Well Being: Selective Serotonin‑ReUptake Inhibitors (SSRI)

The medical community continues prescribing SSRIs like an automated candy dispenser.

• Should people expect to be happy all the time?

• What percent of the time is it acceptable to be unhappy before a Selective Serotonin‑Reuptake Inhibitors (SSRI) is recommended?

We all have to deal with stress, anxiety, depression, anger, etc. But some of us deal with it better than others. Or so it may seem.

The most common way to treat depression, unhappiness, anxiety, panic disorder, PTSD, and so many other ills of modern society is with a pill, a drug. Specifically, one that has an odd but rarely mentioned adverse event.

There are many side effects of SSRIs, but one that isn’t mentioned nearly enough is sexual dysfunction.

For many drugs in the class of SSRIs, the Food and Drug Administration labels do list sexual dysfunction in the user (i.e., the patient taking the medication) as an adverse effect. But how often do physicians mention this to patients?

In one recent study, Sexual dysfunction was highly prevalent among both females (88.7%) and males (84.5%) with antidepressants (mostly on SSRIs/SNRIs)) use (ref). This is not a controversial statement, but it is well established in the scientific literature.

“The condition is known as post-SSRI sexual dysfunction (PSSD) and is characterised most commonly by genital numbness, pleasureless or weak orgasm, loss of libido and erectile dysfunction.” (ref)

But the truth is that about 17% of women in the United States are on Selective Serotonin Reuptake Inhibitors (SSRIs), and women account for over 70% of all SSRI users

Of interest, about the same time that SSRIs were introduced, the rate of single women began to rise. Currently, about 55% of women are “unpartnered.” This is up from around 45% in 1990.

For adult men ages 25-54 in 1990, about 29% of men were unpartnered (i.e., not married and not living with a partner). By 2019, that share rose to 39%. Among young adult men under age 30, as of ~2020, about 63% described themselves as single (not married or cohabiting/partnered) (ref).

Coincidence?

Of note, for somewhere between 0.5 to 5% people who experience post-SSRI sexual dysfunction (PSSD), this syndrome will be semi-permanent or even permanent, lasting long after the SSRI treatment is stopped. There is no medical code for this condition, so there is no easy way to estimate the true incidence rate.

Yet, the medical community continues prescribing SSRIs like an automated candy dispenser.

Where is the informed consent?

In addition, findings suggest that there was a lack of understanding, awareness, informed consent or acceptance among healthcare providers about PSSD, which (1) compounded the suffering, trauma, hopelessness and alienation that people with PSSD experience about their condition and (2) contributed to an overall lack of trust in physicians and/or medicine in general and therefore reliance on oneself to find relief from the symptoms of PSSD (ref).

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Reasons that a physician recommends a SSRI

• Major Depressive Disorder (MDD) - primary and most common indication.

• Generalized Anxiety Disorder (GAD)

• Panic Disorder

• Social Anxiety Disorder

• Obsessive–Compulsive Disorder (OCD)

• Post-Traumatic Stress Disorder (PTSD)

• Premenstrual Dysphoric Disorder (PMDD)

• Postpartum Depression (PPD)

• Chronic Pain Conditions (Adjunctive Use)

• Eating Disorders (Adjunctive Use)

• Menopausal Hot Flashes (Off-label)

What aren’t they being prescribed for?

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The use of SSRIs in women is so common that 8-10% of women take SSRIs during pregnancy.

Bioethicists state that it is impossible to do randomized clinical trials (RCTs) on pregnant women for ethical reasons, which is why more studies haven’t been conducted on the use of SSRIs during pregnancy. Despite this fact, the pharmaceutical companies will then state, without blinking an eye, that RCTs haven’t shown any ill effects and that retrospective and animal studies aren’t the “gold standard.” Whelp - that certainly is a double standard!

Yet, in one published study, the health records from more than 15,000 people in Finland were evaluated, and the authors found that rates of depression in early adolescence were about three times higher among those who had prenatal exposure to SSRIs compared with those who did not - whose mothers also had “psychiatric disorders.” The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% by age 14.9, compared to 1.9% whose mothers did not take SSRIs during pregnancy, but were in the psychiatric disorder, no medication group (ref).

This means that between 300,000 and 400,000 kids are being exposed to these drugs each year in the USA during pregnancy. Suppose the rate of depression is tripling in these children. In that case, that’s adding a significant burden of unnecessary depression, with a million or more adolescents being depressed enough to seek medical attention. This is an unacceptable burden being placed on these young American adults.

In addition, it has been hypothesized that the rise in pediatric gender dysphoria cases could be associated with SSRI use during pregnancy. This is another significant risk that has not been adequately studied.

However, and maybe more importantly, the FDA has NOT recognized behavioral changes, sexual dysfunction, or dysregulation in the offspring (i.e., children of pregnant women) as a labeled side-effect of maternal SSRI use during pregnancy.

Yet, animal studies show adult offspring exposed to maternal SSRIs can have:

• Altered sexual behavior

• Altered stress responses

• Altered social behavior

• Changes in brain sexual-dimorphic nuclei

• Changes in serotonin system wiring

Furthermore, there is even a syndrome identified as “Neonatal Selective Serotonin Reuptake Inhibitor Withdrawal Syndrome.” Yep, little newborns whose mothers took SSRIs while pregnant or nursing may be at risk for withdrawal symptoms - for which no clinical guidelines have been developed (ref).

Of course, we all “know” SSRI discontinuation can absolutely produce rage, anger surges, and extreme irritability. Yet when physicians obtain informed consent, they rarely mention this aspect of the drugs.

Yet, despite all the risks associated with SSRIs, the age-adjusted suicide rate rose from about 10.4 per 100,000 in 2000 to about ~14.2 per 100,000 in 2018. This mega trend does not instill confidence in these drugs. Anything but…

Of course, we need to take depression and psychiatric disorders seriously. And yes, people often require medical treatment.

But social isolation, lack of a partner, lack of community, lack of someone to talk to, lack of being connected to family, and frankly, the lack of feeling productive all give rise to many of our common psychiatric maladies. A diet high in sugary and ultraprocessed foods will affect mood. That regular attendance in church is associated with lower rates of suicide or suicide-related outcomes,

The truth is that physicians take the easy way out by turning to drugs as the first line of defense against psychiatric issues. And this is just wrong. Maybe it's time to return to healing people in that old-fashioned way by promoting traditional values, preserving family relationships, and being involved in one’s community. By talking to people to discover what is wrong in their lives. By providing real guidance. By surrounding them with a supportive community.

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References - for animal offspring exposed to maternal SSRIs:

Social behavior, stress coping, seminatural environments

1. Houwing et al., 2019 – “Perinatal fluoxetine exposure changes social and stress-coping behavior in adult rats housed in a seminatural environment” (Neuropharmacology)

   • Species: Rat

   • Exposure: Fluoxetine during gestation + lactation

   • Adult outcomes: In a seminatural environment, perinatally exposed rats showed altered social and stress-coping behavior (e.g., differences in defensive and coping strategies, social interaction patterns) compared with controls. MPI for Psycholinguistics

2. Houwing et al., 2019 – “Subjecting dams to early life stress and perinatal fluoxetine exposure: effects on juvenile and adult social behavior” (Front Neurosci)

   • Species: Rat; “maternal vulnerability” model (SERT+/- dams with early life stress)

   • Exposure: Dams got fluoxetine through gestation and lactation.

   • Adult offspring: Reduced social behavior in adult males from fluoxetine-treated control dams; sex- and genotype-dependent effects when combined with maternal stress. Frontiers

3. Sylte et al., 2021 – “Effects of perinatal fluoxetine exposure on novelty-induced social and non-social investigation behaviors in a seminatural environment” (Psychopharmacology)

   • Species: Rat

   • Exposure: Perinatal fluoxetine

   • Adult outcomes: Adult offspring in a seminatural setting showed increased locomotor activity and changes in non-social exploration, with relatively limited changes in social investigation. PMC+1

4. Houwing et al., 2020 – “Perinatal fluoxetine treatment and dams’ early life stress history have opposite effects on aggressive behavior…” (Psychopharmacology)

   • Species: Rat

   • Exposure: Fluoxetine throughout gestation and lactation

   • Adult outcomes: Perinatal fluoxetine reduced aggressive behavior in adult males, with minimal effects on sexual behavior; maternal early-life stress had opposite, aggression-increasing effects. SpringerLink

Sexual behavior / reproductive neurobiology

5. Rayen et al., 2013 – “Developmental Fluoxetine Exposure and Prenatal Stress: effects on sexual behavior and sexually dimorphic brain structures” (Endocrinology)

   • Species: Rat

   • Exposure: Maternal stress during pregnancy; dams treated with fluoxetine through lactation

   • Adult outcomes: Male offspring showed altered sexual behavior and changes in sexually dimorphic brain regions (e.g., medial preoptic area), indicating organizational effects of early fluoxetine exposure on reproductive neurocircuitry. PubMed

6. Baann et al., 2025 – “Perinatal fluoxetine exposure increases male rat sexual behavior in a seminatural environment” (Behavioral/Neuropharm journal)

   • Species: Rat

   • Exposure: Fluoxetine to dams during pregnancy and lactation

   • Adult outcomes: Adult males showed increased number of copulatory behaviors and overall sexual activity in seminatural conditions, suggesting enduring effects on sexual motivation/performance. PubMed+1

Anxiety-, depression-, and fear-related circuits

7. Arzuaga et al., 2023 – “Prenatal stress and fluoxetine exposure in mice differentially affect anxiety-like behavior and cognitive flexibility in adult offspring” (Neuroscience)

   • Species: Mouse

   • Exposure: Restraint stress during pregnancy ± fluoxetine

   • Adult outcomes: In males, combined prenatal stress + SSRI increased self-grooming (repetitive behavior) and impaired spatial reversal learning. In females, stress or SSRI alone impaired reversal learning. Anxiety-related behavior was also altered. PubMed

8. Zanni et al., 2025 – “Perinatal SSRI exposure impacts innate fear circuit activation and behavior in mice and humans” (Nat Commun)

   • Species: Mouse, plus human cohort

   • Exposure: Developmental SSRI exposure (perinatal)

   • Adolescent/young adult outcomes: Increased defense responses to predator odor and heightened activation of amygdala/extended fear circuits; in humans, in utero SSRI exposure associated with higher anxiety/depression symptoms and greater limbic activation to fearful faces in adolescence. Nature+1

9. Francis-Oliveira et al., 2013 – “Effects on acute stress response and behavior in the offspring of dams treated with fluoxetine during pregnancy and lactation” (Neurosci Lett)

   • Species: Rat

   • Exposure: Maternal fluoxetine during gestation and lactation

   • Adolescent/young adult outcomes: Altered behavioral responses to stress and changes in HPA axis responsiveness, suggesting lasting programming of stress reactivity. ScienceDirect

Brain network / sensory processing outcomes

10. van der Knaap et al., 2021 – “Perinatal SSRI exposure affects brain functional activity associated with whisker stimulation in adolescent and adult rats” (Sci Rep)

    • Species: Rat

    • Exposure: Perinatal fluoxetine

    • Adult outcomes: fMRI during whisker stimulation showed increased activation of hippocampus, perirhinal/entorhinal cortex, piriform cortex, secondary visual cortex, etc., indicating long-term re-wiring of sensory and associative networks. Nature

11. Rahn et al., 2019 – “Maternal fluoxetine exposure alters cortical hemodynamic and calcium responses in offspring” (preclinical imaging study)

    • Species: Mouse

    • Exposure: Maternal fluoxetine across perinatal period

    • Adult outcomes: Persistent alterations in somatosensory cortical responses (hemodynamics and calcium signals) during sensory stimulation, indicating durable cortical circuitry changes. CORE

12. Meyer et al., 2017 – “Perinatal SSRI exposure permanently alters cerebral receptor mRNA levels” (Neuropharmacology)

    • Species: Rat

    • Exposure: Perinatal SSRI (fluoxetine)

    • Adult outcomes: Long-term changes in cortical and hippocampal receptor mRNA expression in adult offspring; no strong behavioral phenotype in their test battery, but clear molecular reprogramming. PMC

13. Maloney et al., 2018 – “Examining the Reversibility of Long-Term Behavioral Disruptions in Progeny of Maternal SSRI Exposure” (eNeuro)

    • Species: Mouse

    • Exposure: Dams treated with fluoxetine over different developmental windows (gestation, lactation)

    • Adolescent/young adult outcomes: Offspring showed reduced ultrasonic vocalizations, altered social hierarchy behavior, repetitive behaviors, and tactile hypersensitivity; the paper also tests partial reversibility with post-weaning interventions. PMC+1