5- Top 10 HIDDEN Risks of SSRIs (Dr. Josef)

Source: https://www.youtube.com/watch?v=6QYW-1xsISg

Correct Answer: B. Post-SSRI Sexual Dysfunction

Explanation: Dr. Josef defines PSSD as Post-SSRI Sexual Dysfunction, a persistent and potentially permanent side effect.

What does PSSD stand for?

A. Post-Serotonin Stress Disorder
B. Post-SSRI Sexual Dysfunction
C. Persistent Sexual Stress Disorder
D. Psychological Sexual Side Disorder

Correct Answer: C. Increased libido

Explanation: Dr. Josef lists loss of sexual pleasure, numb genitals, erectile dysfunction, difficulty with orgasm, and emotional blunting—not increased libido.

Which of the following is NOT listed as a symptom of PSSD?

A. Genital numbness
B. Difficulty having an orgasm
C. Increased libido
D. Emotional blunting

Correct Answer: C. Persistent side effects after stopping or a sudden crash after discontinuation

Explanation: He explains that some develop sexual side effects that never improve after stopping, while others experience a sudden crash after discontinuation.

According to Dr. Josef, PSSD may appear in which two main ways?

A. Immediately after starting SSRIs or years later
B. Only during medication use
C. Persistent side effects after stopping or a sudden crash after discontinuation
D. Only in people with prior sexual dysfunction

Correct Answer: C. It is embarrassing for doctors, regulators, and pharmaceutical companies

Explanation: Dr. Josef states that PSSD is a source of embarrassment for doctors, regulators, and pharmaceutical companies.

Why has PSSD gained attention only in recent years, according to Dr. Josef?

A. It is a newly discovered condition
B. Patients rarely report it
C. It is embarrassing for doctors, regulators, and pharmaceutical companies
D. It only affects a very small number of people

Correct Answer: C. 1 in 216

Explanation: Dr. Josef cites Dr. Ben Sheree’s estimate of 1 in 216 SSRI users.

What incidence rate of PSSD did Dr. Ben Sheree estimate using healthcare databases?

A. 1 in 1,000
B. 1 in 500
C. 1 in 216
D. 1 in 50

Correct Answer: C. 13%

Explanation: Dr. Josef reports that 13% of surveyed young LGBT SSRI users experienced persistent sexual dysfunction.

What percentage of young LGBT SSRI users reported persistent sexual dysfunction in Yazy Pirani’s survey?

A. 5%
B. 10%
C. 13%
D. 25%

Correct Answer: B. Feeling flat or like watching life through a window

Explanation: Patients describe emotional blunting as feeling flat or living life as if looking through a window.

What is emotional blunting described as by patients taking SSRIs?

A. Increased emotional sensitivity
B. Feeling flat or like watching life through a window
C. Heightened empathy
D. Increased emotional reactivity

Correct Answer: D. 71%

Explanation: Dr. Josef states that 71% reported emotional blunting.

What percentage of people reported emotional blunting in Professor John Reed’s 2018 online study?

A. 40%
B. 55%
C. 60%
D. 71%

Correct Answer: C. Increased risk of suicide

Explanation: Dr. Josef explains that the risk of suicide is higher when starting or changing doses.

What risk is particularly increased when starting or changing the dose of antidepressants?

A. Weight loss
B. Cognitive improvement
C. Increased risk of suicide
D. Reduced anxiety

Correct Answer: C. Under 25 years

Explanation: The FDA found increased suicidal behavior in individuals under 25 taking antidepressants.

According to the FDA meta-analysis cited, which age group showed increased suicidal behavior on antidepressants compared to placebo?

A. Over 65 years
B. 40–60 years
C. Under 25 years
D. All age groups

Correct Answer: B. By inducing manic-like symptoms

Explanation: Dr. Josef explains that SSRIs can induce agitation, irritability, and impulsivity resembling mania.

How can SSRIs contribute to a misdiagnosis of bipolar disorder?

A. By curing depression too quickly
B. By inducing manic-like symptoms
C. By masking anxiety disorders
D. By eliminating mood swings

Correct Answer: B. Trouble focusing and mental exhaustion

Explanation: He lists trouble focusing, forgetting words, mental exhaustion, and loss of cognitive sharpness.

What cognitive side effects are associated with antidepressants according to Dr. Josef?

A. Improved memory and focus
B. Trouble focusing and mental exhaustion
C. Increased creativity
D. Faster processing speed

Correct Answer: C. A steady decline in cognitive performance

Explanation: Cognitive performance declined steadily over 3, 5, and 8 weeks.

What did the 2016 study cited by Dr. Josef show regarding cognition after starting SSRIs?

A. Cognitive improvement over time
B. No change in performance
C. A steady decline in cognitive performance
D. Immediate recovery of cognition

Correct Answer: B. Increased abdominal obesity and insulin resistance

Explanation: Dr. Josef lists abdominal obesity, high triglycerides, insulin resistance, and type 2 diabetes.

What metabolic risks are associated with long-term antidepressant use?

A. Reduced appetite and weight loss
B. Increased abdominal obesity and insulin resistance
C. Improved metabolism
D. Lower diabetes risk

Correct Answer: C. 50%

Explanation: Dr. Josef states that 50% experience withdrawal, and about half of those describe it as severe.

According to studies mentioned, what percentage of people experience antidepressant withdrawal?

A. 10%
B. 25%
C. 50%
D. 75%

Correct Answer: C. Fatal arrhythmias

Explanation: QT prolongation can disrupt heart electrophysiology and increase fatal arrhythmia risk.

What cardiac risk is associated with antidepressants due to QT interval prolongation?

A. Bradycardia
B. Heart murmurs
C. Fatal arrhythmias
D. Valve disease

Correct Answer: C. Sudden cardiac death at higher doses

Explanation: The FDA warned not to exceed 40 mg/day due to increased risk of sudden cardiac death.

What did the FDA warn about Celexa (Citalopram) in 2011?

A. Risk of liver failure
B. Risk of addiction
C. Sudden cardiac death at higher doses
D. Increased anxiety

Correct Answer: C. By disrupting platelet function

Explanation: Dr. Josef explains SSRIs disrupt platelet-based clotting.

How do SSRIs increase the risk of gastrointestinal bleeding?

A. By damaging the stomach lining directly
B. By increasing stomach acid
C. By disrupting platelet function
D. By slowing digestion

Correct Answer: C. Bleeding risk increases further

Explanation: The combined effect further increases bleeding risk.

What happens when SSRIs are combined with NSAIDs like ibuprofen?

A. Bleeding risk decreases
B. No interaction occurs
C. Bleeding risk increases further
D. NSAIDs become ineffective

Correct Answer: C. 2 points on a 52-point scale

Explanation: Dr. Josef states SSRIs reduced depression by an average of 2 points on a 52-point scale.

According to the meta-analysis cited, how much did SSRIs reduce depression scores compared to placebo?

A. 10 points on a 52-point scale
B. 5 points on a 52-point scale
C. 2 points on a 52-point scale
D. 15 points on a 52-point scale

Correct Answer: C. Protracted withdrawal

Explanation: Dr. Josef describes long-lasting symptoms after withdrawal as protracted withdrawal.

What term does Dr. Josef use to describe long-lasting symptoms after antidepressant withdrawal that do not resolve?

A. Acute relapse
B. Medication resistance
C. Protracted withdrawal
D. Chronic depression

Correct Answer: B. Similar to a brain injury

Explanation: He states that protracted withdrawal can resemble a brain injury.

How does Dr. Josef describe protracted withdrawal in some patients?

A. A mild rebound effect
B. Similar to a brain injury
C. A psychological relapse only
D. A temporary adjustment period

Correct Answer: C. Symptoms remain unchanged

Explanation: Dr. Josef explains that for some patients, reinstating the medication does not reverse symptoms.

What happens if some patients reinstate antidepressants after developing protracted withdrawal?

A. Symptoms immediately resolve
B. Symptoms improve slowly
C. Symptoms remain unchanged
D. Symptoms worsen permanently

Correct Answer: C. Doctors fail to recognize the condition

Explanation: He states that many doctors are clueless about recognizing protracted withdrawal, leaving patients to suffer alone.

Why do many patients with protracted withdrawal suffer for years?

A. They refuse treatment
B. Doctors recognize but cannot treat it
C. Doctors fail to recognize the condition
D. Symptoms are unavoidable

Correct Answer: B. Diagnosing withdrawal as relapse

Explanation: Dr. Josef explains withdrawal is often misdiagnosed as the underlying illness returning.

What mistake do doctors often make when patients experience withdrawal symptoms?

A. Lowering the dose too slowly
B. Diagnosing withdrawal as relapse
C. Stopping all medications immediately
D. Ordering unnecessary imaging

Correct Answer: C. Protracted withdrawal

Explanation: He emphasizes that coming off too quickly increases the risk of protracted withdrawal.

According to Dr. Josef, what risk increases when antidepressants are stopped too quickly?

A. Immediate relapse
B. Weight gain
C. Protracted withdrawal
D. Improved cognition

Correct Answer: C. Faster cognitive decline

Explanation: Dr. Josef states antidepressant use was associated with faster cognitive decline.

What did the 2025 cohort study cited by Dr. Josef find regarding antidepressants and cognition?

A. Improved long-term cognition
B. No association with cognition
C. Faster cognitive decline
D. Reduced dementia risk

Correct Answer: C. Dose-dependent relationship

Explanation: He explains higher doses were linked to greater cognitive decline, indicating a dose-dependent effect.

What made the 2025 cognitive decline finding more significant?

A. Large sample size
B. Short follow-up period
C. Dose-dependent relationship
D. Focus on adolescents

Correct Answer: B. Lowering basal metabolic rate

Explanation: Dr. Josef explicitly states antidepressants lower basal metabolic rate.

How do antidepressants contribute to weight gain according to Dr. Josef?

A. Increasing physical inactivity only
B. Lowering basal metabolic rate
C. Improving insulin sensitivity
D. Reducing caloric intake

Correct Answer: C. Underlying mental illness

Explanation: He states doctors frequently explain weight gain as a sign of the underlying illness.

What do doctors often attribute antidepressant-related weight gain to?

A. Medication toxicity
B. Poor diet alone
C. Underlying mental illness
D. Aging

Correct Answer: C. 1 year

Explanation: He states trials last no longer than one year.

What is the maximum duration of most antidepressant clinical trials mentioned by Dr. Josef?

A. 3 months
B. 6 months
C. 1 year
D. 5 years

Correct Answer: C. Uncertainty and potential worsening

Explanation: He expresses concern that drugs may wear off and make people worse over time.

What concern does Dr. Josef express about long-term antidepressant use?

A. Immediate toxicity
B. Complete loss of effect over time
C. Uncertainty and potential worsening
D. Guaranteed dependence

Correct Answer: C. Incomplete information disclosure

Explanation: He states patients are not told the full story, preventing informed decision-making.

Why does Dr. Josef believe patients cannot properly weigh risks and benefits?

A. Lack of education
B. Limited appointment time
C. Incomplete information disclosure
D. Poor adherence

Correct Answer: C. Drug companies

Explanation: He states drug companies fund clinical research.

According to Dr. Josef, who funds most clinical research on antidepressants?

A. Governments
B. Independent charities
C. Drug companies
D. Patient advocacy groups

Correct Answer: B. By controlling universities and journals

Explanation: He says they influence universities, professional societies, and academic journals.

How do pharmaceutical companies influence the medical narrative according to Dr. Josef?

A. Through advertising only
B. By controlling universities and journals
C. By regulating doctors
D. By banning criticism

Correct Answer: C. Time pressure and convenience

Explanation: Dr. Josef states doctors are overwhelmed and under time pressure, making prescriptions the fastest option.

Why are doctors incentivized to prescribe antidepressants quickly?

A. Financial bonuses
B. Fear of lawsuits
C. Time pressure and convenience
D. Patient demand only

Correct Answer: B. Anti-science or anti-psychiatry

Explanation: He explains critics are often accused of being anti-psychiatry or anti-science.

What label is often used against people who criticize antidepressants?

A. Anti-medicine
B. Anti-science or anti-psychiatry
C. Misinformed
D. Non-compliant

Correct Answer: D. Itself

Explanation: He states the system is built to protect itself, not patients.

What does Dr. Josef say the healthcare system is designed to protect?

A. Patients
B. Doctors
C. Scientific truth
D. Itself

Correct Answer: C. Patients make uninformed decisions

Explanation: Dr. Josef explains patients are left making decisions without being told the full story.

What ultimately happens when risks are buried under marketing slogans?

A. Improved adherence
B. Faster recovery
C. Patients make uninformed decisions
D. Reduced stigma

Correct Answer: C. Lack of informed consent

Explanation: He emphasizes that withholding risk information violates informed consent.

What does Dr. Josef identify as the core ethical issue in antidepressant prescribing?

A. Medication cost
B. Overdiagnosis
C. Lack of informed consent
D. Drug availability