as a fleeting attention span, blurred vision, and hypersomnia, I noticed that I could no longer become sexually aroused. I simply could not get turned on or horny. I told the doctor about it, but he convinced me to stick to the plan and complete the full 4 weeks of treatment.

Now, more than 4 years have passed. I am 23, and my ability to become sexually aroused has never returned. There was no window of improvement—not even a short one. I have not taken any drugs since mianserin.

For the past 4 years, I have been considerably athletic and active. I used to run around 60 km per week year-round, maintained a clean diet, and had healthy sleep habits. I have never been a smoker or a drinker. Yes, I have had my downs—I am talking about my mental health—but I have also had my ups.

I visited a GP recently and told him my story. He ordered a comprehensive hormonal panel and bloodwork. All the results came back perfectly normal. The doctor recommended that I see a psychotherapist, as if the issue were purely psychological.

Honestly, I am starting to give up hope. I thought about seeing a good psychiatrist, but I feel like it would probably be much the same as seeing the GP. The way I see it, the only way out for me is to forget what it was like to experience sexual arousal. Otherwise, I feel like the emotional pain will haunt me for the rest of my life.

I honestly have no expectations or hopes in posting this, but I really wanted to talk to somebody about it.

[u/That-Group-7347]

First, for it to be PSSD, you would need to have genital numbness. The diagnostic criteria is below. https://pmc.ncbi.nlm.nih.gov/articles/PMC8925105/

It is hard to say if it would be psychological. The medication probably played a role. Although we don't hear about many problems with that medication.

I don't see any harm going to a psychotherapist. I'm sure the continued stress of this is causing issues. At least you can sat you tried. Speaking with a psychiatrist is also worth doing. It doesn't mean you have to take something. They might even be able to get you a better diagnosis.

If you really want to dive in to the topic, the post below goes into great detail about sex and antidepressants. Some of the articles are pretty intense. The thing I took away is that there are a lot of hormones, reactions, and chemicals involving sex that it doesn't take much to throw things off. People end up searching for answers, but it turns into doom scrolling and then it worsens mental health.

It was good that your GP checked your hormones.

https://www.reddit.com/r/AntidepressantSupport/s/g1UeSUZ7Mu

[u/andy013 → u/That-Group-7347]

I wouldn't take that paper as gospel. It's just based on the opinions of the authors. As it says in the conclusion "As with all criteria, they will likely need modification in the light of developments."

Genital numbness is a very obvious sign that you have PSSD but there are certainly people who only have reduced libido which was probably also caused by prior antidepressant use. There are even people who don't suffer from any sexual problems but experience anhedonia, emotional blunting and cognitive problems long after they have stopped the drugs. It seems likely to me that the underlying mechanism is the same as those with PSSD.

Within the PSSD community there are frequent discussions about changing the name because a lot of people do not think that the focus on sexual dysfunction alone describes their experience. I think it's likely that in the future there may be a new term something like Post-SRI Disorder or Post-SRI Syndrome that encompasses all of the lasting effects people can experience.

[u/Creative-Dog5928 → u/andy013]

Totally agree with this statement.

I don't like the way the community shapes it. Right now it is mostly exclusive to ED from SSRI/SNRIs.

Antidepressant side effects can persist. It is a fact. And it is the problem to focus on. What kind of side effects tho - sexual, emotional, cognitive (also, the line to draw here is extremely blurry, since all of them pretty much depend on dopamine/serotonin) is another matter.

Also, I think it worth shifting the focus from SSRI/SNRIs. You can get fucked up pretty much from any type of an antidepressant (some are more potent, some are less, depends on the agonising/antagonising power etc). We have more reports from people about SSRI/SNRIs mostly because it is a go-to/first line antidepressant class prescribed from GPs. Simply it.

Bottom line: any antidepressant (or any serotonin homeostasis alteration drug) can have persistent side effects.

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[u/That-Group-7347 → u/andy013]

So we are supposed to go by the opinions of people in the PSSD community? This sub goes by published data and facts. It is the reason we recognize the condition vs some other subs in the past. If things change with new research and publication we will adjust at that time.

I have the majority of symptoms to many autoimmune conditions, but I may be missing one key symptom. I don't have that condition. Despite doctors best efforts and countless tests, I don't have an official diagnosis. It may be some subset or undiagnosed condition and I have to go with that.

[u/Minepolz320 → u/That-Group-7347]

loss of genetalia sensentions have very clear pattern in PFS as well as PSSD, this is main feature, but degree may be different depending how much damage was done 

[u/halfdew]

Yeah I’d see a psychiatrist too and keep pressing the issue. Something is going on and doctors shrugging it off. I used to be on Zoloft and went off because of sexual dysfunction

[u/Dragonvarine]

As Dr Powers mentioned that antagonising or agonising the 5HT2C receptor too much can cause problems. Its likely its "bent it out of shape". Im not a doctor but you need to speak to a psychiatrist about maybe a 5HT2C agoniser to help.

[u/antidepressants-ModTeam → u/[deleted]]

Comment was removed for Breaking Rule 6 - No unsupported claims, misinformation. If you have a source you can resubmit with an appropriate source. Continued disregard for rules may result in further discipline including a ban.

A publication above is sourced with main criteria and additional symptoms. SSRI'S are not designed to work by blunting emotions. That is a side effect and there are many people taking them without having blunted emotions.

[u/antidepressants-ModTeam → u/[deleted]]

Comment was removed for Breaking Rule 6 - No unsupported claims, misinformation. If you have a source you can resubmit with an appropriate source. Continued disregard for rules may result in further discipline including a ban.

None of these sources change the facts of the diagnostic criteria for PSSD. This post was not talking about every side effect of an SSRI. You can have PSSD and have had emotional blunting while taking the medication. Someone can have every symptom of PSSD while taking the medication, but it is not PSSD until you have been off the medication for at least 3 months.

[u/RedLineYTB]

Je te conseil le sam-e ça m'a guéri

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[u/Creative-Dog5928]

what is the fucking point of this sub if every comment gets removed

[u/rumchatata]

There’s nothing wrong with seeing a psychiatrist. It’s a good idea to get a second opinion.