Talk:Post-SSRI sexual dysfunction

Recreation

Although an AFD resulted in a merge for this subject, I have recreated the page from a new draft. The reason is that AFD was 9 years ago, and there have been more publications on the topic since, including reviews. [1] [2][3][4] Si I suspect MEDRS is now satisfied. Graeme Bartlett (talk) 22:30, 12 December 2022 (UTC)

It is mentioned in DSM-5 which is the principle reference book for psychiatrists FallingPineapple (talk) 23:22, 13 December 2022 (UTC)

I don't know how relevant the MDMA study is to PSSD

the Ecstasy users reported feeling significantly

more depressed, unpleasant, sad, abnormal, and unsociable

than the nonuser controls; 7 days later, the mood states of all

groups had returned to baseline (Parrott and Lasky, 1998)

https://www.sciencedirect.com/science/article/abs/pii/S0091305701007110?via%3Dihub

There are numerous indications of serotonergic damage in humans. In a PET scan study, McCann et al. (1998) documented a reduced density of 5-HT transporter sites, which correlated with the extent of past Ecstasy use;

Also this point is different compared to PSSD as PSSD is not dose dependent

FallingPineapple (talk) 06:31, 17 December 2022 (UTC)

I think it's worth including, simply because MDMA represents another case of a serotonergic medication that can cause lasting symptoms similar to PSSD. There doesn't seem to be a 1-to-1 correlation between PSSD and post-MDMA damage, but nonetheless I don't think one can rule out a possible similarity in mechanism.--Xardwen (talk) 22:39, 19 February 2023 (UTC)

I get your point and I agree. FallingPineapple (talk) 21:37, 21 February 2023 (UTC)

Use of <strong>...</strong> is per Wikipedia:Manual of Style

This edit got removed yesterday but I believe it is needed per Wikipedia:Manual of Style/Text formatting#Boldface, if you know of a better way denoting importance please let me know.

"For semantical emphasis (to denote importance, seriousness, or urgency), you can also use the HTML element <strong>...</strong>, or the template {{strong}}." FallingPineapple (talk) 05:42, 19 January 2023 (UTC)

Sources

This blog post includes and updates a list of PSSD literature. I believe it could be used on the page since it doesn't make any claims and only is links to articles making it verifiable.

Please check it every once in a while to update the literature table for relevant sources FallingPineapple (talk) 07:33, 21 January 2023 (UTC)

Relevance of Reddit and Forum

I understand the point of including the number of members on the PSSD forum and Reddit, ostensibly to show how many people the condition effects. However, other pages like breast cancer do not list the number of subscribers to r/breastcancer or on any breast cancer forums, and I fail to see how the size of the forums are useful information to the topic at hand. Yoleaux (talk) 19:22, 4 February 2023 (UTC)

I think it's worth including given that PSSD is currently very under-studied, and there aren't really any "official" metrics to point to when trying to estimate how many people suffer from the condition. The two sources cited earlier under the "Frequency of PSSD" heading plus the online survey in the following section are pretty much all we have, and none of these have very large sample sizes. Given the absence of wide-ranging, well-conducted studies, the next best thing would seem to be listing frequency of self-reports, which membership within support groups is somewhat of a proxy for. At the very least, it suggests that there are thousands of individuals across the world who have this problem, as opposed to say tens or hundreds. --Xardwen (talk) 22:34, 19 February 2023 (UTC)

I think it's the only frequency indicator of this disease right now before more studies are done. Breat cancer don't have this problem since they know relevant frequencies. FallingPineapple (talk) 21:37, 21 February 2023 (UTC)

Genital Numbness after use of SSRI

There were 2 studies which I currently can't find which are directly linked to PSSD

1- 70-85%(can't remember exact number) of patients within 1 hour of taking SSRI had genital numbness

2- a percentage (although small <10%) had persisting sexual dysfunction in one SSRI trial.

If you find which studies I am mentioning please add them. FallingPineapple (talk) 21:41, 21 February 2023 (UTC)

Sourcing concerns

I am concerned about the sourcing of this article, I removed some content that was poorly sourced but it's clear to me that it needs a rewrite to dramatically reduce the amount of unconfirmed speculation in the article and focus on what it says in secondary MEDRS compliant sources. One source I manually checked did not even mention the subject, which is an original research problem. (t · c) buidhe 06:31, 18 April 2023 (UTC)

note: some of these sources would be permissible to cite in the article. (t · c) buidhe 17:59, 18 April 2023 (UTC)

You have removed all tertiary references in the guise of removing "excessive quotations" instead of only removing quotations that you seem not to be fit, if the "excessive quotations" were the problem why are you not only removing the quotations but have removed all the tertiary references alongside it?

You have removed majority of recognised standard textbooks/medical guidelines and position statements from national or international expert bodies such as DSM-5 and BNF in the guise of removing primary sources. (WP:MEDRS). Removal of whole sections with no regard to WP policies are not allowed per WP:Vandal.

[1]

I propose bringing back the WP:MEDRS compliant sources. The changes you've made, and removing all primary sources. FallingPineapple (talk) 11:37, 22 April 2023 (UTC)

The article still has a lot of primary sources. A bunch of strung together quotations is not allowed per the rules on quotations. (t · c) buidhe 14:08, 22 April 2023 (UTC)

Your edits do not comply with WP:Baby

In this edit [5] as mentioned in the previous reply, you have removed majority of tertiary sources pretending you're only removing quotations which is against WP:Quote. Since the quotations are from tertiary sources removing the whole section and references to them is against Wikipedia policies.

Instead of only removing primary sources, you've removed majority of WP:MEDRS compliant sources.

As I proposed, please remove the primary sources, keep the WP:MEDRS sources. (Not to throw the baby out with the bathwater as shown in the link). FallingPineapple (talk) 15:36, 22 April 2023 (UTC)

You're welcome to write encyclopedic prose and cite any medrs compliant sources. What I removed was not that. (t · c) buidhe 17:07, 22 April 2023 (UTC)

You have deleted all references from DSM-5, BNF, references to NHS statement, Textbook of Rare Sexual Medicine Conditions which are all WP:MEDRS compliant. Your edits were against WP:BABY and WP:QUOTE

The non WP:BABY compliant edit

Sources which are compliant with WP:MEDRS as mentioned below.

"reliable, third-party, published secondary sources (such as reputable medical journals), recognised standard textbooks by experts in a field, or medical guidelines and position statements from national or international expert bodies."

As mentioned I believe all primary sources should be removed but the compliant sources should be returned. FallingPineapple (talk) 17:40, 22 April 2023 (UTC)

Please review WP:ONUS. Even if all content has wp:medrs compliant sources (it does not) that would not guarantee coverage in the article. Wp:baby is an essay, please stop bringing it up as though it is a guideline or backed by consensus. (t · c) buidhe 19:16, 23 April 2023 (UTC)

I believe the primary sources should be removed, the tertiary and secondary sources which were removed in your edits should return; do we agree on that? FallingPineapple (talk) 19:32, 23 April 2023 (UTC)

also per WP:MEDRS

"News sources may be useful for non-biomedical content, such as information about "society and culture" – see WP:MEDPOP.)"

so some of the Rxisk reporting on decisions of healthcanada for instance would comply with the policy. [6] FallingPineapple (talk) 19:43, 23 April 2023 (UTC)

It's not clear to me that rxisk is a reliable source in general. What evidence is there that it has a reputation for accuracy? For healthcanada, just cite healthcanada.

No, I do not agree that the content cited to the medrs sources should be restored. Just because the sources are OK does not mean that the content was encyclopedic. (t · c) buidhe 21:49, 23 April 2023 (UTC)

Regarding content not being encyclopedic. I notice you've removed the whole BNF section in your edit. Can you write an encyclopedic version of the BNF section for instance so it'd be clear what type of content would suffice? If only the 1 line quote was removed would you consider it encyclopedic?

Per WP:blogs

"Self-published expert sources may be considered reliable when produced by an established subject-matter expert, whose work in the relevant field has previously been published by reliable, independent publications"

It is written by a subject expert who's published multiple times in prestigious journals regarding the same subject. Since the information is off reporting nature mirroring healthcanada information it can be used. per WP:MEDRS FallingPineapple (talk) 23:40, 23 April 2023 (UTC)

If you look at other drug induced conditions such as Drug-induced lupus erythematosus, Drug-induced aseptic meningitis, or Drug-induced QT prolongation, it does not list which medical agencies have put which warnings on which drugs. It just says based on RS which drugs are likely to cause the condition. Therefore, I conclude that this level of detail is probably WP:UNDUE and/or WP:NOT. (t · c) buidhe 00:04, 24 April 2023 (UTC)

You're assuming those articles are perfect and concluding based on that assumption. Perhaps the warnings should be added to those articles as well.

Removing those sections are against WP:MEDORG and WP:BESTSOURCES also WP:DUE FallingPineapple (talk) 00:14, 24 April 2023 (UTC)

None of these guidelines say such details are WP:DUE. You could ask about best practices on WT:MED if you like. (t · c) buidhe 00:19, 24 April 2023 (UTC)

It is WP:DUE since repeatedly different med orgs have came to similar conclusions. FallingPineapple (talk) 00:23, 24 April 2023 (UTC)

If so then there's no need for attribution. Just find a source that explicitly says a certain drug can cause PSSD and put it in wikivoice without mentioning various medical agencies. (t · c) buidhe 00:30, 24 April 2023 (UTC)

I just looked for multiple medications on Wikipedia, and they have written about blackbox warnings on their Wikipedia pages, your examples seem to be suffering from selection bias. Hence your argument is WP:! . FallingPineapple (talk) 00:21, 24 April 2023 (UTC)

Blackbox warnings may be included in articles on a specific medication—but this article is not about a specific medication, but rather a drug induced condition. (and are the BNF warnings black box? all medications have warnings and side effects). Just because content may be WP:DUE in one article does not make it WP:DUE in another. If we're going to have information about which drugs have warnings attached, I think it would be better to present that in a list of medications i.e.

• Medication 1 (agency 1, agency 2)

Otherwise I don't see how this type of content could be WP:DUE. Also, I am not sure in this case if citing sources that don't explicitly mention PSSD could be original research. (t · c) buidhe 00:27, 24 April 2023 (UTC)

BNF warnings are within the BNF reference book and their website + on the medication leaflets etc

I see, it could've been written up much better...

that's a good idea.

The statements from EMA, HealthCanada etc are directly mentioned in the secondary(review articles) and tertiary sources (textbooks). FallingPineapple (talk) 00:43, 24 April 2023 (UTC)

Repeating Disruptive WP:BABY behavior

User buidhe is removing entire WP:MEDRS sources from NHS, European Medicines Agency and Psychological textbooks repeatedly even after being warned about his/her violations of WP:BABY.

You've been removing tertiary sources despite being told not to multiple times, you revert changes that introduce the removed tertiary based on an strawman of existence of sources which do not exist in the edit. Please read the change logs before undoing again! You're reverting only based on assuming what's going to be in the article.

In case you decide to remove tertiary sources again, you need to explain your reasoning.

Please read the following section in WP:BABY

"A general misunderstanding of the Help:Reverting (WP:REVERT) process and Wikipedia:Reverting (WP:RV) essay as meaning "undo anything that is not perfect": An editor determines a portion of another contributor's edit needs to be deleted, but removes the entire contribution instead of just the portion that needs to be deleted."

Stop removing WP:MEDRS sources, if you find any problematic parts they should be removed, compliant sources should not be removed based on WP:BABY. If you have a problem with the information from governmental bodies you need to make that clear with better sources instead of removing them with no reason. FallingPineapple (talk) 16:38, 23 April 2023 (UTC)

(News sources may be useful for non-biomedical content, such as information about "society and culture" – see WP:MEDPOP.)

Wikipedia:Identifying reliable sources (medicine) FallingPineapple (talk) 18:31, 23 April 2023 (UTC)

A few of the tertiary sources

Dear @Buidhe regarding your edit,

please refer to the following:

"Post-SSRI sexual dysfunction - An important iatrogenic condition, recognised by regulators" 1

"The announcement came earlier this week. On June 11, the European Medicines Agency formally declared that it was recognizing Post-SSRI Sexual Dysfunction (PSSD) as a medical condition that can outlast discontinuation of SSRI and SNRI antidepressants." 3 2

There are many other tertiary sources such as "Textbook of Rare Sexual Medicine Conditions, chapter named "Post-SSRI Sexual Dysfunction (PSSD)" 4

There are many other tertiary sources in the article itself as-well. FallingPineapple (talk) 12:49, 16 July 2023 (UTC)

The EMA didn't describe PSSD as a "disorder" so I would consider it to fail verification. It said that sexual dysfunction was a possible side effect of ssri usage which is not the same thing as being its own disorder. (t · c) buidhe 14:09, 16 July 2023 (UTC)

This secondary article Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors ;it's being referred to as a disorder here.

also here https://www.sciencedirect.com/science/article/abs/pii/S2050052121000603

It's also mentioned in Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

I assume you're aware of these, why don't you consider these verifiable? FallingPineapple (talk) 14:21, 16 July 2023 (UTC)

Also the EMA mentions persistent sexual dysfunction after use of SSRI has stopped, it differs from your misinterpretation of it ("possible side effect of ssri usage which is not the same thing as being its own disorder"). FallingPineapple (talk) 14:22, 16 July 2023 (UTC)

• Sorry, where is the link to the EMA's "formal declaration" about recognizing PSSD. None of the above links seem to be it? Bon courage (talk) 06:00, 17 July 2023 (UTC)

  The claim that EMA has recognized the diagnosis seems to have been plastered all over the internet in an attempt to validate the diagnosis in the public eye. I think this exhange is of interest, it is not a MEDRS source, but the claim that "...it is not within the remit of the EMA to classify medical conditions." seems correct. That is not the role of a medical products agency.

  As far as PSSD being part of DSM-5, that's just a flat out lite not true, is it? Draken Bowser (talk) 16:52, 17 July 2023 (UTC)

  Page 449 of the 2013 edition of the DSM-5 states the following: “In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.” (link to a RxiSK post which provides a PDF of the relevant section from the DSM: (Redacted)) Xardwen (talk) 18:32, 18 July 2023 (UTC)

  I.e. the condition PSSD is not mentioned in the DSM-5, only the potential for long-term symptoms is. Draken Bowser (talk) 18:45, 18 July 2023 (UTC)

  Xarden you have linked an WP:ELNEVER copyright violation. The DSM is copyrighted, and we cannot accept on Wikipedia a forum post that breaches copyright by publishing a scan of a copyrighted work. Please don't do that again; that forum is not welcome anywhere on Wikipedia as it breaches copyright. SandyGeorgia (Talk) 20:58, 18 July 2023 (UTC)

  Ah, understood- apologies for my cluelessness, won't happen again.Xardwen (talk) 23:58, 18 July 2023 (UTC)

  Xardwen this addition is now the third instance of you not understanding the importance of WP:COPYRIGHT and intellectual property. First, a Youtube of that nature is WP:UNDUE in this article, even if it had been a legit BBC YouTube; in that case, it could belong in External links. But it's not a BBC YouTube; who is Tower Ravens and how do they have the copyrights to this segment ? Please take care greater care to respect that when you edit Wikipedia, you have to understand policies, as your edits are immediately live. SandyGeorgia (Talk) 22:53, 19 July 2023 (UTC)

  I think a little background information might help here.

  The first thing to know is that the study of what's "a medical condition" (a disease, a disorder, a syndrome, etc.) and what's not is called nosology. It's a real academic field, and there are some core principles involved:

  • To be "a medical condition", the first important principle is that it has to be a medical condition, as in just one medical condition. Although there's some level of the usual Lumpers and splitters debate in the field, they're all united in saying that you can't lump separate things together. (For example: Da Costa's syndrome is not "a medical condition" because it is actually (at least) three separate medical conditions [PTSD, mitral valve prolapse, and ME/CFS, and probably traumatic brain injury as well], with all with completely different causes and somewhat different symptoms.) This situation probably qualifies as a single entity, but of course it's up to the experts, not the Wikipedia editors, to decide that.
  • The other main bit is to sort out is what kind of medical "thing" it is. Generally speaking, this process requires figuring out if there is a known etiology and a consistent pattern of symptoms. In the real world, the main point of this step is so that when a doctor says the baby has Scaryitis, all the other doctors know exactly what condition was diagnosed, but the part that we care about right now is the categories they think in. If you have a consistent pattern but no known etiology [initially], then it will generally be called a syndrome. If you have both, it's likely to get called a disease or a disorder. If it benefits from medical intervention but is not generally deleterious (e.g., pregnancy), then it will be called a medical condition (the most generic and inclusive of the labels).
  • And, very relevantly, depending on the cause, the entity might be labeled a Complication (medicine) or a Side effect. The EMA link provided above recommends that the packages name "symptoms of sexual dysfunction" as a possible side effect of SSRIs and SNRIs. This means that the linked document does not "formally recognize it as a medical condition" or "declare it to be a disorder" or anything like that. They said it was a reported side effect, and did not say that it was a disorder, syndrome, or medical condition.

  Second:

  The other important thing to understand is that "not a medical condition" does not mean "not real". Fever is real, but it is technically a symptom of many medical conditions, rather than a medical condition itself. Vomiting is real, and it is a side effect of many drugs. Hair loss is real, and it is a sometimes permanent side effect of chemotherapy.

  Wikipedia tries to be precise when we're writing, so we want to say that PSSD is a real thing that happens to real people in the real world, but we don't want to make claims that are technically not true (e.g., that PSSD is "a recognized medical disorder"). This requires careful writing. For example, instead of writing something technically inaccurate, like "The European Medicines Agency formally recognized Post-SSRI Sexual Dysfunction (PSSD) as a medical condition", we can (and should) write something indisputably accurate, like "the European Medicines Agency required that all SNRIs and SSRIs carry warnings about persistent post-SSRI sexual dysfunction". WhatamIdoing (talk) 18:18, 21 July 2023 (UTC)

  Thank you, this is very clarifying- I see the distinction and agree that it's important to make.Xardwen (talk) 22:27, 2 August 2023 (UTC)

Lack of reviews

With only nine literature reviews in the last ten years, it would be helpful if someone would get hold of the full text of PMID 34627736 SandyGeorgia (Talk)

I have a PDF of the review above I'm happy to share, how do I go about this?

That (Peleg) has already been shown to be poor quality; no longer interested in getting it. SandyGeorgia (Talk) 19:29, 27 July 2023 (UTC)

There's also a review that just got published in the British Journal of Nursing that might be useful, but I don't have access unfortunately.Xardwen (talk) 19:24, 27 July 2023 (UTC)

It's available through Wikipedia:The Wikipedia Library, but it looks like you're 142 edits short of qualifying. Someone at Wikipedia:WikiProject Resource Exchange/Resource Request or Wikipedia talk:WikiProject Medicine might have access.

A few notes from a quick skim: the incidence and prevalence of PSSD is unknown (which doesn't stop the author from saying that it's "rare"), there's the familiar list of symptoms, he argues that it might be unethical to prescribe these drugs without specifically naming this side effect, some of the symptoms of PSSD overlap with symptoms of depression or could be caused by other conditions, and (skipping over the sections on recreational drug use and people with HIV), a bit of Further research is needed. Overall, there is probably nothing wrong with it, but I would not say that it is an especially impressive review, and we might find the reviews he cites to be more useful. WhatamIdoing (talk) 23:19, 2 August 2023 (UTC)

I finally got access through TWL, and agree there's not much there to work with, nor anything new, nor much that disagrees with anything we've got. It cites Bala, which we've got. It mentions in passing only

• De Luca R, Bonanno M, Manuli A, Calabrò RS. Cutting the first turf to heal post-SSRI sexual dysfunction: a male retrospective cohort study. Medicines (Basel). 2022; 9 (9): 45. 10.3390/medicines9090045

on treatment options that have been studied, but no further content. It says some guidance can be found at:

• General Medical Council. Guidance on professional standards and ethics for doctors. Decision making and consent. 2020.

which is a general guide to decision making and consent (best I can tell it never mentions PSSD, but my ctrl-f was choking on the page).

But more generally, it is an article whose main aim seems to be to alert the nursing profession that they may encounter this and should be prepared to talk about it wrt informed consent and medications. It mentions advocacy efforts. I don't think any of the content is game-changing, and overall is about informed consent:

• "The [General Medical Council 9] gives some guidance on this subject: it states that 'it wouldn't be reasonable' to share every possible risk of harm or side-effect and advises that the consultation should be tailored to each individual, depending on what is important to that person. The [ 9] further advises that any risk of serious harm, however unlikely, 'should usually' be disclosed. Given that antidepressant medication labels carry a warning that PSSD is a possible long-lasting consequence ([16]) and not just a side-effect, there is a strong case for necessary disclosure under the GMC (2023) guidance."

SandyGeorgia (Talk) 02:31, 3 August 2023 (UTC)