Kindly answer by Dr. Broberger

[sjv16477]

Some days ago I started to write to each possible researcher and physician potentially interested in studing PSSD. I found them looking on "Pubmed" for the authors of every publications about "SSRI and Sexual Dysfunction". I wrote them a mail explaining what PSSD is, linking studies and asking if they could be potentially interested in studying it or, at least, asking to incorporate and consider Persistent SSRIs' sides in their next studies.

This is the answer of one of them, I'm publishing it (with his consent) to induce everyone to write to scientists and physicians, because we cannot expect or hope that researchers will bring their interests in a topic that they never heard about: for the world we are inexistent, PSSD doesn't exist and pratictioners and people think that SSRIs cannot cause such damages.

I discourage you to write to Dr. Broberger because he has already said everything, but I encourage to look on pubmed for other researchers in the field of SSRI, of antidepressants, of sexual dysfunctions, of long term effects of drugs telling them what PSSD is and asking them to put in their studies this new insight. This surely will lead to a bigger awareness and then to the official recognition and researches on this topic.

"Thank you for your e-mail and interest in our work. I was sorry to learn about the troubles that you have experiencing but appreciate that you took the time to write me about them. I am at heart a basic scientist, with the aim of understanding the mechanisms through which the brain operates using animal experiments. But it is also my hope that the insights gained from our work will ultimately come to clinical use. While I became familiar with the widespread problems of SSRI-associated sexual dysfunction in the course of our work with the recent article, I was not aware of the specific condition that you describe, where problems persist after discontinuation of the medication.

The underlying hypothesis for our recent article was that SSRIs suppress the activity of dopamine neurons in the region of the brain called the hypothalamus (where much of the master control of the body's endocrine hormone system takes place), which in turn would lead to that dopamine's inhibition of prolactin release from the pituitary gland is lost, leading to increased prolactin levels in the blood. [...]

As you have probably learned while reading the literature, SSRIs, although they were originally designed to increase serotonin levels in the brain by blocking the molecule that removes serotonin from the synapse, also unintentionally interact with many other molecules. These molecules include several different classes of ion channels - the molecules that determine if a neuron is excitable or not. These ion channels are found an a wide range of brain cells, meaning that SSRIs have many potential targets where it elicits its effects. (Indeed, it may very well be that the antidepression actions of SSRIs also are partly produced by such so-called "off-target" actions.) In our paper, we showed that the effects of SSRIs on hypothalamic dopamine probably is the result of several different actions which include both serotonin and non-serotonin neurons.

Among the curious properties of SSRIs, it has been suggested that they may also stimulate the production of new neurons (so-called neurogenesis). This work has focused on the hippocampus region of the brain, and been proposed as a reason why SSRIs take several weeks of treatment before they reach full antidepressant effect (as it takes time for cells to divide and integrate into neural networks). If this is true - and it still needs more work to be validated - it could also account for other long-lasting, persistent effects of SSRIs such as the PSSD that you describe. [...] This may suggest that the nervous system had "gotten used to" the actions of SSRI and in its absence expresses an altered function in the branches that regulate sexual function.

[...] In a sense, it is perhaps not surprising that SSRIs may give rise to many different unintended effects: they are one of the most commonly prescribed drugs (and since people are different they may also react differnetly to the same drug, and more people also means more ways to react), the serotonin system innervates a large number of different brain regions and, as I wrote before, there is also evidence that at least some SSRIs interact with other brain proteins than just the serotonin transporter. So while this treatment has been of great benefit to many sufferers of depression (and the other diagnoses for which SSRIs are prescribed) it's important that there is an awareness of the types of side effects that may follow upon their use. Certainly, sexual dysfunction, both as a symptom of disease (in e.g. some diabetes patients) and as a side effect of therapy (e.g. SSRIs) is historically underdiagnosed.
It is my impression, as a newcomer to the field I should stress, that this should be discussed more by both clinicians and scientists. Getting doctors to report suspected side effects to pharmacovigilance authorities is important to get a systematic picture of the extent

[...] Our project in designed in the context of pregnancy and nursing (where prolactin output changes dramatically), but may have implications for any state - physiological or pathological - where there is a persistent change in neuroendocrine function. I will certainly incorporate this new insight into PSSD into our thinking about the results. [...]In other animal experiments, investigators have described off-target (i.e. not serotonin-mediated) actions of SSRIs (most commonly fluoxetine) in e.g. the hippocampus and olfactory systems, so it is certainly possible that other dopamine systems could also be sensitive to SSRIs.

And I want to encourage you to continue to write to scientists. Especially in the world of basic research, there is sometimes a disconnect between the projects and the clinical reality that many patients live in. This is problematic, since it is from basic research that many of the clues into truly new treatment options emerge. By informing basic (as well as more clinically oriented) scientists about less known, but still common and debilitating, conditions, we can bridge this gap. It has become apparent to me that, while we in the past decades have learned a lot about how the central nervous system controls reproduction (including e.g. the timing of the menstrual cycle and production of sex hormones), the regulation of sexual functions by the brain are still poorly understood. But it seems to me interest in this field is increasing.

While I am regrettably able to offer speculations rather than answers, I still hope this has been helpful to you. I also hope your problems will resolve, and that awareness of drug-associated sexual dysfunction will increase in the future with improved treatment as a result."

Then no excuse, stop to waste time and energy doing unuseful speculation on forums and let's do something of actual concrete. I'm not a native english speaker but using google I've done a decent english mail that I sended to dozens of researchers and Dr. Broberger is only the first that answered.

Please do the same, Strength in numbers!

[future-recovery]

Thank you very much sjv!
Good answer from him.

It reminds me a little bit of

Most antidepressants are designed to perturb the mechanisms that regulate the neurotransmitter serotonin – an evolutionarily ancient biochemical found in plants, animals, and fungi. Many adaptive processes evolved to be regulated by serotonin, including emotion, development, neuronal growth and death, platelet activation and the clotting process, attention, electrolyte balance, and reproduction. It is a principle of evolutionary medicine that the disruption of evolved adaptations will degrade biological functioning. Because serotonin regulates many adaptive processes, antidepressants could have many adverse health effects.

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334530/

[sjv16477]

Thank you very much sjv!
Good answer from him.

It reminds me a little bit of

Most antidepressants are designed to perturb the mechanisms that regulate the neurotransmitter serotonin – an evolutionarily ancient biochemical found in plants, animals, and fungi. Many adaptive processes evolved to be regulated by serotonin, including emotion, development, neuronal growth and death, platelet activation and the clotting process, attention, electrolyte balance, and reproduction. It is a principle of evolutionary medicine that the disruption of evolved adaptations will degrade biological functioning. Because serotonin regulates many adaptive processes, antidepressants could have many adverse health effects.

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334530/

This is a wonderful publications with a new and a wider view of what SSRIs do, this must be considered by researchers and pratictioners. Maybe very useful to write also to Dr. Andrews and staff.

[fasttrack1982]

What a great thing to do writing to scientists and doctors...I greatly appreciate your efforts, and it gives me hope that some scientists will take us seriously.

[sjv16477]

Thank you, but you should not appreciate my effort : you should replicate my effort doing the same! Every one have to send a mail to a scientist asking to study the syndrome. In is answer Dr. Broberger explained very well why and how this is important. This is the only actual usefull things we can do until now, please let do it!

[future-recovery]

I sent a mail to a scientist, but no response. I sent a mail to the medical faculty of a university that they should teach their students about PSSD. No response.

One has to send mails to many scientists and universities because the majority will presumably not respond. Moreover we could try to mail authors of the literature that students read. Though it's not always possible to contact famous authors (and I guess that they often get paid by pharma companies)..
We should try to inform medical students about PSSD. There might be some facebook groups with medical students.

[sjv16477]

Then you discouraged yourself only after two not-answered mail? I send literally hundreds of mails to facoluty of medicine, of psychiatry, to unversity professors involved in the field of psycopharmacology. Then I went on pubmed and I looked for every publications about "SSRIs" and "Sexual Dysfunciton"and I wrote to the corresponding author of these studies. Surely two mails are better then anything, if each member of this forum would send two mails surely we will bring us the attention of some scientists.

Students (and patients and sometime pratictioners) very often look on wikipedia to find further information, then is very important to add to the sectione !Adverse effects" of each SSRIs a brief sentence, like "Symptoms of sexual dysfunction have been reported to persist after discontinuing SSRIs, although this is thought to be occasional" with some references.

Wikipedia pages are consulted every days by hundreds of people, surely this will help us to spread awareness.

[Bigmum]

Mayby, listt of scientist that are ptentially interested whould be helpful.....

[GIXXER]

Great work.

We need more activism like this from members on here.

I have a feeling the medical community really is unaware of PSSD, and its up to us suffers to bring it to their attention.

[sulawesi]

Great work, sjv! A big step into the right direction! I'll inform myself about scientists who research about ssri in Germany and if there are any I'll write them.