Врачи фиксируют рост потребления препаратов среди зумеров, что сопровождается снижением либидо, ослаблением сексуального влечения и чувствительности.
Эксперты предупреждают: подобная тенденция может привести к снижению интереса к отношениям, ухудшению формирования устойчивых связей и, в перспективе, к демографическому снижению
2025 Nov 15 at 16:19
"
----
https://www.nytimes.com/2025/11/12/maga ... fects.html
"
More Teens Are Taking Antidepressants. It Could Disrupt Their Sex Lives for Years.
Research on adults who take S.S.R.I.s shows they tamp down sexual desire. Why aren’t we studying what that could mean for adolescents who take them?
By Daniel Bergner
Daniel Bergner is a contributing writer to the magazine, where he has written about, among other things, mental health issues and sexual desire.
Published Nov. 12, 2025
Updated Nov. 13, 2025
Marie began taking fluoxetine, the generic form of Prozac, when she was 15. The drug — an S.S.R.I., a selective serotonin reuptake inhibitor — was part of her treatment in an outpatient program for an eating disorder. It took its toll on her sexuality. “I was in touch with initial sparks of sexual energy relatively young,” she said, remembering crushes as far back
as the age of 6 or 7. Shortly before starting on the drug, she was dazzled, from a distance, by a blue-eyed hockey player at school, tall and funny and charismatic. She recalled the fluster and fantasies he stirred. But on the medication, she felt the infatuation vanish swiftly.
“And then,” Marie said, “I realized, Oh, I’m not developing new crushes.” She had no clue that the drug might be the cause: “I wasn’t informed about sexual side effects.”
Even as the worst of the eating disorder abated, psychiatrists and family doctors told Marie and her parents that she should stay on an antidepressant. She complied, while trying and failing to escape the sexual side effects. She traded fluoxetine for other antidepressants, including Wellbutrin, a different class of antidepressant, which is sometimes prescribed to combat low libido. She’s 38 now and has been off psychiatric medication for six years. But sexual desire remains absent. “For me it’s just an empty dark space,” she said. “There’s nothing there.”
Marie told me she has PSSD, post-S.S.R.I. sexual dysfunction, a loss of sexuality that persists after the drug is no longer being taken. It’s a controversial designation, because while the sexual side effects of S.S.R.I.s are well established — depleted or deadened desire, erectile dysfunction for men, elusive arousal for women, delayed and dulled orgasms or the inability to reach orgasm at all — the general assumption is that they subside completely when the drug is no longer in your system. Some psychiatrists suspect that PSSD is actually a result not of repercussions from the drugs but of the problem that led the patient to be medicated in the first place. Depression itself can stymie sexuality. So can anxiety, the other leading reason patients are prescribed S.S.R.I.s.
Yet there is a gradual shift underway toward professional recognition of PSSD. The DSM-5, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, states that “in some cases, serotonin-reuptake-inhibitor-induced sexual dysfunction may persist after the agent is discontinued.” The E.U.’s European Medicines Agency has issued similar words of caution, as have regulators in Canada, Australia and Hong Kong. In the United States, Prozac comes with a warning about the problem. And advocacy groups for consumers are pushing the Food and Drug Administration to require all S.S.R.I.s, the most commonly prescribed class of antidepressants, to carry such warnings. Clinicians have published more than 500 case reports in academic literature about the experience of PSSD. A 2020 editorial in The British Medical Journal argued, “Post-S.S.R.I. sexual dysfunction is underrecognized and can be debilitating both psychologically and physically.”
The statistical risk of PSSD is unclear. The scant research that has lately been done is riddled with limitations. Estimated rates run from the condition being very rare to its being more common. In one study, erectile dysfunction affected less than 1 percent of former S.S.R.I. users, while another found that genital numbness impacted at least 13 percent of those surveyed. But either way, PSSD may have urgent implications for young people.
I talked with more than 20 people with PSSD — most of them in the United States and a few in Canada, England and India — for this article. (They are now between the ages of 23 and 45 and asked to use only first or middle names to protect their privacy.) Though the condition can affect people who begin taking an S.S.R.I. in adulthood, I focused mainly on those who started on the drugs in their teens or earlier. I was interested not only in their extreme experiences but also in how their cases might reflect on more typical experience.
If side effects occur along a spectrum of intensity and duration — spanning from negligible to overwhelming, from transient to going on indefinitely after a drug is no longer taken — then the accounts of the most afflicted were a sign of what might be happening near the middle of the spectrum. There, where the common range of reactions lies, the side effects of S.S.R.I.s might well be meddling with the development of young libidos. They might be imposing a degree of dormancy during a period when the libido is naturally spiking — meddling more subtly than with someone like Marie yet interfering significantly and perhaps with enduring consequences. Full-blown PSSD might be rare, but it seemed to hint at more likely and important repercussions of reducing emergent sexuality.
The effects of S.S.R.I.s on young sexuality are all the more relevant because prescriptions for the drugs have soared. Around two million 12-to-17-year-olds in the United States are on S.S.R.I.s. One large 2024 study in the journal of the American Academy of Pediatrics tallied, month by month, the percentage of that age group who filled an antidepressant prescription between 2016 and 2022. During that time, the rate climbed by 69 percent, with the Covid pandemic’s emotional reverberations almost surely playing a part, though a notable rise was underway before then. Among college students in 2023-24, according to a survey with over 100,000 participants, 22 percent had taken an antidepressant during the previous year. This was up from 8 percent in 2007.
For many, the drugs may grant relief from the weight of depression or the siege of anxiety, and for some, the medications may be lifesaving. The drugs may avert self-harm or suicide. But some clinicians believe it seems probable that with S.S.R.I.s, something sexually disruptive may also happen.
Beginning at 19, with the stress of moving out of his family’s home and starting college, Cael was prescribed a succession of S.S.R.I.s as well as S.N.R.I.s. — selective serotonin and norepinephrine reuptake inhibitors, medications in a closely related category. (S.N.R.I.s also carry warning labels for PSSD in many countries outside the United States.) Sexual dysfunction, he says, came with the pills: precarious erections and, if he could reach them, orgasms that felt like pleasureless abstractions. Cael is 23 now and has been off the medications for a year and a half. What disappeared has not returned. He can’t help dwelling on whether his loss will be permanent. “What if I have this for the rest of my life?” he asks.
One of the most haunting accounts I heard of PSSD came from a parent. Ruth told me that a couple of decades ago her daughter was prescribed Zoloft, an S.S.R.I., at 11 by a psychiatrist, after a humiliating incident at school “left her feeling out of sorts and anxious.” About the prescription, Ruth said, “I guess I thought that was a good thing.” She spoke of her naivete at the time and “blind trust” in psychiatry. Her daughter wound up staying on the drug for a decade, until 2011. Only over the past few years has Ruth learned, from her daughter, about the sexual side effects she still lives with and about her grief. “Her erogenous zones don’t work,” Ruth said. “It makes me deeply sad, because our sexuality, the pleasure we get from our bodies and our intimacy with another person, it’s such a beautiful experience; it helps us to feel not alone.” Thinking back, Ruth said, “I have huge, terrible regret” about allowing her child to be medicated. “I can’t believe I so easily said yes.”
Two decades ago, Dr. Alexander Scharko sounded an alarm in The Journal of the American Academy of Child and Adolescent Psychiatry about the possible effects of S.S.R.I.s on the sexual maturation of young people. Scharko, then a postdoctoral research fellow at the Johns Hopkins University School of Medicine, set out to analyze existing studies on whether S.S.R.I.s could cause sexual dysfunction in adolescents. But he found that there was no research, and no data beyond several case reports.
In his paper, Scharko laid out the well-known problem in many adults of sexual side effects caused by S.S.R.I.s. Scharko argued that the same was probably true in adolescents. He suggested that the drugs might be distorting the erotic development of young people. “Can S.S.R.I. use in childhood or adolescence,” he asked, “negatively affect sexual functioning in adulthood?” He emphasized the lack of formal research.
Reliable data would require the kind of carefully designed long-term studies that are seldom done with psychiatric medications, partly because pharmaceutical corporations fund much of the research on psychiatric drugs, and the companies don’t have a great financial interest in finding out how well or poorly patients are doing down the line. Scharko wondered too if the absence of exploration extended to practitioners’ individual interactions with patients: “Clinicians may be failing to ask adolescents about sex and sexual functioning in the context of S.S.R.I. treatment.”
Scharko expected his paper to cause a stir. But when I spoke with him recently, he told me about the near-total silence that followed, a quiet that continues. “Since I published in 2004,” he said, “I haven’t seen much of anything else on this topic.” Scharko’s career as a child and adolescent psychiatrist has spanned from stints on the medical-school faculties at Hopkins and the University of Pennsylvania to an extensive hospital practice focusing on kids who struggle simultaneously with severe medical and psychiatric conditions. One of his areas of expertise is pediatric psychopharmacology. He often prescribes S.S.R.I.s to his patients. But he worries about the drugs’ widely embraced and fast-rising use. “Although there have been clinical trials among the adolescent population,” he said, and although they have looked into side effects like dry mouth and nausea, “I haven’t seen sexual questions being asked as they assess for adverse events. I don’t hear my colleagues talking about it.”
It’s still the case, as it was in 2004, that there are no dedicated studies of sexual side effects among the young. All that is available is extrapolation from research among adults. Depending on the symptom, ?d?rug and duration of use, between 30 and 80 percent of adults taking S.S.R.I.s live to varying degrees with diminished desire, sensation and function, according to a 2019 study in The Journal of Clinical Medicine. (Because of their predictable dulling effects, S.S.R.I.s have long been used as an off-label treatment for premature ejaculation.) So, though it’s unproven, it’s possible to infer that a comparable percentage of young people taking the drugs experience a dimming of their sexual selves.
Scharko talked about the strange dissonance between, on the one hand, a culture saturated in sexuality and, on the other, a discomfort or even a “taboo,” he said, against talking “about adolescents and their sexual development.” The unease, he went on, affects practitioners and “certainly moms and dads” and “certainly the adolescents themselves.” A result is a prevailing avoidance.
“These medications are powerful,” he said, “and we don’t know how far-ranging the adverse effects could be in children and adolescents.” He described the particular plasticity and “vulnerability” of young brains, and he decried the ongoing void in research. A crucial time in the formation of the sexual self seemed to him almost willfully ignored. “If I start a school-age child” on an S.S.R.I. “for obsessive-compulsive disorder, and the child has a good response to it, and stays on it, and then goes through puberty, what happens then? I can’t really tell you.” He added, “But my guess is, something happens.”
Dr. Amir Levine is one psychiatrist who has echoed Scharko’s worries. In a 2015 paper in Pediatrics, Levine, an associate professor of psychiatry in the Division of Child and Adolescent Psychiatry at Columbia University, responded to Scharko’s article and reiterated Scharko’s “largely unheeded” message that, in Levine’s words, “we are failing to ask something very important of an entire population” — and thus failing to confront and comprehend the influence of S.S.R.I.s on sexual maturation. “It’s a hugely regrettable omission from the clinical studies,” he said.
The drugs, he noted, can sometimes be “miraculous.” Though most of his practice is now focused on adults he recalled one young patient who couldn’t go to school because of her anxiety and yet who, within months, with medication, was able to go happily to sleepaway camp. Then he returned to the possibility that the drugs affect emergent sexuality — “that you can give a medication to a patient and potentially it can alter their sex life for a long, long time.”
The sexual side effects of S.S.R.I.s may, for some, be linked to specific physiological reactions. Dr. Irwin Goldstein has just finished an imaging study of internal penile tissue, performed during an injection-induced erection, with ultrasound technology that provides especially high resolution. Goldstein is a clinical professor of urology at the University of California, San Diego, and a specialist in sexual medicine who sees 50 to 75 new patients each year for erectile dysfunction. In his study, which he has presented at a major sexual-medicine conference and which he expects will soon join his 400 peer-reviewed publications, 38 of his subjects came to him for E.D. and traced their impotence to taking an S.S.R.I. This group ranged in age from 16 to 43 and had been off the medication for a median period of 21 months. There were two comparison groups. One tied their E.D. to trauma like a motocross accident, repetitive bicycle-seat injury or being kicked in the crotch. The other E.D. comparison group was made up of men over 50 and diagnosed with conditions like diabetes, cardiovascular disease and high cholesterol, known risk factors for erectile difficulty. The comparison groups had no history of S.S.R.I. use.
Goldstein showed me an aggregate ultrasound image for each group. In the first group, the internal tissue of the penis was black, indicating excess collagen. This was pervasive scarring, which can contribute powerfully to impotence. In the penis, Goldstein elaborated, S.S.R.I.s can cause an overproduction of what are called oxygen radicals, leading to scarring and malfunctioning. The tissue of the over-50 group had the same stark deterioration. The physiological effect of S.S.R.I.s within the penis looked closely akin to the impact of aging and diseases that are well-established contributors to erectile dysfunction. Here was one plainly physical way, he said, that a form of PSSD can occur. The group with injuries to the groin had no such decay.
Other mechanisms behind PSSD, less easy to discern, could lurk within the mysteries of the psyche and its murky relationship to the biochemistry of the brain. Because of the brain’s extreme intricacy, a degree of blindness may inevitably permeate the science and use of psychiatric medications. Within the brain, S.S.R.I.s increase the availability of serotonin, a neurotransmitter, which may foster feelings of well-being and stave off despondency, hush voices of self-laceration, calm panic and generally help people to cope. But the medications’ effects on other neurotransmitters, on hormones, on the essential electrical properties of cells, on myriad neurological interactions, are understood at levels scarcely more than speculative.
Given the incalculable influence of S.S.R.I.s within the brain, and given that, within our psyches, our sexuality is interwoven in indefinable ways with who we are, it’s not surprising that PSSD sufferers speak of lasting damage beyond sexuality. The blunting of nonsexual emotion often accompanies PSSD. “I don’t feel attached to them anymore,” Cael said of his parents, his siblings. “I could go years without seeing them, and I wouldn’t miss them.”
Sean, another young man I spoke with, recounted being put on Celexa, a standard S.S.R.I., three years ago when he was 22 years old, as the anxiety he’d been living with became intolerable during final exams at college. He told of a result so immediate that it sounded improbable, though such speed isn’t unheard-of among those with PSSD. He took a moderate dose, a 10 milligram pill, and an hour later, he said, “I had numb genitals.” He abandoned the drug almost right away and has taken no psychiatric medication since. “Three years later,” he explained, his penis “feels like my elbow — if you touch my elbow, it’s that same kind of sensation.” And there is emotional numbness to go with the physical. “I can’t feel any connection to you guys — I feel like my soul was ripped out of my body,” he told a small group of his closest friends. He has tried to get doctors to pay attention. “They were like: That’s impossible. It’s all in your head.”
Another intertwined distress is the disappearance of creativity. Marie remembers losing her ability to improvise musically when she was put on fluoxetine in high school. Suddenly, she said, “I had no flow state” on the piano or her other instruments, flute and saxophone. When she was babysitting and children asked her to play in the imaginary ways she’d loved before, she could barely join them. “I reached for it,” she said, “and it wasn’t there.” For Marie, creativity and fantasy, in ways erotic and not, are still closed off. “Sometimes I feel like a robot.”
Dr. Tami Benton leads the department of child and adolescent psychiatry and behavioral sciences at the Children’s Hospital of Philadelphia. I talked with her and then with a colleague in her department, Dr. Penelope Carter, about S.S.R.I.s and sex. Thinking of her initial and follow-up sessions with adolescents considering or already taking S.S.R.I.s, Benton, who has been practicing for three decades, said: “I raise the sexual side effects, whether you’re having sex or not. Young people frequently engage in masturbation and other sexual practices, and we know that the S.S.R.I.s can impact the ability to have an orgasm, can impact your sexual abilities and experience — we have to ask adolescents about it.”
When I asked Carter about informed consent with her adolescents, she replied: “It is a possible side effect. If you Google it, it’s going to come up. I mention it because they’re going to see it, and I don’t want them to think: Why didn’t my doctor tell me this? I don’t trust my psychiatrist. If you don’t trust the process, you’re not going to get better.”
Benton and Carter each talked about not rushing to medicate their patients and about therapy playing a key role in treatment. Carter emphasized that the paralyzing isolation that depression or anxiety can impose or the risk of self-harm can dictate medication. Those sorts of emotional troubles were their focus. Benton said that among her recent teenage patients on S.S.R.I.s, sexual side effects came up only rarely. This was at odds with what the adult research implied. And at one point in our conservation, she reflected, “I wonder if we do a good job at inquiring about the sexual side effects.”
Carter saw the issue as secondary. “Adolescents have such a high sex drive,” she said, with boys getting erections “when the wind blows,” so a reduction wasn’t as concerning to her as leaving depression untreated. On S.S.R.I.s, “some boys and girls might not feel that va-va-voom when they see someone attractive,” but the drugs were “overall pretty benign.” In any event, she said, “stop the S.S.R.I. and the orgasms come back,” as does the libido.
The transience of sexual side effects is a dominant faith among prescribers: Discontinue the medication, and the sexuality completely returns. But stories like those told by Marie, Cael and Ruth suggest otherwise. So does evidence from rodents. It’s imperfect evidence, because rodent brains are a long way from our own. Nevertheless, pharmacological and neurological researchers regularly design experiments that allow them to use rats and mice as human stand-ins when trying to learn about the effects of psychiatric drugs. In a 2010 study published in Biological Psychiatry, researchers gave male rats a generic Prozac at the age of rat adolescence, allowed sufficient time for the drug to clear from their systems, then monitored the males’ sexual behavior, in adulthood, when in the presence of a receptive female. Compared with a control group, the previously medicated rats were much slower to mount, took much longer from starting sex to ejaculation and, within any one session, ejaculated much less often. Not all similar experiments have produced data quite so definitive, and results with female subjects have been a bit blurry, maybe because female rodent sexuality is trickier to measure. But all in all, the rodent research carries cautionary implications.
Liz told a story that interlaced the loss of eros with other deep-seated shifts. And like Marie’s story, Liz’s involved music. At around 16, because she felt as if her parents weren’t listening, she went to her family doctor and confided that she was terrified at school — that she was being bullied, including incidents of having rocks thrown at her and being shoved to the ground. Within 15 minutes, in her memory, the physician, judging her in need of medication, sketched on a Post-it note a rough picture of the neurons in her brain, explained that her serotonin was low and sent her off with a prescription for Seroxat, the British equivalent of Paxil, an S.S.R.I.
Liz, who is 45 years old, was, until then, a girl who masturbated to fantasies of the actor Jeff Goldblum. “I fancied him in ‘The Fly,’” she said. “Before he turned into a fly, obviously.” She was also a girl who inherited and absorbed her father’s and grandmother’s talent at the piano. From the age of 3 or 4, she joined her father as he played ragtime pieces, sitting beside him and plinking out the high parts by ear. She soon practiced relentlessly, Mozart and Chopin and the pop songs that spoke to her, adding embellishments and flourishes of improv, fascinated by the way one tiny alteration could tilt the mood of a musical moment. With the television muted, she wrote scores to accompany scenes. By her midteens, she envisioned studying music at a university and going on to a career composing scores for movies.
Liz said Seroxat snuffed out her sexual feelings; it also seemed to steal the heightened, exquisite sensitivity, “the spine tingles,” she had always felt listening to, playing and creating music. With that gone, her artistic determination and ingenuity disappeared. “It’s somehow tied to the sexual. Everything became robotic and formulaic. I couldn’t invent stuff on the piano.” Her ambitions were derailed.
Liz has been trying to wean herself off Seroxat for decades, with plenty of reversals. There were withdrawal symptoms, now a widely acknowledged problem. But doctors repeatedly diagnosed her with rebounding depression. They told her to go back on the medication, and she heeded their judgment. Then she decided to try once more. Very slowly, she has now managed to taper to an almost nonexistent dose, with zero in her sights. She has been at negligible levels — well below therapeutic amounts — for years. Still, she said, “I don’t feel anything down there at all.” Neither sensation nor desire show signs of reviving. But there have been hints of musical sensitivity, and she has started playing again.
One afternoon, at a keyboard she keeps in a cramped room no bigger than a small walk-in closet, she played, with unmistakable talent, passages of Chopin and parts of “I Only Have Eyes for You.” There was beauty broken by a jagged tempo or the search for a note, a chord. She stopped and started again, stopped and started. She wept over her derailment long ago.
Any effort to fully research PSSD will face the challenge of distinguishing between the effects of S.S.R.I.s and the impact of the depression, anxiety and other psychological troubles the drugs are meant to treat. What if doctors have been right in their response — “It’s all in your head” — to patients like Sean? What if Marie and Liz are blaming medication for frustrations and disappointments rooted in their psyches?
This perspective isn’t hard to find on r/Psychiatry, a Reddit forum for mental health practitioners, when PSSD is discussed. “The patient insisted that his sexual and interpersonal difficulties were entirely due to a past failed trial of just five milligrams of escitalopram,” a contributor posted, using the generic term for Lexapro, a leading S.S.R.I., and relating what they said was a case from another practitioner. “When my colleague explained that the symptoms could be better explained by underlying affective and personality pathology, the patient was furious.”
Alongside the unknowns is a disturbing history of professional denial around the sexual impact of S.S.R.I.s. When the drugs first came on the market in the 1980s and early ’90s, the pharmaceutical industry and many prescribers took a default position of minimizing sexual side effects, declaring them uncommon. The 1995 Physicians’ Desk Reference maintained that there was a 1.9 percent incidence of sexual dysfunction among those who took fluoxetine. “Listening to Prozac,” the psychiatrist Peter Kramer’s 1993 best seller about the drug, mostly relegates sexual side effects to the end notes; it only once touches on them in the main text, describing them as a benefit to a husband who had been overly fond of pornography.
By now, the psychiatric profession generally recognizes high rates of sexual side effects in adults. And all six of the psychiatrists I talked with for this article noted the importance, when prescribing, of informing adolescent patients about the possibility. They also mentioned the necessity, depending on varying state laws about consent, of informing parents. But Dr. Awais Aftab, who works with adolescents and adults and is a clinical associate professor of psychiatry at Case Western Reserve University School of Medicine, thinks that most prescribers are not having that conversation. “I know of very few psychiatrists who discuss it as a potential side effect,” he said, judging by patients who come to him after having seen other practitioners, by his educational work with practicing trainees and by conversations with colleagues. He added that genuine informed consent throughout the practice of medicine is all too rare. Doctors “might ask you to look at a pamphlet,” he said. “That’s the culture that has developed. It’s: Here’s the medication I’m recommending.”
Peggy J. Kleinplatz, a professor of medicine at the University of Ottawa, told me about a moment that shed light on how family physicians and other primary-care providers — who write the majority of S.S.R.I. prescriptions in the United States and Canada — might be thinking about informed consent with patients. In 2019, Kleinplatz gave a presentation to family physicians at a Canadian medical conference. She asked her audience of some 50 doctors how many of them were aware of the sexual side effects of S.S.R.I.s. “Eighty percent raised their hands,” she estimated. She asked how many informed their patients about these effects when they prescribed. “Just one hand went up.” Then she asked why they didn’t. “They said it’s a matter of patient compliance.” To inform about potential sexual side effects, they worried, was to risk the patient not taking the drug that the doctor thought necessary.
Jim Phelps, a semiretired psychiatrist who spent much of his career focusing on mood disorders and consulting in general medical and university health settings, observed that prescribers are faced with a conflict between “autonomy and beneficence,” between fully informed patient agency and a sort of benevolent dictatorship run by the practitioner. This problem, he explained, was particularly acute with S.S.R.I.s, whose efficacy may depend on the placebo effect. He put the placebo factor at roughly 35 percent and said that in telling a patient about sexual side effects, and thus “mucking up” the patient’s optimism about the prescription, the placebo boost might be lost.
Levine, whose paper echoed Scharko’s, offered yet another reason for the likelihood of practitioners failing to broach, let alone monitor, sexuality with young patients — the fear of being labeled inappropriate or worse.
“For some clinicians, talking about sexual side effects with adolescents can feel like walking into a minefield — but we need to find ways to facilitate those conversations, even if it’s through a standardized symptom checklist that helps get the discussion started,” he said.
As for the risk of side effects’ outlasting S.S.R.I. use, none of the psychiatrists I interviewed who see adolescents said they include it in their routines of informed consent. Aftab explained that there just hasn’t been enough research to understand the scope of the problem.
“It’s a truly big issue,” Debby Herbenick, a provost professor at the Indiana University School of Public Health and recent president of the International Academy of Sex Research, said about the need for rigorous studies that grapple with the sexual effects of S.S.R.I.s on young people. “We should care about how young people are developing and how the medications they’re taking might be impacting their normative sexual development.”
A young man named True told me a story that was a reminder that sexual side effects can matter much less than misery. He’s 25 and has been on fluoxetine since he was 16, with a year-and-a-half break at around 21. He started on the drug to deal with a vortex of anxiety over high school grades and college entrance exams that felt as if they were “going to determine my entire life,” he said, and over terror that his school would be the site of a mass shooting. Therapy didn’t help, not enough. He was sleeping “like two, three hours a night, spending all night thinking about not sleeping” and “feeling kind of crazy all the time.”
Fluoxetine was transformative. The drug didn’t eliminate his depression and anxiety, he said, but it was like a protective moat. It kept the predatory feelings mostly on the other side of the water, with the drawbridge raised. Desire for his girlfriend was depleted, erections were more tenuous and orgasms were much tougher to reach, but he wrote this off partly to being in a long-term relationship. When he eventually stopped taking the drug, because he wanted to experiment with sorting through his anxieties unmedicated, erections rebounded and climaxing was no longer a chore. Then, as he gave up the medication-free experiment, the sexual troubles returned. While the moat kept the crippling anxiety at bay, it also often kept erections and orgasms at a remove.
When I asked about PSSD, he guessed that it would not become a problem, given how sexuality was restored when he took a pause from fluoxetine. But as we talked, it wasn’t clear that he worried much about whatever risk he might nevertheless face as his use of the drug lengthens year by year — and as “it’s sometimes hard to stay erect or get erect,” and as “the stars have to align a little” for him to have an orgasm. For him, he said, fluoxetine “works super well.” He was willing to put up with the sexual issues. He tells partners, “Things sometimes get weird down there.” He said that “especially in New York,” where he lives and where “a lot of people are on S.S.R.I.s or have been, people are pretty understanding.”
Like True, Sami told a story of need, but hers was also a story of regret. Sami has a history of depression running back to age 13. Around then, she started cutting herself with a hunting knife. With the help of therapy, exercise and new friends, and without medication, she pulled herself out of that pit, but three years after college, she sank into depression again after a breakup. A therapist steered her to a general practitioner, who prescribed sertraline, the generic version of Zoloft. The drug “did lift me out of that well,” she said.
But she noticed quickly that on the drug, climaxes became “superficial” and “so short-lived,” she recalled. “It infused a dominant emotion of frustration into sex.” She took the S.S.R.I. for just over a year and has been off it for six. Her capacity for transporting sex is still mostly relegated to the past, and she worries that it will stay back there forever, though she told me she thinks it might finally be returning “at a drip’s pace.” She allowed that when she decided to try the drug “I felt I was out of options, and it really did help me.” Yet she said “I would have thought much harder” about it had she known about what she now believes are enduring side effects. “I miss my old body before S.S.R.I.s.”
For Guin, medication hadn’t been necessary, not urgently. To treat depression, a psychiatrist put her on a standard dose of Celexa when she was 17. She wasn’t sure she needed the drug but, she said, “I was very compliant at that point.” Right away, she noticed that her sexual feelings were “dulled down.” Before that, she remembered, “I could orgasm very easily when I wanted to. I was a sexual person; I just hadn’t shared that part of me with anyone yet.” She recalled an early crush, at 12, on a neighbor boy who was about four years older. “His younger sisters and I would hang out, and sometimes he would hang out with us, and do cartwheels and things. I would think about him. I definitely had sexual feelings for him. I would lurk around, waiting for him to walk by after school.”
During college, she struggled in romantic relationships, which she linked to the sexual side effects of the pills. At 23, she tapered off the medication, wanting to regain the sexuality that had dimmed. But she then found herself “completely de-eroticized,” she said. She searched online and read discussions of PSSD and the prospect of permanence. “I thought: I have ruined my life. I have obliterated my ability to have a normal relationship. For the first couple of years, I’d wake up and remember what had happened to me, that this was my reality, and I would just want to go back to sleep and not wake up. I had frequent thoughts of suicide.”
She saw doctors who said her symptoms were her depression returning. They said, “Some people might say their sexuality is less important than their mental health.” Their dismissals imbued shame.
It has been six years since Guin stopped taking her S.S.R.I. She is 29. “I don’t have the capacity for romantic relationships,” she said. “That’s just gone in a stark way. For me, the chemical mechanisms of the romantic are too deeply tied in with sexuality for the romantic to exist independently.” She doesn’t expect her condition to change. “One reason I have improved somewhat mentally is by tolerating a new normal.”
She has just had her first child. Because she has no partner, she used in vitro fertilization. “I wanted a partner,” she said. “I wanted a child to grow up with their mom and dad. Your sexual life is so core when you consider that the sexual relationship is the basis for most long-term relationships.” She explained: “As excited as I am to be a parent, every so often I’m hit with another wave of grief. That I had to resort to this, that it came to this.”
"
