SSRIs and novel sexualities: correlation or causation?
Antidepressants cause sexual dysfunction; is this confusing our kids into adopting "non-binary" identities?
In brief
Antidepressants are more effective at causing sexual dysfunction than they are at treating depression, and more youth are prescribed antidepressants every year. There has also been a recent explosion of youth with gender dysphoria and novel sexualities.
Are medications that stifle libido and sexual function helping our youth mental health crisis, or fueling it?
My background
I worked as a nurse with adults and adolescents in an inpatient psychiatric setting for nearly a decade. I was disturbed to discover that the vendor for patient education resources at my hospital was a company owned by Merck, the pharma giant behind scandals such as Vioxx.
With Vioxx, Merck saw in clinical trials that their product was unsafe; they then manipulated data to bring it to market, fabricated peer-reviewed journals as marketing propaganda, smeared doctors who noticed, and amassed a death toll of at least 55,000 people. With that track record, how could any patient or medical professional trust them as a vendor for unbiased information?
To give a specific example of how Merck’s financial interests biased the educational materials given to patients on my unit, their handout stated that depression is caused by a chemical imbalance, and patients will need to take an antidepressant medication for the rest of their lives.
I can look back to my nursing textbooks and find the same: depression is a chemical imbalance fixed by medication. It only takes a superficial amount of effort to find connections between nursing textbook authors and publishers to pharma giants.
This “chemical imbalance” theory of depression has never been validated. However, the marketing campaigns to keep this “theory” alive have been both subversive and wildly effective - antidepressant prescriptions have never been written with more frequency, and healthcare professionals are often unable to distinguish between marketing and unbiased research.
The efficacy of SSRIs compared to placebo was hidden in unreleased clinical trial data until a series of FOIA requests made them public.
Approximately 80% of the response to medication was duplicated in placebo control groups… If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible.
Again, this was data the manufacturers hid from public scrutiny for years until legal action brought it to light.
If the positive effects of antidepressants are negligible compared to placebo, are the side effects also negligible? Absolutely not. The release of the SSRI clinical trials also revealed the lack of reasonable effort to establish a comprehensive side effect profile. The widespread use of SSRIs is only supported by marketing and propaganda, not by robust, unbiased science.
I became interested in creating evidence-based, unbiased patient educational materials for the medications we were starting patients on every day at my hospital. It was during this effort that I discovered disturbing information about the prevalence, breadth, and sometimes permanence of the sexual side effects of SSRIs.
SSRIs are so effective at causing sexual dysfunction, they are the treatment of choice for PE - premature ejaculation. In fact, in comparison to placebo, they are more effective at treating PE than they are at treating depression.
The marginal benefits of SSRIs in treating depression come several weeks after starting; the sexual dysfunction begins minutes to hours after the first dose.
The side effect experiences of men successfully treated for PE with an SSRI is problematic enough that most do not continue treatment - yet these prescriptions are written for tens of millions of people with depression, for which its benefit is, for most, marginal and transitory compared to an inert placebo.
Pharma uses the fact that depression itself can cause sexual dysfunction to mask the side effects of their products. In fact, many side effects of SSRIs parallel the symptoms of depression itself: insomnia, fatigue, metabolic syndromes, sexual dysfunction, and even suicidality (especially amongst youth).
Mental health professionals minimize the sexual side effects if SSRIs because:
they have been intentionally kept ignorant by an industry that doesn’t want profits impacted and controls all manner of information
they want to encourage compliance (sexual side effects are a common reason to quit a med)
the topic can be uncomfortable to discuss at length and in detail, especially in the context of a teen and their parents
As decades have passed, the truth is evident: SSRIs do not fix a “chemical imbalance,” they cause one. Importantly, this is a development that was hidden and then revealed, not established by a progression of science.
SSRIs and puberty
The prevalence of “nonbinary” identities (including transgender and novel sexualities) amongst youth has exploded in the past few years, creating fuel for the culture wars and speculation into the cause. On my hospital psychiatric unit, the prevalence went from zero to a majority of patients in just a few years. Youth are now suffering an unprecedented mental health crisis as evidenced by rates of anxiety, depression, and suicide.
The increase in “non-binary” identities and novel sexualities has been attributed to the following (or blamed on, depending on your politics):
Increased societal acceptance
Social media
Endocrine blockers
Pollutants
Activist teachers
Online pornography
A viable case can be made for all these influences, but there is another that is not being openly discussed, either in the public discourse or amongst mental health professionals: the sexual side effects of SSRIs.
It is critical to understand that both the lack of nuanced discourse and lack of objective clinical research are intentional because stakeholders do not have the best interest of youth at heart.
Supporters of “gender-affirming care” (hormones, surgeries) reject a biological basis to sexuality, as evidenced in the Matt Walsh documentary “What is a Woman?” In their view, sexuality is intrinsic, gender is a construct, and the body should be modified to match beliefs. This viewpoint is so self-contradictory it is difficult to summarize a reasonable-sounding definition. The clinical research conducted by these ideologues will only support this view because their results are ideologically derived. To give one example, the 2022 Seattle Children’s Hospital study on “gender-affirming care” simply ignored their very high rate of participant attrition; only 65 out of 104 participants completed the year-long study. In other words, in a study about the efficacy of gender-affirming care, they excluded the mass of people who stopped seeking gender-affirming care. Despite such obvious flaws, this and similar studies are used as “evidence” supporting their preferred care model.
States like California and Minnesota won’t allow minors to get tattoos, but they will medically transition children without parental consent based off research that is essentially fraudulent and weaponized by activist organizations like WPATH.
It is indisputable that the ideal outcome for a person with any body dysmorphia is self-acceptance prior to permanent medicalization. This is not bigotry. The stories of detransitioners are appalling and heart-breaking. Transgender people do exist, and deserve compassionate care. However, an affirmation-only approach to youth sexual identity confusion is medical malpractice.
Ponder this: what other medical diagnosis does a patient get to dictate to their doctor?
Confusion, new genders, new sexualities
The “A” in 2SLGBTQIA+ is for “asexual.”
SSRI side effects include:
Genital numbing
Loss of interest in sex (low libido)
Erectile dysfunction (men)
Vaginal dryness (women)
Weak orgasms or inability to orgasm
Changes to impulses and inhibitions
Dissociation
Do these side effects manifest themselves in the variety of new categories around sexuality? Consider “47 Terms That Describe Sexual Attraction, Behavior, and Orientation,” including:
If you identify as asexual, you may experience a little sexual attraction or none at all.
Puberty is accompanied by identity instability, which can include sexual confusion. How much more confusing is it for kids experiencing the above-listed side effects? What psychological harms happen to youth who are rendered incapable of a normal sexual experience by their medication? Will the lack of an expected sexual response caused by an SSRI make a person question their sexuality and identity?
In my experience, most people are surprised to find out that most of our serotonin is not in our brain. This helps explain how SSRI side effects can be systemic, but are poorly understood:
Different theories have been proposed to explain the pathophysiology of PSSD: epigenetic gene expression theory, cytochrome actions, dopamine-serotonin interactions, proopiomelanocortin and melanocortin effects, serotonin neurotoxicity, downregulation of 5-hydroxytryptamine receptor 1A, and hormonal changes in the central and peripheral nervous systems.
The “chemical imbalance” narrative was always too simple; as time has passed, our growing understanding of the complexities of these body systems has raised more questions than it has answered - but you can’t make a cute, persuasive television commercial with that. Making billions of dollars in sales is a lot harder when you can’t explain to anyone how your product works; that’s when you have to resort to hiding clinical trial data and spending billions to influence doctors and the public.
Parallels in prevalence
The mental health struggles of America’s youth are not impacting both sexes equally; compared to male peers, female youth are more likely to be:
Non-heterosexual
Transgender or “non-binary”
Prescribed antidepressants
Subject to peer contagion (eating disorders, cutting behavior)
The issue is complex, but is it unreasonable to expect that if antidepressants worked, the boom of antidepressants being written to youth would result in youth being less depressed, not more?
Research gaps
What percent of youth prescribed an SSRI later develop gender dysphoria or a novel sexuality?
With meds, there is one bully who dominates the entire research playground: pharma. Large clinical drug studies are immensely expensive, and they are predominantly conducted by companies with billions invested in the results. When other studies create conflict, pharma launches a campaign to discredit them and smear their researchers (even when they know they are right - or, especially when they know they are right).
The depth of this corruption of science cannot be exaggerated; profits are prioritized over outcomes, and financial conflicts of interest have twisted medical research into a fraud of what science should be: transparent and neutral. The federal institutions charged with protecting the public from these predatory behaviors have themselves been captured, and media companies won’t report on it because their income is mostly pharma advertising.
Medicalizing children into a lifetime of dependency on pharma products is a profitable business model, and is clearly the type of ethical ground pharma giants inhabit. Medical professionals face propaganda that the caring, evidence-based approach with confused youth is to medicalize them with medications, hormones, and surgeries that can have a lifetime impact.
Informed consent
In most of modern medicine, true informed consent is not possible because science has been replaced by marketing and propaganda. Most healthcare professionals do not understand that they operate within a system designed to keep them ignorant, and they actively avoid the discomfort that comes with acknowledging the depth of the problem.
Both those stanchly opposed and those radically in favor of “gender-affirming care” agree on one thing: the stakes couldn’t be higher. Corporatists and ideologues overwhelm the good-faith actors, control the research, control censorship, and thereby control the narratives. This leaves parents with few trustworthy sources with the literal lives of their children at stake.
If my speculation is wrong - if there is no link found between SSRIs and novel sexualities - at least we will know to look elsewhere. It is tragic that there are so many valid contenders to blame for damaging our youth.
Links and Further Reading
Transgender, Asexuality and SSRIs
Antidepressants and sexual dysfunction: a history
Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap
Current efforts at informed consent are most likely inadequate, particularly for the treatment of children and adolescents.
Post-SSRI Sexual Dysfunction: A Literature Review
SSRIs and SNRIs for Premature Ejaculation in Adult Men
Selective serotonin re-uptake inhibitors for premature ejaculation in adult men
Unsafe and ineffective meds are approved by the FDA routinely:
3 Experts Have Resigned From An FDA Committee Over Alzheimer's Drug Approval
Some data:
By 2019, about 10.2% of teen females were on antidepressants, double their male peers at 5.3%
Males outnumber females in identifying as heterosexual (91.2% and 77.6%, respectively).
Over two million minors are prescribed antidepressants in the US
Autism and sexual identity confusion also appear to have overlap
Imagine this doctor-patient interaction at the time an SSRI is being prescribed for depression:
Q: How does this work?
A: We don’t know.
Q: Is it better than placebo?
A: Not really.
Q: Will there be side effects?
A: Yes.
Q: Can they be permanent?
A: Yes.
How did SSRIs get approved in the first place? Why is their use growing, not decreasing?
Absolutely excellent article 👍