@AlexanderDenmark 1381 wrote:

Dr. Mariano

A number of people suffer from a phenonemon called Post-SSRI sexual dysfunction and they are at their wits end about what’s going on and what do about it. There have been listed a lot of theories about what happened and it seems thtát the theory put forth most is that there is persistently comprised catecholaminergic neurotransmission. Obivously these people are miserable about it and no one knows what to do. But looking away from merely the persistent sexual dysfunction, wouldn’t decreased dopamine neurotransmission in the brain also dipose these people to a higher risk of early parkinsons or similar neurogenerative conditions?

Is it caused by damage to the dopamine system in the brain or is it reversible? What happened and what can they do reverse the unfortunate detrimental effects of their experience with the SSRI’s?

Persistent sexual dysfunction despite stopping SSRI use is probably due to problems in the system that were already present before using the SSRI, rather than being the result of SSRI use.

I would not be blaming the SSRI, I would be looking at the rest of the system to find the cause.

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Generally, people use SSRIs to increase serotonin signaling, which reduces norepinephrine signaling. This reduces anxiety, stress, irritability and helps stabilize mood. The reduction in norepinephrine signaling then allows a cascade of signaling changes which helps reduce depression and stabilize mood. The reduction in norepinephrine signaling helps also reduce premature ejaculation.

Increasing serotonin signaling, however may also lead to a reduction in dopamine signaling. How significant this reduction is depends on the dose. The higher the dose, the lower the dopamine signal.

The reduction in both norepinephrine and dopamine may lead to sexual dysfunction (e.g. loss of libido, anorgasmia, etc.) – depending on the dose of SSRI used.

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Generally, I would not expect an increased risk for Parkinson’s Disease or other neurodegenerative changes from SSRI use. They are generally safe for long-term use.

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Some SSRIs, however, such as Paroxetine, have more significant anticholinergic effects. Acetylcholine is important for memory. It is also a trophic factor for glial cell growth. Thus, if acetylcholine is blocked, memory may be impaired. And, if a person is susceptible, glial cell function may become impaired. However, this effect is generally small.

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When a person has a mood disorder (e.g. major depression, bipolar disorder, anxiety disorders), there are neurodegenerative changes as part of the pathophysiology of the illness. For example, hippocampal mass is reduced. This leads to impaired memory, for example, as a symptom of illness.

The use of SSRIs helps restore brain mass in these illnesses. Thus, the small anticholinergic effect is generally overwhelmed by the nootropic effects of treatment.

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In the elderly, however, particularly those already with an ongoing neurodegenerative illness like Alzheimer’s disease, with the loss of acetylcholine neurons, anticholinergic medications pose a risk for increasing confusion and memory problems. In Alzheimer’s disease, anticholinegics may accelerate the neurodegenerative changes.

SSRIs are low in such risk but the anticholinergic effect still need to be considered and kept in mind.

More potent anticholinergic medications include: antihistamines (every antihistamine is also anticholinergic), Antacids which are H-2 blockers (they are antihistamines), medications for diarrhea and overactive bladder (they are often simply anticholinergic medications), etc. etc.

Anticholinergic effects are very common in medications – both as the main effect and the side effect.

@AlexanderDenmark 1390 wrote:

@DrMariano 1385 wrote:

Persistent sexual dysfunction despite stopping SSRI use is probably due to problems in the system that were already present before using the SSRI, rather than being the result of SSRI use.

I would not be blaming the SSRI, I would be looking at the rest of the system to find the cause.
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Thank you very much Dr. M

What kind of problems in the system before the use of SSRI meds could this be since there were was no sexual dysfunction or reduced libido prioer to using this medication?

Frequently, they are the same ones that lead a person to use an SSRI – signaling or metabolic-nutritional problems underlying depression, anxiety, premature ejaculation, irritable bowel syndrome, etc.

Each time i use an SSRI i get testicular pain and shrinkage (if use is prolonged) offcourse i am in a state of very fragile Testosterone to DHT production and since dht is needed for maintaining testicular and surrounding glandular and organ mass it can be understood why this happens. The problem is that SSRIs i think are overused and overprescribed while they should be given only to people who are in very bad mental situation and in fear of commiting suicide or doing harm to themselves