Psychosocial Characteristics and Reporting Patterns of Women's Experiences With SSRI-Linked Sexual and Non-Sexual Side Effects

Abstract

ABSTRACT Introduction A majority of women who use Selective Serotonin Reuptake Inhibitors (SSRIs) experience iatrogenic sexual dysfunction – primarily decreased arousal and desire (Lorenz et al., 2016). Experiencing SSRI-linked sexual side effects predicts decreased medication satisfaction and adherence, but few psychosocial factors have been identified that may increase risk of experiencing SSRI-linked side effects. Objective To describe characteristics of young women who report experiencing sexual versus non-sexual side effects linked with SSRI use. Methods 818 emerging adult women (mean age = 19.7, SD = 2.5) in the Southeastern and Midwestern United States reported their lifetime history of medication use (including SSRIs), mental health, unwanted sexual activity, and age of sexual debut. Those who reported ever using an SSRI medication indicated if they had ever experienced any of 20 possible SSRI-related effects, including sexual effects (e.g., desire changes, problems becoming aroused, problems having an orgasm, and increased pain during sex) and 16 non-sexual effects (e.g., weight gain, insomnia, emotional dulling). Linear logistic regression examined psychosocial predictors of reporting sexual versus non-sexual SSRI-linked side effects. Results 187 women (22.9% of sample) reported ever using an SSRI to manage mental health. Among the women who reported lifetime SSRI use, 89 (47.6%) reported experiencing at least one non-sexual side effect, while 45 (24.1%) reported experiencing at least one sexual side effect. Of those who reported that they experienced non-sexual side effects, 45 (50.6%) also reported one or more sexual effect. Every respondent who reported experiencing sexual effects also reported nonsexual effects – that is, nobody reported sexual side effects in the absence of nonsexual side effects. Respondents were 3.8x more likely to report sexual side effects if they ever experienced unwanted sex, p = .005; while mental health disorder history did not significantly predict sexual side effect reporting, p = .226. On the other hand, unwanted sexual experiences did not contribute to models predicting non-sexual effect reporting, p = .236; whereas mental health disorder history was a significant factor, linked with 1.76x increased odds for each positive screening of three possible psychiatric diagnoses, p = .016. Respondents’ age of sexual debut did not significantly contribute to predictions of sexual or non-sexual effects, ps = .813 and .709. Conclusions Among this sample of young women who used SSRIs, sexual and nonsexual side effect reporting was not unilaterally distributed; while non-sexual effects sometimes occurred independently from sexual effects, sexual effects always occurred in the presence of non-sexual effects. This finding raises important questions about whether sexual side effects might be mediated by other secondary effects, like fatigue or emotional dulling. Further, women's unwanted sexual experiences uniquely predicted increased likelihood of reporting sexual effects, whereas their mental health disorder history uniquely predicted increased odds of reporting non-sexual effects. Future directions include testing how patient-provider communication influences patient perception of side effects and how various unwanted sexual experiences (forced and coerced) may differentially impact women's risk of experiencing SSRI-linked side effects. Disclosure No