The Treatment Landscape for PSSD
Post-SSRI Sexual Dysfunction has no approved pharmacological treatment. The EMA's 2019 recognition of PSSD as a real adverse effect was a landmark moment, but it did not produce treatment guidelines — because the research base is still too thin to support them.
In this vacuum, people with PSSD have turned to online communities, case reports, and mechanistic reasoning to identify approaches worth trying. This article surveys the most commonly reported approaches, with honest assessments of the evidence and the proposed mechanisms.
| Approach | Evidence Level | Reported by Community | Mechanism Theory |
|---|---|---|---|
| Psilocybin / microdosing | Mechanistic overlap; no PSSD RCTs | Widely reported; mixed outcomes | 5-HT2A agonism, BDNF upregulation, neuroplasticity |
| Testosterone / DHEA optimisation | Case reports; no PSSD RCTs | Commonly tried; partial improvement in some | Address secondary hormonal dysregulation from SSRI use |
| Aerobic exercise | Strong evidence for BDNF/dopamine; indirect for PSSD | Widely reported as helpful for energy/mood | BDNF upregulation, dopamine restoration, neuroplasticity |
| Alpha-lipoic acid + acetyl-L-carnitine | Evidence for diabetic neuropathy; not PSSD | Anecdotal reports in community | Small-fiber neuropathy support (Heikkinen 2022 hypothesis) |
| Lion's mane mushroom | NGF stimulation evidence; no PSSD trials | Reported for cognitive symptoms | Nerve growth factor (NGF) stimulation; potential nerve repair |
| Sleep optimisation | Strong evidence for hormonal/neurological health generally | Widely reported as supportive | Testosterone production, BDNF consolidation, receptor recovery |
| Bupropion (Wellbutrin) | Case reports; no PSSD RCTs | Some report partial improvement in libido | Dopamine/norepinephrine reuptake inhibition; no serotonin effect |
Psilocybin and Microdosing: The Most Discussed Approach
Psilocybin has attracted the most discussion in PSSD communities, driven by its unique mechanism as a 5-HT2A agonist — the opposite of SSRIs' indirect downregulation of these receptors. According to Shrooomz's research into serotonergic health, the mechanistic rationale for psilocybin in PSSD is more compelling than for most other approaches, though clinical evidence is absent.
Community reports suggest that outcomes are heterogeneous. Some individuals report meaningful improvement in emotional range and connectedness after psilocybin experiences. Fewer report improvement in genital sensation or orgasm quality. Some report no change. The variability likely reflects the heterogeneity of PSSD mechanisms — if small-fiber neuropathy (Heikkinen 2022) is a primary driver in some patients, central neuroplasticity approaches may have limited effect on peripheral nerve damage.
Lion's Mane: The NGF Connection
Lion's mane mushroom (Hericium erinaceus) stimulates nerve growth factor (NGF) production. Given the 2022 Finnish finding of small-fiber neuropathy in PSSD patients, NGF stimulation has attracted interest as a potential approach to nerve repair. Lion's mane has demonstrated NGF-stimulating effects in multiple in vitro and animal studies, and one small human trial showed cognitive benefits in older adults.
No studies have tested lion's mane specifically for PSSD or for the type of small-fiber neuropathy documented in Heikkinen et al. 2022. The mechanistic rationale is plausible; the clinical evidence is absent.
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Shop Secret Shrooomz →Frequently Asked Questions
Is there an approved treatment for PSSD?
No. There are no FDA-approved therapies or treatment guidelines for PSSD, and robust randomized trials are lacking. Most information comes from case reports, patient experiences, and theoretical models rather than proven interventions.
Does psilocybin help with PSSD?
There are no randomized trials testing psilocybin for PSSD. While some individuals report subjective changes after psychedelic experiences, these accounts do not establish efficacy and could be due to placebo effects or other factors.
Can exercise improve PSSD symptoms?
Regular physical activity can improve general sexual function and mood in many people, which might indirectly benefit some with PSSD. However, there is no direct, controlled evidence showing that exercise reverses PSSD specifically.
What about hormone optimization for PSSD?
Hormone therapies (e.g., testosterone) are sometimes pursued, but data specific to PSSD are limited and not robust. Risks exist with hormonal treatments, and efficacy for PSSD remains unproven; any therapy should be supervised by a clinician.
Are alpha-lipoic acid or lion’s mane effective for PSSD?
There are no PSSD-specific controlled trials showing benefit from alpha-lipoic acid or lion’s mane. These supplements are used by some individuals based on theoretical mechanisms or anecdotal reports, but evidence of efficacy is not established.
How should someone approach self-treatment for PSSD?
Given the lack of proven therapies, consult a clinician before trying new strategies and avoid abrupt changes to antidepressants. Consider psychosocial support and reliable information sources, while remaining cautious about unvalidated claims and potential risks or interactions.