Antidepressants Are Having Horrific Effects on Sexual Function: Dr. Josef Witt-Doerring

15 or 16% of the population now taking anti-depressants when they've gone out and asked people who actually use these medications whether they're experiencing sexual dysfunction approximately 60% of people will endorse it we should only be using these medications after we've done everything else dr ysef Wit During is a boardcertified psychiatrist former FDA medical officer and now director of the Taper Clinic he treats patients suffering from postsri sexual dysfunction PSSD and protracted withdrawal two conditions becoming more common and in some cases permanent in people who have stopped taking anti-depressants ssris and anti-depressants are really popular drugs and some people just don't want to believe that they could potentially cause something so catastrophic how can patients who have decided to discontinue the use of psychiatric medications do so safely and how can we as a society gain control of our mental health what I saw going through all of that as a drug safety officer was essentially that we really were practicing outside of what the psychiatric clinical trials and the evidence showed doctors have been led astray uh about the drugs to the point where they overestimate the benefits and minimize the harm this is American Thought Leaders and I'm Yana Kellik dr yseph Whit During such a pleasure to have you on American thought leaders thanks for having me Yan so a very common side effect of anti-depressant drugs is actually sexual dysfunction if I understand perhaps the most common and a lot of people assume that after they come off these drugs that this will actually go away but that isn't always the case and in a surprising number of cases exists where it hasn't so tell me about that so what you're referring to is a condition called PSSD or or post SSRI sexual dysfunction and although this has been talked about since the '9s you know published in the medical literature it's only gained uh widespread recognition recently i mean we've had several drug regulators the not most notable of which is the uh EMA the European Medicine's Agency uh actually update the labels of all the SSRIs and the SNRIs these are classes of anti-depressant medications to warn about this risk and you know like you said there are a growing number of people who when they come off these medications they they find that their sexual functioning uh never returns again and despite this being what I think is a extremely important risk and something that everyone would want to know about before being exposed to this type of medications it's hardly known um amongst doctors and um and because of that many patients aren't told about it either so maybe give me a sense of first of all how common it is for just people that are on anti-depressants in the first place when they've gone out and asked people who actually use these medications whether they're experiencing sexual dysfunction approximately 60% of people will endorse it um however that may even be an underestimation because just with the sensitivity of talking about sexual functioning some people may may not want to talk about it but it is what I think probably the most common effect of the medication and and what about just in general like how common is it for people to take anti-depressants in the first place it's been increasing a lot actually and the most recent statistic that I've seen I think it's from 2018 is that there's about 13.2% of the US u population taking these medications i think it's about 8% for men and it's about 18% for women on these drugs and so it's it's incredibly common these days and in fact that was from 2018 before CO happened and I know that they've been seeing increases in anti-depressant prescription since then so it's likely even higher now how well do they work it is a controversial uh point and I want to preface it by saying there's a lot of variety so there are going to be some people where they're very beneficial and some people where it's not so so Irving Kersh uh he's a he's a researcher he looked at this and he found that when they got all of the clinical trials together and they did a meta analysis to see what the overall effect was it was approximately a twopoint difference on a 57 point scale now that seems very measly and um so that means two points in helping someone become less depressed yes yeah out of 57 out of out of 57 um and so you know a two point difference on scores out of 57 that's that's not a lot but for a long time we were told that they fixed a chemical imbalance you know that was in a lot of marketing and there were a lot of researchers a long time ago saying this um and that kind of entered the zeitgeist you know people thought if you're depressed or anxious could possibly be this chemical imbalance but uh researchers in the UK Joanna Monref and and her group out of University College of London published this umbrella meta analysis where they looked at all of the data into potential chemical aberrations in depression and they found nothing and this wasn't disputed by anyone so so they're not fixing a chemical imbalance and so the most logical way to sort of explain what these drugs are doing is depending on the drug they're either having some combination of of of numbing or anxiety reduction they can be slightly energizing for some people and they can be sleeppromoting now depending on the person that can be very therapeutic or not you know if you're a very high strong person and you have a lot of jitteriness and anxiety to be on an SSRI you might experience that as being as being very therapeutic um but for others that blunting is is not going to help them and then there's also a lot of questions about the longevity of that effect and and developing tolerance to it and there are some researchers out there who who do worry and I think it's credible that being on long-term anti-depressant medication might actually make a proportion of people more prone to depression and anxiety overall so it's actually really complicated um that there can be many things can be true there can be a a proportion of people who get on these medications experience it at the as therapeutic and it works long time for a long time but then there's also another group of people who it's really not that helpful for them and in fact it could be making them worse and the problem is it's we don't have research to predict who is going to have a good effect from this and a negative one you know one of the things that I've learned over the last years is you really have to look at the costbenefit analysis right as a as a doctor when you're going to prescribe a drug there's there's always a some cost some drugs it's very low but so and I I guess I'm always asking are doctors doing that analysis right I don't think it's happening enough I work at a clinic would you know which I founded with my wife where we help people come off these medications and so a lot of people will tell me that they go and see their family medicine doctor and sometimes they get diagnosed with a short 5-minute conversation sometimes they even fill out a check like check marks on a questionnaire in in the waiting room and then and then the doctor will come in and prescribe a medication that potentially has serious effects it's it's kind of like a roll of the dice sure I think most people are not going to have the serious problems but if you roll the dice enough you you are going to get some people who will be seriously harmed and the real shame that I think here is you know when I talk to the people who are injured um from these medications and who are having a lot of the problems they look back on why they went in there originally and they talk about a lot of problems that could have been resolved in other ways you know if it was grief maybe they just needed to meet with a doctor or a therapist or just wait maybe they didn't need any interventions they just needed to be told that their sadness was justified and that it would go away and that they someone would be there for them some people were just drinking too much coffee living sedentary lifestyles with you know with poor diet and they needed some someone to help them with their sleep and their diet and um maybe some of the substances they were using some people are having problems with work and relationships and they look back on this and they think "Wow there could have been so many things uh that I wish someone would have supported me with kind of held me and held me accountable to before the doctor prescribed the meds um that ultimately led me on this path i also want to be sympathetic to the doctors because I have sat in their shoes and I have worked in these county settings our health care system is not set up to support people in that way you know it's very transactional visits um and so I I sympathize for a lot of doctors as well who are being tasked with helping people with problems as complicated as anxiety depression i mean think it's one of the most complicated things so many different things can cause that medical and life problems and they're not really being given appropriate tools or time to help these people and so there's these uh systemic problems that lead to these extremely transactional visits where people aren't getting the kind of care that you would want for a loved one if that um and it's it's it's a big problem and that's why we have you know like 13% probably higher it's probably around 15 or 16% of the population now taking anti-depressants uh Dr yseph one sec we're going to take a quick break and we'll be right back folks and we're back with Dr yseph Whit During medical director of the Taper Clinic and so I mean what I hear you're saying is that although it can definitely help some people it's probably being used too much because of the the nature of the medical system today yes yeah when you said that earlier that there's no chemical bal imbalance that's being fixed here I have to tell you I still believed until that moment Yeah that that it was mhm i think that's what we've been you know conditioned to believe yeah i mean drug companies and and there's this famous Zoloft commercial from back in the day where there's this bouncing blob and it says you may be suffering from a chemical imbalance that um go and talk to your doctor about Zoloft you know a popular SSRI medication as if we understood that there was this well-defined biochemical process that that was disrupted and and this drug could come in and fix it and you know and and all of the downstream problems would go away from there you know the sad feelings and such and you would like a magic bullet hit it at its root now I'm not trying to say there's no genetic factors that influence uh someone to become anxious or depressed we know there's a whole range of different personalities which do have genetic influences it's more neurotic people they tend to become depressed more you know variations in you know human personality and such and and maybe there's some genetic problems we haven't identified that tilt people that way but it is certainly not a well understood biochemical process that these drugs insert themselves into and fix the way that these drugs work you know it can be numbing it can be energizing um and it's essentially a papering over of um of of symptoms you know it's not root cause medicine it's a it's a papering over of symptoms and so there is a place for the drug you know I'm certainly not an anti-drug person but it should only be after lifestyle interventions social interventions looking for medical reasons that can cause depression you have things like sleep apnea you can have vitamin deficiencies and more recently and this is incredible there's been some very promising research on dietary interventions like the ketogenic diet which have been able to and I'm not saying this lightly they've been able to reverse symptoms of schizophrenia and bipolar to the point where people who have been on medications for decades have been able to come off um and one really popular person is Lauren Kennedy West who has um a YouTube channel it's called living with schizophrenia she had built a following of like 300,000 people talking about acceptance of the diagnosis you know rationalizing you know the role of medications um in the treatment and then she did this this treatment and she's been able to come off and it's just been very interesting to to watch her journey and there's there's hundreds of people just like her and so we should only be using these medications after we've done everything else at that point you know paper over them with drugs that have risks but not before doing that i would say in 95% of interactions with doctors that's not happening one because the doctors aren't Yeah because the doctors aren't resourced and it's very transactional i want to go back to PSSD you mentioned numbing okay and and so my I understand that um for some number of people there's very significant numbing that that ends up being permanent so and also tell me like what what's the known prevalence of this where where it actually becomes something that's permanent so from the epidemiologic studies that I've seen uh to date uh there's one figure out there and it's that it that the incidence of this could be around 1 in 216 people i mean you could debate the terminology but it's it's not very common but it's it's common enough that it's you know when you have 13 potentially 15 16% of the population on this we're talking about hundreds of thousands of people yeah i mean something to the tune of 200,000 maybe more would would be the back of napkin calculation yes in in the United States um and so um it's it's common enough that I think people could expect to see it so the most classic story of this is that you have a young person and they and they they start taking this medication and they'll experience some degree of sexual dysfunction um you know decreased um libido maybe some difficulty sustaining an erection uh uh decreased um you know muted orgasms things like that now they'll take it for several years and then when they come off the medication it starts to intensify most people are told um yes this is an effect of the drug this is actually a common effect that's not a secret most doctors will tell people about uh sexual dysfunction while on the drug but people expect to actually get better on the way off and that's not what happens in this smaller group this one in 216 it actually intensifies and so they become more numb and um the way the way people describe that the numbness is they actually develop something called genital anesthesia um which is completely different from any other type of common sexual dysfunction the the main differential for that is usually like a performance anxiety so like a psychological you know psychological uh stress manifesting and you know inability to perform or it can be cardiovascular problems that lead to uh impetence um and difficulty maintaining an erection those things don't cause genital anesthesia and there are case reports in the literature of people putting things like tiger balm which um has a very strong sensory effect like if you were to put it on a sensitive area mhm people feel no nothing there was one woman who she even like pressed a hard bristled brush against you know against the area down there to see if she could have any sensation and there was nothing and so it is a genital anesthesia that occurs with these people you cannot explain that away by performance anxiety or or anything else this is neurological problems happening there so it's as if all erogenous sensation from that you know that pleasurable feelings that you would expect to have down there have gone away it's like touching the back of your hand this this this disruption so there's that part of it now obviously there's erectile dysfunction and all of that but the other thing that is not talked about a lot but is actually even more troubling to the people is the emotional blunting that comes along with it and sometimes even cognitive dysfunction so of uh a part of the story that's often missed is people think it's just a sexual problem it's not and and the people who suffer from this they they describe feeling like just the the volume on their their their feelings has been turned down and they'll say things like you know I'll hug my parents or uh my child and there's no warmth there i'm listening to a song from my youth which I loved and you you used to just fill me with nostalgia and I'd get this prickling on the back of my neck and it and it's gone and so they they feel like they're watching their life as if it's through like a TV with the volume turned down they're not really in it and and all of those those sensations that actually make us feel alive which you and me we we we sit in them every day to the point that we don't notice but you do notice them uh when you have one of these neurological injuries that that knock out these these sensations again for some people it it can also cause some cognitive dysfunction as well memory problems there's a lot of sleep issues and they actually struggle to work for many people this isn't going away um it's this this is a potentially permanent problem there are some people where you know maybe after three three years something like that there's some gradual improvement but there are case reports of people out there um who have had this happen decades ago and they're still walking around with sexual dysfunction and this blunting it's had a catastrophic effect on their lives and it's you said something earlier and you said and basically Yand and this isn't you know something like performance anxiety this is something quite different and what I heard in that is that it's likely that a lot often doctors aren't able to understand what they're seeing because it's just not something that's generally known i mean some people would call it like medical gaslighting is is is what happens they go and they say "I'm having this problem." And the doctor will like write them off but for it to truly be medical gaslighting doctors need to have been informed about this the truth is they they've never actually seen it before they've no way of understanding what's happened something that I think is a an absolute failing of our regulators and um and and our doctors that we haven't gotten the word out about this but the experience of someone when they get this is is horrible on the better side it's being dismissed by several doctors not being taken seriously kind of being written off maybe and but then on the worst side I've had some people say that they've been uh accused of being psychotic you know that you've developed a delusion around this happening it couldn't possibly be related to the drug because our conception is that we only understand drug induced side effects to occur when someone is on a medication and and the fact that it is enduring afterwards doesn't make sense and so they'll say that the person is is almost delusional there's been instances where they've they've turned family members against them they they say you know your loved one they're spending too much time on the Reddit forums where they're talking about this um even though this is acknowledged by several regulators around the world they write it off and they say "Couldn't possibly happen." Some people have even been hospitalized over this um um for for for a delusional disorder i mean it's the you know the level of I I'd say just like isolation and horror that some of these people find themselves in when know you've had a severe neurological injury and and no one no one believes you it's it's awful and the one thing that I want to add here for anyone clinical who may be watching this and just being like "This doesn't make sense um that something like this could happen." A really good example uh that's very similar to this is actually the antiscychotic medications which do almost the exact same thing with a different side effect now there's a side effect that you can have from antiscychotics called tie-dye diskynesia which is um most people have may not know the word that but they've seen it in the Batman movies with the Joker he's always depicted with his tongue kind of moving and he's making lip smacking movements there's a common side effect of long-term antiscychotic use involuntary movements and now what happens in these patients when they've been on the drug for several years is they start to develop these movements and then when they remove it they intensify and just like in PSSD for for some people it will go away over the course of several years but there's also a lot of people who um have it permanently afterwards so this kind of pattern isn't really an exception and it's kind of a norm that we see with other psychiatric medications as well i think it's just less recognized for for a couple reasons one movement disorders it's hard to blame a movement disorder on your psyche you know you're clearly having a movement disorder but you can blame cognitive problems feeling dissociated sexual performance you can say well it's probably your depression or your anxiety and so it and also I think SSRIs and anti-depressants are really popular drugs and some people just don't want to believe that they could potentially cause something so catastrophic and I want to be really clear about something any final thoughts as we finish today i mean it would just be the recap that if you're hearing this right now and you are worried about a medication that you are taking please do not stop it cold turkey um please do not rush off it make sure you are informed that you need to go slowly because it could really make things worse well Dr yseph Whit During it's such a pleasure to have had you on thanks for having me Yan thank you all for joining Dr yseph Whit During and me on this episode of American Thought Leaders i'm your host Yana Kell [Music]