Previously safe SSRI how likely to cause PSSD?

[Sascha100]

First of all, I'm really sorry if posts in this forum should only be posted by sufferers. If that is the case Im sure this post is going to get deleted. Anyway.
Im a 27 years old guy from Germany that has been suffering from severe OCD, depression, anxiety and derealization since I was a child. I have done tons and tons of therapy and have taken Paxil, Sertraline and Luvox. Luvox was the drug that really helped me so much. It gave me a life worth living without having to obsess constantly and being bedridden. I am aware of PSSD. And I am really scared. I am off Luvox now for 7 months but I am feeling very bad again. I never had problems with withdrawals and the sexual problems I had on Luvox (which werent severe, diminished libido, delayed orgasm, which wasnt bad and slightly less sensation in my Penis) diminished immediately when I got off it. I said there werent severe because I was on a high dose (250mg) and still could have sex daily. I know I have to get back on it again but I am scared of PSSD. I just want to know if the chance is any lower if the same SSRI didnt give PSSD in the first place? Ive already messaged a german sexual researcher and psychiatrist and he told me if we look at the theories of PSSD it wouldnt make sense to get it on an SSRI that has been used safely before. But of course he added that in the end you never now. What is your opinion on that? I looked up the theories and couldnt really understand why you are not/ less likely to get it on a previously safe SSRI. I really like to hear your opinion!
I already messaged GhostPSSD and he believes me successful previous taper makes me at least more likely to not get PSSD. Ive messaged other PSSD researcher and the answers vary from "we dont know" to "if you look at theories of PSSD it would be unlikely to get if from the previously safe SSRI. I know that cases like that exist though. So, what are your thoughts? I really hope for some critical insights and not just "SSRIs are all bad". I totally understand that PSSD is hell and if you get it you probably would never advise anyone to get on them again. Still I hope for some more unbiased insights.. Thank you so much guys.

[Sascha100]

Maybe I need to add that I used Paxil 40mg (decently high dose) and Sertraline at 300mg (astronomically high dose, I was totally not aware of any side effects of anything at that point in my life. While Paxil, I also used Seroquel for a short amount of time but it didnt help me at all. I tapered all of them rapidly, really rapdily and I now know how stupid that was. But everything cleared up very fast in all cases (Sertralin, Paxil and Luvox). I know that on one side Im probably more likely to get PSSD because of so many SSRIs already (seems to increase the likelihood) and the messing around with fast tapering but on the other hand I never had problems at all with SSRIs. I know that I would regret if forever if I get PSSD this time but my life is hell already and the Luvox really helped me massively. I will try tDCS and TMS before and even trying Neurofeedback at the moment because of course I want to avoid going on them again. But if all those things yield absolutely no fruits, I probably will restart (I also did lots and lots of therapy, my OCD is particularly aggressive because I probably have had PANDAS OCD which started as early as age 3 with obsessions, hypochondriac thinking and tics).

[Trazohell]

Dude look at my story (footer line), going back to these medications was the biggest mistake of my life. All these problems from before are a joke now, it's one of the worst things a (young) man can go through. I was like you, depressed and later also anxious since my childhood, but I was still a man with dreams. There is absolutely no guarantee that if you don't had any problems with SSRI in the past, that this will remain so. Many people get PSSD in the second, third, fourth, ... round. So try psychotherapy or maximum MAO inhibitors (Moclobemide as first line therapy). And never listen to psychiatrists who say "you need SSRI" and "PSSD is very rare or doens't exist", I did this unfortunately and now I'm in this shithole.

[Semogomes]

The place you are says everything. Try meditation, keto, exercising. Go from there

[arahant]

First of all, I'm really sorry if posts in this forum should only be posted by sufferers. If that is the case Im sure this post is going to get deleted. Anyway.
Im a 27 years old guy from Germany that has been suffering from severe OCD, depression, anxiety and derealization since I was a child. I have done tons and tons of therapy and have taken Paxil, Sertraline and Luvox. Luvox was the drug that really helped me so much. It gave me a life worth living without having to obsess constantly and being bedridden. I am aware of PSSD. And I am really scared. I am off Luvox now for 7 months but I am feeling very bad again. I never had problems with withdrawals and the sexual problems I had on Luvox (which werent severe, diminished libido, delayed orgasm, which wasnt bad and slightly less sensation in my Penis) diminished immediately when I got off it. I said there werent severe because I was on a high dose (250mg) and still could have sex daily. I know I have to get back on it again but I am scared of PSSD. I just want to know if the chance is any lower if the same SSRI didnt give PSSD in the first place? Ive already messaged a german sexual researcher and psychiatrist and he told me if we look at the theories of PSSD it wouldnt make sense to get it on an SSRI that has been used safely before. But of course he added that in the end you never now. What is your opinion on that? I looked up the theories and couldnt really understand why you are not/ less likely to get it on a previously safe SSRI. I really like to hear your opinion!
I already messaged GhostPSSD and he believes me successful previous taper makes me at least more likely to not get PSSD. Ive messaged other PSSD researcher and the answers vary from "we dont know" to "if you look at theories of PSSD it would be unlikely to get if from the previously safe SSRI. I know that cases like that exist though. So, what are your thoughts? I really hope for some critical insights and not just "SSRIs are all bad". I totally understand that PSSD is hell and if you get it you probably would never advise anyone to get on them again. Still I hope for some more unbiased insights.. Thank you so much guys.

I got prescribed Sertraline for OCD in the past, I had even taken up to 150 mg/day for a while before tapering it off.

It is quit surprising that you:

I said there werent severe because I was on a high dose (250mg) and still could have sex daily.

Sertraline was a shotgun hit on my sexuality, and it was seen within the first week, as porn looked like cartoon, It "fixed" my OCD but it has taken nearly 5 years of my life on PSSD, something that only improved last year up today. I guess my OCD symptoms were much more genetic, since I have my father and other family members with same symptoms. SSRI helped but with awful side effects.

The weird part is that with my PSSD symptoms improving, some of my old compulsive repetitive "cracking" of the neck worsened recently. Like the "habit" to a feeling of tension which builds up and can only be relieved by the movement in question. I will not take SSRI again for obvious reasons, when researching I got into NAC as something to help:

https://www.ncbi.nlm.nih.gov/pmc/articl ... %20effect.
Four clinical trials and five case reports/series were identified. Study durations were commonly 12-weeks, using 2,400–3,000 mg/day of NAC. Overall, NAC demonstrates activity in reducing the severity of symptoms, with a good tolerability profile and minimal adverse effects. Currently there are three ongoing randomized controlled trials using NAC for OCD (two adults and one pediatric), and one for excoriation.

https://youtu.be/s945zr6P_rs?t=342

That is what I am taking now while trying to ease my OCD symptoms...

OCD sucks, but keep in mind that all medical interventions can cause harm, including surgery, medications, psychotherapy, and recommendations to exercise.
In medicine, interventions must be understood and explained to patients in terms of "risk-benefit" relative to prognosis without treatment. This is the foundation of informed consent.
There are a range of different psychiatric medications used to treat different conditions, each with varying levels of efficacy compared to placebo. OCD is one of the rare ones that placebo does basically nothing, and It has been shown in many placebo-controlled, double blind, randomized trials. Which is totally different from example from the "generic depression" especially in young people which has high rates of placebo response.