The peer reviewed literature includes compelling case reports of individuals who developed sexual dysfunction while taking SSRIs, recovered from the condition being treated, discontinued the SSRI, but whose sexual health did not return to baseline. See Csoka and Shipko 2006; Csoka, Bahrick, and Mehtonen, 2008; Kauffman and Murdoch, 2007; Bolton, Sareen and Reiss 2006.
It's always impressive and appreciated when folks cite sources, but here's a few reasons this doesn't really sway my clinical judgment any:
This thread has been interesting and I'll certainly be curious to see some actual studies about this issue. Case reports by definition are anecdotal and changing practices based on just on anecdotes is bad juju. It definitely gives me a "hmmm" anyway.
poppycock. this is an incredibly naive and baseless claim (similar to claims that people who laugh or smile aren't depressed that some people come up with). Yes loss of libido is a common feature of depression but many patients with depression continue to experience significant sexual interest, particularly if their premorbid personality was somewhat hypersexual. For example patients with narcissistic personality disorder or even borderline personality disorder will often have hypersexuality or sexual behavior during depressive episodes, as will patients with a hyperthymic temperament. Patients with bipolar spectrum disorders may also have significant depression with hypersexuality (but no other features of mania). I treated a patient whose depression was driven by significant shame for having normal sexual thoughts and drive. In fact, part of the reason the pt improved with an SSRI was because it diminished his libido and made him feel less perverted. Compulsive sexual behavior may arise in depressive illness as a sort of affective equivalent. Patients may use sex as a sort of antidepressant to emotionally numb themselves. In the most severe depressive states you may also see a focus on sexual thoughts and behavior. I treated a patient with psychotic depression who had been catatonic for 2 years. He believed he was a pedophile (which turned out to be delusional) but had also been compulsively masturbating and became interested in bestiality. Paradoxical hypersexuality has been reported as occurring in the literature. Finally, "depression" is such an amorphous term and pathoplastic condition that not everyone has the same experiences. Hell not even depressed mood is required for the diagnosis. And loss of libido or hyposexuality, which often an accompanying feature of depression in general and melancholia in particular is not even part of the DSM or ICD-10 criteria for depression. It would be a mistake to assess severity of depression based on sexual drive. I have treated several severely depressed patients who maintained a rich inner world of sexual phantasy and kink.
While true, this doesn't help us consent anyone. It would help shorten the inserts to just "and this can cause anything you can think of".
So we have a 70-some year old lady on the unit--no colateral and not much frontal lobe function. Nice enough, not thoroughly demented, but perseverative as all get out, will NOT stop talking about this and that project, community stuff she's done, celebrities she claims to have known, her friend who's a state senator, and on and on and on....
This morning in report, we're told that pt is telling everyone that "Senator B" is coming to visit between 10 and 11. Everybody is dismissing it, even making fun a little--she'd made the same claim yesterday. At 1030, I walk through the dayroom and see the patient with a casually dressed middle-aged female visitor. Stop by to check on her..."Hi Doctor, this is Senator B!" Sure enough...patient worked on campaigns long ago. It was a treat for me to have a prominent state legislator on my unit to see us in action (hopefully she'll keep us in mind next budget session!), and to see her support and advocate for her friend. But anyhow--you can't just dismiss every "crazy" delusion, can you?
