All Episodes
Previous Next
March 29, 2025 - Epoch Times
23:08
Antidepressants Are Having Horrific Effects on Sexual Function: Dr. Josef Witt-Doerring
| Copy link to current segment

Time Text
15 or 16 percent of the population now taking antidepressants.
When they've gone out and asked people who actually use these medications whether they're experiencing sexual dysfunction, approximately 60 percent of people will endorse it.
We should only be using these medications after we've done everything else.
Dr. Josef Witt-During is a board-certified psychiatrist, former FDA medical officer, and now director of the Taper Clinic.
He treats patients suffering from post-SSRI sexual dysfunction, PSSD, and protracted withdrawal, to conditions becoming more common, and in some cases permanent, in people who have stopped taking antidepressants.
SSRIs and antidepressants 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 about the drugs to the point where they overestimate the benefits and minimize the harm.
This is American Thought Leaders, and I'm Janja Kellek.
Dr. Yosef Wit-During, such a pleasure to have you on American Thought Leaders.
Thanks for having me, Jan.
So a very common side effect of antidepressant 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 then a surprising number of cases exist where it hasn't.
So tell me about that.
So what you're referring to is a condition called PSSD, or post-SSRI sexual dysfunction.
And although this has been talked about since the 90s, you know, published in the medical literature, it's only gained wider spread recognition recently.
I mean, we've had several drug regulators, the most notable of which is the EMA, the European Medicines Agency.
Actually update the labels of all the SSRIs and the SNRIs, these are classes of antidepressant medications, to warn about this risk.
And like you said, there are a growing number of people who, when they come off these medications, they find that their sexual functioning never returns again.
And despite this being what I think is an extremely important risk and something that...
Everyone would want to know about before being exposed to this type of medications.
It's hardly known amongst doctors, 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 antidepressants 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.
However, that may even be an underestimation because just with the sensitivity of talking about sexual functioning, some people may not want to talk about it.
But it is what I think probably the most common effect of the medication.
And what about just in general?
How common is it for people to take antidepressants in the first place?
It's been increasing a lot, actually.
The most recent statistic that I've seen, I think it's from 2018, is that there's about 13.2% of the U.S. 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 incredibly common these days.
And in fact, that was from 2018 before COVID happened.
And I know that they've been seeing increases in antidepressant prescriptions since then, so it's likely even higher now.
How well do they work?
It is a controversial 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 Kirsch, 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 two-point difference.
On a 57-point scale.
Now, that seems very measly.
So that means two points in helping someone become less depressed?
Yes. Out of 57. Out of 57. And so, you know, a two-point difference on scores out of 57, 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.
And that kind of entered the zeitgeist.
You know, people thought if you were depressed or anxious, could possibly be this chemical imbalance.
But researchers in the UK, Joanna Moncrief 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 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 numbing or anxiety reduction.
They can be slightly energizing for some people and they can be sleep promoting.
Depending on the person, that can be very therapeutic or not.
If you're a very high-strung person and you have a lot of jitteriness and anxiety, to be on an SSRI, you might experience that as being very therapeutic.
But for others, that blunting is not going to help them.
And then there's also a lot of questions about the longevity of that effect and developing tolerance to it.
And there are some researchers out there who do worry, and I think it's credible.
That being on long-term antidepressant medication might actually make a proportion of people more prone to depression and anxiety overall.
So it's actually really complicated.
Many things can be true.
There can be a proportion of people who get on these medications, experience it as therapeutic, and it works 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 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 cost-benefit analysis, right?
As a doctor, when you're going to prescribe a drug, there's always some cost.
Some drugs, it's very low.
And 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, 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 five-minute conversation.
Sometimes they even fill out check marks on a questionnaire in the waiting room.
And then the doctor will come in and prescribe.
A medication that potentially has serious effects.
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 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 from these medications and who are having a lot of 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.
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 someone would be there for them.
Some people were just drinking too much coffee, living sedentary lifestyles with poor diet.
They needed someone to help them with their sleep and their diet and maybe some of the substances they were using.
Some people having problems with work and relationships.
And they look back on this and they think, wow, there could have been so many things that I wish someone would have supported me with, kind of held me and held me accountable to before the doctor prescribed the meds 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 healthcare system is not set up to support people in that way.
You know, it's very transactional visits.
And so 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, 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 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.
And it's a big problem.
That's why we have, you know, like 13%, probably higher.
It's probably around 15% or 16% of the population now taking antidepressants.
Dr. Yosef, one sec, we're going to take a quick break, and we'll be right back, folks.
And we're back with Dr. Yosef Witt-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 nature of the medical system today.
Yes, yeah.
When you said that earlier, that...
There's no chemical imbalance that's being fixed here.
I have to tell you, I still believed until that moment that it was.
I think that's what we've been conditioned to believe.
Yeah, I mean drug companies, 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.
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 was disrupted, and this drug...
Could come in and fix it, and all of the downstream problems would go away from there, 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 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 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.
And it's essentially a papering over of symptoms.
You know, it's not root cause medicine.
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.
And one really popular person is Lauren Kennedy West, who has 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, rationalizing the role of medications in the treatment.
And then she did this treatment and she's been able to come off.
And it's just been very interesting to watch her journey.
And 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, 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 resourced and it's very transactional.
I want to go back to PSSD.
You mentioned numbing.
And so I understand that for some number of people, there's very significant So, from the epidemiologic studies that I've seen to date, there's one figure out there, and it's that the incidence of this could be around 1 in 216 people.
I mean, you could debate the terminology, but it's not very common.
But it's common enough that 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 be the back of napkin calculation.
Yes, in the United States.
And so 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 start taking this medication.
And they'll experience some degree of sexual dysfunction, decreased libido, maybe some difficulty sustaining an erection, decreased 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...
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 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 1 in 216.
It actually intensifies.
And so they become more numb.
And the way people describe that...
The numbness is they actually develop something called genital anesthesia, which is completely different from any other type of common sexual dysfunction.
The main differential for that is usually like a performance anxiety, so like a psychological stress manifesting and inability to perform, or it can be cardiovascular problems that lead to impotence 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 has a very strong sensory effect, like if you were to put it on a sensitive area.
People feel nothing.
There was one woman who, she even pressed a hard bristled brush against the area down there to see if she could have any sensation, and there was nothing.
It is a genital anesthesia that occurs with these people.
You cannot explain that away by performance anxiety or anything else.
This is neurological problems happening there.
So it's as if all erogenous sensation from that pleasurable feelings that you would expect to have down there have gone away.
It's like touching the back of your hand, 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 a part of the story that's often missed is people think it's just a sexual problem.
It's not.
And the people who suffer from this, they describe feeling like just the volume on their feelings has been turned down.
And they'll say things like, you know, I'll hug my parents or my child and there's no warmth there.
I'm listening to a song from my youth which I loved and you just fill me with nostalgia and I get this prickling on the back of my neck and it's gone.
And so 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 all of those sensations that actually make us feel alive, which You and me, we sit in them every day to the point that we don't notice, but you do notice them when you have one of these neurological injuries that knock out these sensations.
Again, for some people 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.
This is a potentially permanent problem.
There are some people where, you know, maybe after three years, something like that, there's some gradual improvement.
But there are case reports of people out there 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 you said something earlier, and you said, basically, Jan, 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 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 medical gaslighting is what happens.
They go and they say, I'm having this problem, and the doctor will write them off.
But for it to truly be medical gaslighting, doctors need to have been informed about this.
The truth is they've never actually seen it before.
They have no way of understanding what's happened.
Something that I think is an absolute failing of our regulators and our doctors that we haven't gotten the word out about this.
But the experience of someone when they get this is horrible.
On the better side, it's being dismissed by several doctors, not being taken seriously, kind of being written off.
But then on the worst side, I've had some people say that they've been...
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 the fact that it is enduring afterwards doesn't make sense.
And so they'll say that the person is almost delusional.
There's been instances where they've turned family members against them.
They say, You know, your loved one, they're spending too much time on the Reddit forums where they're talking about this.
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 for a delusional disorder.
I mean, it's, you know, the level of, I'd say, just like isolation and horror that some of these people find themselves in when Now, you've had a severe neurological injury, and no one believes you.
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 that something like this could happen, a really good example that's very similar to this is actually the antipsychotic medications, which do almost the exact same thing with a different side effect.
There's a side effect that you can have from antipsychotics called tardive dyskinesia, which is, most people may not know the word, 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 antipsychotic use in voluntary 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 some people it will go away over the course of several years, but there's also a lot of people who have it permanently afterwards.
So this kind of pattern isn't really an exception.
It's kind of a norm that we see with other psychiatric medications as well.
I think it's just less recognized.
For a couple of reasons.
One, movement disorders.
It's hard to blame a movement disorder on your psyche.
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 also, I think SSRIs and antidepressants 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 at cold turkey.
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. Josef Wit-During, it's such a pleasure to have had you on.
Thanks for having me, Jan.
Thank you all for joining Dr. Josef Witt-During and me on this episode of American Thought Leaders.
▲
Export Selection