How SSRIs May Be Altering Teen Sexual Development

Lead: In recent years clinicians have prescribed selective serotonin reuptake inhibitors (S.S.R.I.s) to increasing numbers of adolescents to treat depression, anxiety and related disorders. Emerging patient accounts and regulatory statements suggest these drugs can blunt sexual desire and function in adults, and clinicians and researchers are asking what that could mean when exposure begins during adolescence. Between 2016 and 2022 antidepressant fills rose sharply among 12-to-17-year-olds, raising questions about effects on the sexual maturation that typically unfolds in those years. Some former adolescent users now report persistent loss of libido and sensation long after stopping medication.

Key Takeaways

• Rising use: About two million U.S. 12-to-17-year-olds are estimated to be taking S.S.R.I.s; a 2016–2022 study found prescription fills in that age group increased by 69 percent.
• Adult evidence: Studies of adults link S.S.R.I. use to lowered desire, arousal problems, erectile difficulty and delayed or absent orgasm; one review in 2019 estimated 30–80 percent experience some sexual side effects.
• PSSD recognition: Clinical literature and some regulators now acknowledge post-S.S.R.I. sexual dysfunction (PSSD) can persist after discontinuation, though prevalence estimates vary widely.
• Anecdotal reports: Dozens of people who started S.S.R.I.s in adolescence describe enduring reductions in sexual feeling and romantic attachment, sometimes lasting years.
• Biological signals: Small imaging and tissue studies (including ultrasound of penile tissue) and animal experiments suggest possible physiological pathways for long-term change, though mechanisms are not settled.
• Consent gaps: Multiple clinicians report that sexual side effects are inconsistently discussed with adolescent patients and families before initiation.
• Research shortfall: There are no large, long-term, prospective studies specifically designed to measure S.S.R.I. effects on sexual development when exposure begins in childhood or adolescence.

Background

Antidepressant prescribing for young people climbed noticeably in the 2010s and accelerated through the Covid era. A large analysis published in 2024 by researchers aligned with the American Academy of Pediatrics tracked monthly antidepressant fills among U.S. 12- to 17-year-olds from 2016 to 2022 and reported a 69 percent increase in fills over that period. Among college populations, recent surveys find antidepressant use increased from roughly 8 percent in 2007 to about 22 percent in 2023–24, underscoring broader trends of sustained exposure in late adolescence and early adulthood.

S.S.R.I.s became widely used because they can reduce depressive symptoms, tamp down severe anxiety and in some cases lower suicide risk when combined with careful monitoring and therapy. In adults, however, their predictable effect on serotonin pathways is also associated with sexual side effects — diminished desire, trouble with arousal, erectile difficulties and delayed or blunted orgasm. Historically, clinicians assumed these effects resolve after stopping the drug; a growing set of case reports and recent regulatory language challenge that assurance and have introduced the term PSSD to describe persistent sexual dysfunction following S.S.R.I. exposure.

Main Event

Multiple first-person accounts collected from people who began S.S.R.I.s in their teens describe long-lasting changes in sexual experience. Some individuals report an immediate numbing of genital sensation and emotional blunting; others report a gradual dampening of crushes, fantasy and romantic feeling that began while on medication and did not fully return after discontinuation. These narratives include people who were prescribed fluoxetine (generic Prozac), sertraline (generic Zoloft), escitalopram (Lexapro) and other drugs in the class, as well as related agents such as S.N.R.I.s.

Clinicians who treat young patients differ in practice. Some child and adolescent psychiatrists say they routinely raise sexual side effects during consent conversations; others — including many primary-care prescribers, who write the majority of adolescent S.S.R.I. scripts — report rarely doing so, citing worries about adherence or discomfort discussing sexual development with minors. A 2004 review that asked whether S.S.R.I. use in childhood could alter adult sexual functioning has not been followed by large prospective trials, and repeated calls for targeted adolescent research have largely gone unanswered.

Researchers seeking biological explanations point to several lines of evidence. Small human studies using imaging or tissue analysis have reported changes in genital tissue or blood-flow characteristics in former S.S.R.I. users; in one ultrasound-based series, investigators observed scarring-like patterns in penile tissue among men who linked their erectile dysfunction to prior S.S.R.I. exposure. Rodent experiments in which animals received S.S.R.I.s during adolescent-equivalent windows have shown altered sexual behavior in adulthood after the drug cleared, though animal-to-human extrapolation has important limits.

Regulators and professional resources are beginning to update their language. The DSM-5 notes that serotonin-reuptake–inhibitor–induced sexual dysfunction can persist after discontinuation in some cases, and agencies in the European Union, Canada, Australia and Hong Kong have issued cautionary statements. Consumer advocates have petitioned the U.S. Food and Drug Administration to require broader labeling about PSSD for S.S.R.I.s.

Analysis & Implications

Adolescence is a period of rapid neurobiological and psychosocial maturation: hormonal surges, synaptic pruning and formation of social and sexual identities all occur in overlapping timeframes. Intervening pharmacologically during those developmental processes has benefits — symptom relief, improved functioning, reduced immediate risk — but also raises the theoretical concern that drug effects could interact with developmental trajectories in ways that are not seen when treatment begins in later life. If S.S.R.I.s blunt sexual motivation or sensation during a critical formative window, they could plausibly alter patterns of sexual learning, partner selection and erotic development.

Inferring causation from individual reports is difficult. Depression and anxiety themselves diminish libido and social engagement; those underlying disorders could explain persistent sexual difficulties independently of medication. Selection bias also complicates interpretation: people with troubling, persistent symptoms are more likely to come forward and be counted in case series. Still, the weight of clinical anecdotes, regulatory caution and mechanistic signals from imaging and animal studies creates enough concern to justify rigorous investigation.

From a public-health policy perspective, the balance is delicate. For many adolescents with severe symptoms, S.S.R.I.s provide crucial relief that can enable schooling, social functioning and safety. Yet the informed-consent process should reflect uncertainties about long-term sexual outcomes so that young patients and caregivers can weigh trade-offs. On the research side, designing prospective cohort studies and randomized trials with pre-specified sexual-development endpoints — and funding them independent of commercial incentives — should be a priority if clinicians and families are to make fully informed choices.

Comparison & Data

These figures illustrate scale and uncertainty: millions of adolescents are exposed, but precise rates for persistent post-discontinuation dysfunction are not established. That gap makes it difficult to produce population-level risk estimates to inform consent and policy. Careful longitudinal cohorts that measure sexual development before, during and after exposure would address both incidence and potential causal pathways.

Reactions & Quotes

Clinicians who study adolescent psychiatry and sexual medicine express a mix of concern and caution about the evidence gaps.

“We are failing to ask something very important of an entire population,”

Dr. Amir Levine, Columbia University (child and adolescent psychiatry)

Levine and others argue for routine inquiry about sexual side effects during prescribing and for standardized symptom checklists to make conversations less fraught.

“In some cases, serotonin-reuptake–inhibitor–induced sexual dysfunction may persist after the agent is discontinued,”

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)

The DSM-5 language reflects a shift toward acknowledging persistence as a possible outcome, even if it does not resolve questions about frequency or mechanism.

“We should care about how young people are developing and how the medications they’re taking might be impacting their normative sexual development,”

Debby Herbenick, Indiana University School of Public Health (sex-research expert)

Unconfirmed

• PSSD prevalence: Precise rates of persistent sexual dysfunction after adolescent S.S.R.I. exposure are not established by population-level longitudinal studies.
• Permanent causation: It is not yet proven that S.S.R.I.s cause permanent sexual impairment in a definable fraction of adolescent users, separate from the effects of underlying mood or anxiety disorders.
• Definitive biological mechanism: While imaging, tissue and animal studies suggest possible pathways, a single validated mechanism explaining PSSD in humans has not been confirmed.
• Reversibility timeline: The duration and probability of recovery after stopping medication remain uncertain for many individuals reporting long-term symptoms.

Bottom Line

Millions of young people are being treated with antidepressants at a time when sexual and romantic identities are forming. The adult literature and dozens of patient accounts indicate that S.S.R.I.s can blunt sexual function and that, in some cases, those effects endure. Because adolescence is a sensitive developmental window, those possibilities merit careful, prioritized study rather than extrapolation from adult data alone.

Clinicians should be transparent with adolescent patients and their families about known sexual side effects, the limits of current knowledge about long-term outcomes and the trade-offs between symptom relief and uncertain developmental risks. Funders, regulators and research institutions should support prospective studies with sexual-development endpoints so that families and practitioners can make better-informed decisions.

Sources

• The New York Times Magazine — feature reporting (original reporting and patient interviews)
• DSM-5 / American Psychiatric Association — clinical diagnostic guidance
• European Medicines Agency — regulatory safety communications
• Journal of Clinical Medicine (MDPI) — 2019 review on sexual side effects in adults
• Pediatrics / American Academy of Pediatrics — 2024 prescribing analysis (prescription-fill trends)
• Biological Psychiatry — rodent and physiological studies relevant to developmental exposure