These are a few segments pieced together that talk about Sexual Side Effects of psychiatric medications. We reveal a company that has tried to hijack and market one of the major side effects of SSRI antidepressants as a treatment for premature ejaculation, at the expense of potentially numbing sexual pleasure and sensation for months or even years. This example of how companies prioritize profit over your well-being is especially egregious in my professional opinion.
Michael: I think of the Zoloft (Sertraline) ad with a little bouncing sad person. There's a little ball that is not very happy at parties and then shows a neuron and the decreased serotonin reuptake inhibition occurring. All of a sudden, it shows that Zoloft increases the amount of serotonin available in the synapse, and the next thing you know, the little bouncy ball no longer has the cloud around it and it's happy, it's hanging out at parties. That ad made it pretty clear to people that all I need to do is take this medication to increase serotonin and therefore I'm gonna get better, an oversimplification of a very complex disease state, but obviously that ad was incredibly effective. And part of this whole SSRI boom [00:01:00] in the ‘90s, coming out, it was presented as a fact. Looking back, a lot of psychiatrists and others have said, such a gross simplification creates this idea, instead of saying this is a theory based upon what we know about serotonin and where serotonin receptors are, but to just simply be that we just need to increase serotonin and it's gonna be better. And when you give that to somebody as an ad, and, shoot, if providers aren't being told much more than the patients are, you're gonna run with that and you're gonna see a lot of prescriptions given for that medication.
Ethan: That's probably the best example that I can think definitely in mental health of just a overly reductionistic way of looking at a diagnosis or a problem that depression is related to low serotonin. And hey, funny thing, we have this drug that increases serotonin, so it's gonna fix everybody. Zoloft, I heard this the other day, is now being marketed and used as a last-longer-while-having-sex type of thing, by HIMs, for premature ejaculation. [00:02:00] I mean, that's a great example of the shifting and moving nature of the industry when it comes to drugs, side effects, or uses for different drugs. These HIMs and HERs commercials, I don't know what the parent company is, but they're an online platform that is marketing SSRIs or SSRIs like Prozac (Fluoxetine), Zoloft, Lexapro (Escitalopram), for premature ejaculation. What makes that funny or ironic is for a long time, they've been trying to minimize the public perception of the side effect of sexual dysfunction that comes with SSRIs. I remember in medical school I was taught if you had sexual dysfunction with one of your antidepressants, well you could just stop the antidepressant or you could [00:03:00] start another medicine to combat the sexual dysfunction, but these new commercials, it is evidence of and sheds light on, the rise in medicalization, labeling non-medical conditions as medical conditions. Touting antidepressants as the remedy for premature ejaculation.
Michael: It's misleading in some ways too, the idea that we had this unintended consequence of one medication that we're going to rebrand as another thing. It's like the pay-no-attention to the man behind the curtain over there. You sell something as a cure, again, is another product with its own constellation of risks and benefits. This cascade of use medicine A for issue B and use B for C, and, you get into further unintended consequences versus just finding another way to address the initial thing. And in this case, like you said, it's taking something [00:04:00] that may not be an issue, but we now make the stigma now that says, oh if I don't adhere to whatever I think premature is, then now I've got a problem we have to fix.
Ethan: Yeah. So these Serotonin Reuptake Inhibitors, the most widely used class of antidepressants, they actually, over time, destroy peripheral nerves and lead to sexual dysfunction. There is a condition called PSSD, Post-SRI Sexual Dysfunction. Even after stopping the medicine, those peripheral nerves can be destroyed by the medication over time or with the discontinuation, or especially with abrupt withdrawal of it, and these peripheral nerves, they can regenerate, but they can take up to a couple of years to regenerate. These companies are selling a side effect of a medication[00:05:00] for what would have to be a temporary treatment. So essentially, they're trying to catch this window of when these antidepressants are destroying enough of the peripheral nerves to delay the time to ejaculation, and they're touting it as a treatment. That makes me so mad. It really gets my blood boiling, if you can't hear it in my voice.
Michael: Yeah, a lot of, it's an under-appreciation of the risks and benefits of starting medications. You know, I tell people all the time, students, patients, you've gotta respect the drug. Not to say SSRIs are bad in and of themselves, but when you have a medication that has a swath of various risks and benefits, or number of side effects to just simply use it just because it may have one small thing it does, again, unintended benefit, and then say therefore you need to be on it long term, a little bit disregarding of some of the potential collateral that comes with it.
Ethan: Yeah. So anyway, don't use antidepressants for your premature ejaculation. For [00:06:00] God's sake, just ejaculate. And then what's the recovery time? What's that called again? It's not called recovery time. It's called a refractory period. So after you ejaculate, there is the period of time that it takes before you're able to ejaculate again. Why don't we try this for your premature ejaculation? Why don't you ejaculate and then have sex with your partner sometime shortly after that to guarantee that you last a little bit longer. And you know what, if you ejaculate again, then you can probably have sex again after a shorter refractory period and last longer. You should not take a medicine every day so that you can last a little bit longer in bed. It's so dishonest, disgenuine, and, only looking at the profit margin when companies are marketing this to the American public and to people that are my age and [00:07:00] younger.
Michael: If it makes you feel better, it was created by a venture capitalist group, just looking at their portfolio. They started out, it was ED (Erectile Dysfunction) treatments and hair loss treatments and then moved on from there.
Ethan: Cariprazine (Vraylar) is a good one. I went to a dinner one time and they had a speaker, a physician who was really well-respected in the bipolar disorder community, the academic community, giving us this talk about Cariprazine and bipolar depression. That's the new indication and it's so effective. And he gets to the slide on side effects. He shows the side effects of the group that was not on Cariprazine and the side effect profile of the group that was on Cariprazine. You've got nausea and some vomiting in a couple. And then you've got sexual side effects, which are really common with psychiatric meds. And in the sexual side effect column of each of those, this is 500 patients in each arm of the study, 1 in placebo, none on [00:08:00] Cariprazine. The placebo group had 1 patient of 500 with sexual side effects. The Cariprazine group had 0 patients out of 500 with sexual side effects. You go out and ask 500 people in the community, not on any medicines if they're having sexual side effects from anything, and you're gonna get a proportion of those that are gonna say yes. I raised my hand and I'm like, ‘Where are all the sexual side effects? How did you all have the patient report the side effect profile?’ I never got a good answer. He kind of diverted the question a little bit and scurried away from it, but I'm sitting there like, ‘This doesn't make any sense. You're telling me out of a thousand people, not one person is reporting a sexual side effect.’
Michael: That's one of the things actually from a kind of a paper we looked at, was the idea that, spontaneous reporting of side effects is much lower than if you directly ask. If you're waiting for spontaneous, you're not gonna get it. You have to go in there and say, ‘Are you experiencing these things? Then you'll get some information.[00:09:00] ‘
Ethan: I'm convinced they went to the patients in the study and they were like, ‘You're not having any sexual side effects, are ya?’
Michael: It's like if you say you're having this thing, I'm gonna ask you 20 private questions about that thing. So are you having that thing?