2- The Most Embarrassing Antidepressant Side Effect - Dr. Josef

Source: https://www.youtube.com/watch?v=BRzB_pEmXWU&t=201s

Answer: C. They are unwanted, intrusive, and distressing

Explanation: PGAD (Persistent Genital Arousal Disorder ) orgasms are described as unwanted, intrusive, and associated with distress, not pleasure or desire.

Which of the following best describes the orgasms experienced by PGAD patients?

A. They are pleasurable and desired
B. They relieve arousal for long periods
C. They are unwanted, intrusive, and distressing
D. They occur only during sexual desire

Answer: B. Starting or stopping antidepressants

Explanation: PGAD (Persistent Genital Arousal Disorder) can be triggered by starting or stopping SSRIs/SNRIs, which disrupt serotonin-mediated sexual reflex circuits.

Which factor has been reported as a trigger of PGAD related to medication?

A. Taking too much acetaminophen
B. Starting or stopping antidepressants
C. Lack of sleep
D. High caffeine intake

Answer: C. Persist for long periods and be unwanted

Explanation: Core criteria include persistent, unwanted arousal that does not resolve after orgasm and causes distress.

According to Dr. David Healy’s diagnostic criteria, PGAD symptoms must:

A. Be connected to hypersexuality
B. Resolve after orgasm
C. Persist for long periods and be unwanted
D. Only occur in men

Answer: C. Menopausal women

Explanation: PGAD is reported most often in menopausal women, though men can also develop it.

Which population is most commonly reported in the medical literature to experience PGAD?

A. Teenagers
B. Men under 40
C. Menopausal women
D. Pregnant women

Answer: B. Post-SSRI sexual dysfunction (PSSD)

Explanation: PGAD is considered the mirror image of PSSD, which involves loss of sexual sensation.

PGAD is described as the “mirror image” of which other antidepressant-related condition?

A. Erectile dysfunction
B. Post-SSRI sexual dysfunction (PSSD)
C. Delayed ejaculation
D. Premature ejaculation

Answer: B. A neurological glitch in sexual arousal pathways

Explanation: PGAD (Persistent Genital Arousal Disorder) is caused by a neurological misfiring in the body’s sexual arousal circuits, not an increase in libido.

What is the underlying issue in PGAD as described in the text?

A. Excess libido
B. A neurological glitch in sexual arousal pathways
C. Hormonal imbalance
D. Psychological trauma

Answer: B. Nine orgasms while kneeling beside his father’s casket

Explanation: He reported experiencing nine orgasms beside his father’s casket, illustrating the severity of the condition.

Which unusual scenario was reported by Dale Decka due to PGAD?

A. Collapsing in a grocery store
B. Nine orgasms while kneeling beside his father’s casket
C. Orgasm every time he fell asleep
D. Continuous orgasm for a full week

Answer: C. A variety including anti-convulsants, antidepressants, and nerve surgery

Explanation: Treatments are trial-and-error and include anti-convulsants, antidepressants, hormonal suppression, Botox, and pelvic nerve surgery.

Which treatment strategies have been attempted for PGAD?

A. Only psychotherapy
B. Only hormonal therapy
C. A variety including anti-convulsants, antidepressants, and nerve surgery
D. No treatment options exist

Answer: D. Shame prevents reporting, and drug labels don’t warn about it

Explanation: PGAD is under-reported because patients are embarrassed and drug labels do not mention this side effect.

Why might PGAD be more common than documented?

A. It causes no symptoms
B. Patients usually recover before seeking help
C. Doctors routinely screen for it
D. Shame prevents reporting, and drug labels don’t warn about it

Answer: B. Serotonin system in the brain and spinal cord

Explanation: The text states that SSRIs and SNRIs alter the serotonin system in the brain and spinal cord, disrupting sexual reflex circuits.

What part of the nervous system is affected by antidepressants in a way that may trigger PGAD?

A. Dopamine pathways
B. Serotonin system in the brain and spinal cord
C. Glutamate receptors
D. Acetylcholine neuromuscular junctions

Answer: C. A balance between accelerator and brake signals

Explanation: Sexual arousal is controlled by accelerator signals (promoting arousal) and brake signals (restraining it). Antidepressants can disrupt this balance.

According to the information, what normally regulates sexual arousal in the body?

A. A balance between testosterone and estrogen
B. A balance between serotonin and dopamine
C. A balance between accelerator and brake signals
D. A balance between cortisol and adrenaline

Answer: C. By disrupting serotonin signaling that controls sexual reflexes

Explanation: The text explains that changes in serotonin signaling can misfire sexual reflex circuits, sometimes leading to constant arousal.

How can antidepressants trigger PGAD, according to the text?

A. By increasing libido directly
B. By increasing dopamine release
C. By disrupting serotonin signaling that controls sexual reflexes
D. By causing hormonal imbalance

Answer: B. PGAD increases sensation and PSSD removes it

Explanation: PGAD (Persistent Genital Arousal Disorder ) involves excessive nerve activity, while PSSD involves numbness, both linked to disrupted serotonin regulation.

PGAD is described as the mirror image of PSSD because:

A. Both are caused by dopamine deficiency
B. PGAD increases sensation and PSSD removes it
C. PGAD affects men and PSSD affects women
D. PSSD only occurs with SNRIs

Answer: B. The “brakes” fail, leading to overactivity

Explanation: In PGAD, the text states that nerve overactivity occurs because the brake signals fail, leading to uncontrolled arousal.

What failure in the sexual arousal system can occur when serotonin circuits are disrupted?

A. Complete removal of sexual reflexes
B. The “brakes” fail, leading to overactivity
C. The “accelerator” stops working completely
D. Hormonal shutdown