this post was submitted on 21 Oct 2024

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Mental Health

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Do you think SSRIs are a good idea? (self.mentalhealth)

submitted 1 month ago* (last edited 1 month ago) by Psychonometry to c/mentalhealth

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Mild NSFW warning: this post mentions sexual side effects of medication.

SSRIs are the most common type of antidepressant (examples are Prozac/fluoxetine, Zoloft/sertraline, Paxil/paroxetine).

If you have experience with them, do you think they're a good idea?

I came across a paper about side effects which I haven't heard discussed before. Many people know that SSRIs have sexual effects, but apparently they also affect fertility.

This paper describes SSRIs as "gonadotoxic", leading to effects like "decreased sperm concentration and motility, increased [DNA] fragmentation, and decreased reproductive organ weights".

The paper does say "this effect does seem to be reversible", so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?

I would be interested to hear others' thoughts, if you have any.

Edit: Thanks for the replies to this post, they're interesting.

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[–] mbgid 3 points 1 month ago* (last edited 1 month ago) (1 children)

I have been on SSRIs for 20 years. For me they're a good idea, but I've known others who have had a terrible time with them.

Sexual dysfunction is definitely a thing: how much of an issue that will be is going to be a personal decision on weighing up pros and cons. If your sex drive is low as a part of your depressive symptoms or you're already experiencing anhedonia (inability to feel happiness/pleasure) or anorgasmia (inability to achieve orgasm) then going on SSRIs isn't going to make that any worse. But for others the risk of missing sexual pleasure might be an unacceptable trade-off.

For anyone starting SSRIs I think it's best to go slowly and keep in touch with your primary doctor throughout the process. There are a number of SSRIs available, and if one doesn't work out you can try others, and hopefully land on one that works for you.

With all that said, SSRIs don't work for everyone. It's not unusual to feel weird or like things are getting worse when you first start them: it takes some time for the effects to settle. But if you're having a really bad time on them, speak to your doctor about alternatives.

[–] Psychonometry 1 points 1 month ago (1 children)

Thanks for this reply. To be honest I'm not so worried about the well-known sexual side effects. Instead I worry about fertility effects. The paper I mentioned in the OP says that fertility should return to normal when you come off SSRIs, so I guess that's good. But then I came across an article mentioning a study on rats, where they apparently found impaired fertility "which persisted after the drug was stopped".

I bet most local doctors don't even know of these effects. They'll know about erectile dysfunction etc, but this is something different to that.

Maybe I'm worrying too much, I don't know. I wonder if anybody on this site has heard of these effects before.

[–] mbgid 1 points 1 month ago

I don't know anything about its effect on fertility. I know people who have conceived while on SSRIs, but that's purely anecdotal.

It's going to be a judgement call on your part. SSRIs have been in use for long enough that I would expect there's a big pool of data around fertility rates, even if it's not had much analysis done on it. Also, rat models are useful but need to be understood in their context. One study in rats is not overwhelming evidence.