Sexual Dysfunction from SSRI’s- Can Foreskin Restoration Help?

Antidepressants are one of the most commonly prescribed medications in the United States. Unfortunately, sexual side effects such as arousal, libido, orgasm and ejaculation problems have been reported up to 80% of the time in some studies.(1) Because of this, some men turn to foreskin restoration as a way to increase penile sensitivity in hopes that it will offset some of these side effects. While foreskin restoration is beneficial to pursue regardless, it may or may not make a difference in this situation. The exact mechanism of how antidepressants cause sexual dysfunction is not clear, but it is most likely biochemical in nature.(1) Since circumcision causes sexual dysfunction on a physical and mechanical level, foreskin restoration is not going to address the root cause of sexual dysfunction from antidepressants. Since the medications themselves are the root cause, we need to look at whether or not they have any benefit and are worth taking in the first place.

The underlying theory for the use of SSRI’s and other antidepressant medications is that depression is caused by low levels of serotonin, though this theory has not held up to scientific scrutiny. A meta-analysis of 12 systematic reviews and meta-analyses, 1 collaborative meta-analysis, 1 meta-analysis of large cohort studies, 1 systematic review and narrative synthesis, 1 genetic association study and 1 umbrella review showed no association of serotonin levels with depression.(2) Furthermore, another meta-analysis of 42 studies showed that antidepressant medications show no benefit over placebo.(3) The underlying theory of how these medications are supposed to work has been essentially disproven, and the medications themselves have not been shown to have any benefit. Antidepressant medications are one of the biggest medical scams of recent history and are destroying the sexual health of millions of people.

Although antidepressants don’t actually have any effect on depression, they do create neurochemical changes which go beyond just the sexual side effects. Over time, they do cause physical dependence, which makes stopping these medications very difficult. Stopping antidepressants or reducing the dose can cause serious withdrawal symptoms, and should only be done with the guidance of a healthcare professional.(4) The reason many people feel that they need to be on these medications is that they feel worse when they go off of them. This leads them to believe that the medication is providing some benefit, when in reality they are just experiencing withdrawal symptoms. In cases where someone has been on one of these medications for several years, it may even be necessary to slowly reduce the dose over the course of a year or more using hyperbolic tapering(5).

The good news is that sexual dysfunction improves 75% of the time by just halving the dose, and completely resolves almost 100% of the time after the medication is discontinued.(6) If you are on an antidepressant medication and are considering discontinuing it, take a look the Royal College of Psychiatrists guidelines for stopping antidepressants and discuss this with your doctor in order to create a proper tapering protocol.

 References:

1. Atmaca M. Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction: Current Management Perspectives. Neuropsychiatr Dis Treat. 2020;16:1043-1050. Published 2020 Apr 20. doi:10.2147/NDT.S185757

2. Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry 28, 3243–3256 (2023). https://doi.org/10.1038/s41380-022-01661-0

3. Brunoni AR, Lopes M, Kaptchuk TJ, Fregni F (2009) Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic Review and Meta-Analysis. PLoS ONE 4(3): e4824. https://doi.org/10.1371/journal.pone.0004824

4. https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants#:~:text=If%20you%20have%20been%20taking,withdrawal%20symptoms%20in%20the%20past.

5. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext

6. Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019;8(10):1640. Published 2019 Oct 7. doi:10.3390/jcm8101640

Image: Subhrajyoti07, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons