How to prevent PSSD?

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Hi,

My background: I’m a 28-year-old male. I started using escitalopram 10 mg in 2011 because I had a pretty bad anxiety in high school. During the first three years of using escitalopram I didn’t notice any side effects. But in 2014 I started a relationship with one girl and that was the first time I noticed the sexual side effects of escitalopram: I had an erectile dysfunction and I wasn’t that interested in sex. I broke up with the girl and started to taper off escitalopram in the end of 2014. Unfortunately, my mental situation got notably worse in the beginning of 2015. I was desperate with my anxiety and ended up starting escitalopram again with the same dosage (10 mg a day). Since then I have used escitalopram with the same dosage because I have thought that I can’t live without the medication. The sexual side effects have gotten worse gradually and right now I can have an erection only with sildenafil and watching porn. I think I can’t have a normal sex. I started using sildenafil occasionally a couple of months ago and since then nocturnal erections have come back occasionally. In addition, I still have a bit of libido even though it’s a much lower compared to time before I started using escitalopram.

A few months ago I learned about PSSD and now I am very scared and want to taper off escitalopram immediately. I think my mental situation is stable enough and I can control my anxiety without escitalopram. In retrospect I should have never started escitalopram since there is a risk of permanent damage in brain. I have used it for 9 years which is very long time and that is making me even more scared of the persistent sexual side effects. In addition, I used isotretinoin (Roaccuttan / Accutane) for a year from spring 2016 to spring 2017 and I have recently heard that isotretinoin may also cause persistent sexual side effects.

But now I would like to know what I can do in order to minimize the risk of getting PSSD. My plan is to get Escitalopram in liquid form and reduce the dosage by 1 mg every four weeks (so the first four weeks the dosage will be 9 mg, the next four weeks 8 mg etc). Is this a good plan or should I do taper off slower if I want to reduce the risk of getting PSSD?

I have also been thinking about supplements and nutrition. Is there any supplement which can reduce the risk of getting PSSD? And is there anything I can do regarding nutrition? Should I avoid eating something or add something to my diet? My diet is pretty healthy and high-protein because I lift weights regularly. I’m currently using the following supplements:

• Vitamin B
• Vitamin C
• Vitamin D
• Omega 3
• Chelated magnesium
• Probiotics
• Whey protein
• Creatine
• L-Glutamine
• Maltodextrin