What to Know About Teen Sexual Development and S.S.R.I.s

Magazine|What to Know About Teen Sexual Development and S.S.R.I.s

S.S.R.I.s, the most commonly prescribed class of antidepressants, are known to tamp down libidos, and prescriptions to adolescents have soared over recent years. For many, the drugs may grant relief from depression or anxiety, and for some, the medications may be lifesaving. But some clinicians believe it seems probable that something sexually disruptive is also happening in young people.

I explored this issue in my magazine article, in which I mainly focused on those who started on the medications in their teens or earlier. I was interested not only in the experiences of those who described extreme sexual side effects — effects that lasted long after they stopped taking the drugs — but also in how those cases might reflect on more typical experiences. There is basically no research that looks at the impact of antidepressants on emerging sexuality.

Here are four key points in my story.

The rate of S.S.R.I. prescriptions for teens has been on a steep rise.

The rate of S.S.R.I. prescriptions for adolescents (and that of S.N.R.I.s, closely related drugs) has been climbing. Between 2016 and 2022, prescriptions for 12-to-17-year-olds grew by 69 percent. Among college students in 2023-24, according to a survey with over 100,000 participants, 22 percent had taken an antidepressant during the previous year. This was up from 8 percent in 2007. The emotional repercussions of Covid might explain some of the increase, but it was underway before then.

Studies have long demonstrated that S.S.R.I.s dampen sexuality in many adults, but there is no research on the sexual side effects of the drugs in teens.

The adverse sexual side effects of S.S.R.I.s on adults are by now well established, with research showing rates ranging from 30 to 80 percent, depending on the symptom, drug and duration of use. Taking an S.S.R.I. often means depleted or deadened desire, erectile dysfunction for men, elusive arousal for women and delayed and dulled orgasms or the inability to reach orgasm at all.

While there is some research on relatively minor side effects like nausea and dry mouth in teens who take S.S.R.I.s, there is, strikingly, no data on the sexual impact. Though it’s unproven, it’s possible to infer that a comparable percentage of young people taking the drugs experience a dimming of their sexual selves. This may occur just as they’re going through a time of life when sexual maturation is typically underway and when sexuality is usually spiking. Some psychiatrists have raised concerns about what this might mean and decried the lack of discussion and research on this question.

Some people who took antidepressants when they were young say they continue to experience sexual side effects even long after stopping.

It’s generally assumed that when you discontinue an S.S.R.I., sexuality rebounds. But for some, the loss of sexuality persists after the drug is no longer being taken. This condition is known as post-S.S.R.I. sexual dysfunction (PSSD). In these cases, sexual side effects can linger for years and may even be permanent. Some who experience an ongoing diminished libido or other enduring sexual symptoms say it has affected their ability to form and maintain relationships as adults.

PSSD is a controversial designation. Some psychiatrists suspect that the condition is actually a result not of repercussions from the drugs but of the problem — depression, say, or anxiety — that led the patient to be medicated in the first place. Some PSSD sufferers express great frustration that clinicians often don’t believe them.

There is very little research on the prevalence of PSSD, and what there is has all sorts of limitations. In one study, erectile dysfunction affected fewer than 1 percent of former S.S.R.I. users, while another found that genital numbness impacted at least 13 percent of those surveyed.

Some clinicians are calling for a more open discussion about the implications for young people.

Clinicians who prescribe S.S.R.I.s in the United States are probably not spending enough time talking with their young patients or their patients’ parents about potential sexual side effects and the possible reverberations for their sexual selves. Patients need the information in order to weigh the potential benefits of the drugs against the possible costs.

Source photograph for illustration above: Gabrielle Revere