Managing Antidepressant Sexual Side Effects
Reviewed by Kristin Hall, FNP
Written by Geoffrey Whittaker
Webster’s dictionary defines a side effect as — hey, still awake?
Look, we know the deluge of information you get with pretty much any medication on the market today is enough to cross your eyes or cure insomnia, but side effects of things like antidepressants are serious business.
The sexual side effects of antidepressants are really no joke, and if they’re screwing with your sex life, they can qualify as symptoms of depression all on their own.
Getting that sorted out should be a high priority. Below, we’ve explained the relationship between antidepressants and sexual side effects, the potential side effects you may experience and the medications that are most likely to cause these side effects.
We’ve also shared information on what you can do to manage sexual side effects from SSRIs, SNRIs and other medications used to treat depression.
Antidepressants with Sexual Side Effects
Antidepressants are some of the most commonly used prescription medications in the United States. In fact, data from the National Center for Health Statistics indicates that 12.7 percent of Americans over the age of 12 have used antidepressants within the last 30 days.
Like all medications, antidepressants can cause certain side effects. Although the precise side effects can vary from one medication to another, sexual problems are a common side effect of most antidepressants.
While not all antidepressants are linked to sexual side effects, some users experience issues such as difficulty becoming aroused or reaching orgasm and low libido.
In a study published in 2010, researchers compared data on different types of antidepressants and sexual difficulties. They found that certain classes of antidepressants were the most likely to cause sexual side effects. More on that now.
Selective Serotonin Reuptake Inhibitor (SSRI) Sexual Side Effects
Selective serotonin reuptake inhibitors, or SSRIs, are a very common prescription, as they are currently used as first-line treatments for depression and other conditions. Common SSRIs include Prozac® (fluoxetine), Celexa®(citalopram), Zoloft® (sertraline), Lexapro® (Escitalopram) and Paxil® (Paroxetine).
Unfortunately, SSRIs are also the antidepressants most likely to result in sexual side effects. Researchers have found that between 25 and 73 percent of people who use SSRIs experience sexual issues.
Sexual side effects caused by SSRIs can affect both men and women. Researchers aren’t fully sure why these side effects happen. Although genetics may play a role in a person’s risk of experiencing sexual side effects while using an SSRI, some research also indicates that they may be caused in part by SSRIs’ effects on our serotonin levels.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Sexual Side Effects
Serotonin norepinephrine reuptake inhibitors, or SNRIs, are also highly likely to cause sexual side effects. Research shows that 58 to 70 percent of people who use SNRIs will experience sexual side effects.
Common SNRIs include Cymbalta® (duloxetine) and Effexor® (venlafaxine). As with SSRIs, if you are prescribed an SNRI to treat depression or any other condition and experience sexual side effects, it’s important to contact your healthcare provider before making any changes.
Tricyclic Antidepressant (TCA) Sexual Side Effects
Common tricyclic antidepressants, or TCAs, include Pamelor® (nortriptyline), Tofranil® (imipramine) and Norpramin® (desipramine). Research indicates that these antidepressants are slightly less likely to cause sexual side effects than SSRIs and SNRIs. According to study data, around 30 percent of people who use tricyclic antidepressants experience sexual side effects.
Despite this, tricyclic antidepressants are more likely to cause other side effects than newer antidepressants. Common side effects of TCAs include dizziness, constipation and dry mouth (xerostomia).
Other potential side effects include blurred vision, confusion, sedation, urinary retention, rapid heart rate (tachycardia), orthostatic hypotension (a type of low blood pressure), increased appetite and weight gain, among others.
Tricyclic antidepressants can cause withdrawal effects if stopped suddenly, so it’s important to talk to your healthcare provider if you experience any sexual side effects.
Other Antidepressants with Sexual Side Effects
Other types of antidepressants may also cause sexual side effects. For example, sexual side effects are quite common with monoamine oxidase inhibitors (MAOIs), affecting approximately 40 percent of people prescribed antidepressants in this class. MAOIs can also cause other serious side effects and interactions.
Are There Antidepressants without Sexual Side Effects?
Not all antidepressants cause sexual side effects. In fact, the risk of sexual side effects can vary hugely from one class of antidepressants to another. If you’re experiencing sexual side effects, you may want to look into some of the below classes of antidepressants instead.
What’s important to remember, however, is that everyone’s reactions to medications will differ — you may experience sexual side effects more intensely or less intensely than research would suggest.
Sexual function is complicated, and so is the way antidepressant medications affect it.
Antidepressants with the Least Sexual Side Effects
There isn’t a terribly long list of antidepressants without sexual side effects. However, there is a common thread among them — that they affect the neurotransmitters norepinephrine and/or dopamine.
Consider the following:
Norepinephrine and dopamine reuptake inhibitors (NDRIs). NDRIs, including the medication Wellbutrin® (bupropion), are significantly less likely to cause sexual side effects than other antidepressants — only around 10 to 25 percent of people prescribed NDRIs experience sexual side effects. There’s even some evidence that bupropion can improve sexual response when used alongside other medications.
Norepinephrine reuptake inhibitors (NRIs). NRIs, such as Edronax® (reboxetine), are generally unlikely to cause sexual side effects. Research shows that an estimated five to 10 percent of people experience sexual side effects from NRI medications.
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How to Manage Sexual Side Effects from Antidepressants
If you experience sexual side effects after starting an SSRI or another type of antidepressant, it’s important that you talk to your healthcare provider before you do anything.
Yes, that means you should avoid making any changes to your dosage before talking to your healthcare provider — some antidepressants can cause withdrawal symptoms if you adjust your dosage or stop using your medication suddenly.
Your healthcare provider may recommend a number of things before taking you off of an antidepressant, including:
Waiting to see if your symptoms improve. In some cases, your healthcare provider might suggest that you wait for a week or two to see if your sexual side effects go away without making any changes to your treatment.
Changing to a different antidepressant. The risk of sexual side effects varies between antidepressants. For example, research indicates that sexual side effects are particularly common with SSRI and SNRI medications. If you’re prescribed a medication that’s typically associated with sexual side effects, your healthcare provider may recommend switching to a different type of antidepressant.
Reducing your dosage. Many antidepressants are prescribed at a range of therapeutic doses to treat depression and other conditions. Your healthcare provider may raise your dosage or reduce it based on your response to the medication. Sometimes, reducing your dosage slightly may be enough to end or reduce the severity of sexual side effects, all while still providing therapeutic benefits.
Going on a drug vacation. If you’re prescribed a long-acting antidepressant that stays in your system for several days, your healthcare provider may recommend a treatment interruption, or “drug vacation,” in which you briefly stop taking your medication. For example, you may stop using your medication before the weekend to (hopefully) avoid sexual side effects for several days at a time. Drug vacations are normally quite short, after which you will continue to take your medication. It’s important to follow your healthcare provider’s instructions closely to avoid withdrawal symptoms or a relapse of your symptoms.
Changing the time at which you take your medication. Sometimes, side effects can occur at specific times of day, such as shortly after you take an antidepressant. If you notice sexual side effects at a certain time of day or night, your healthcare provider may recommend taking your medication at a certain time of day to potentially stop it from interfering with your sex life.
Scheduling sex around your medication’s side effects. If it’s not possible to change the time at which you take your medication, your healthcare provider may recommend scheduling sex to potentially avoid your medication’s sexual side effects.
Using therapy to overcome sexual issues. Sometimes, sexual issues aren’t solely caused by medication. Even if you’re currently prescribed an antidepressant, issues such as sexual performance anxiety can still affect your sexual performance. If you believe that a psychological factor could be contributing to an issue like erectile dysfunction or difficulty orgasming, talking to a counselor or sex therapist could be an effective way to make progress and improve your sexual wellbeing.
Using ED medication. Erectile dysfunction, or ED, is a common side effect of numerous antidepressants. If you find it difficult to get or maintain an erection after starting antidepressants, your healthcare provider may prescribe ED medication. Currently, the most common ED medications are Viagra® (sildenafil), Cialis® (tadalafil), Levitra® (vardenafil) and Stendra® (avanafil). We’ve explained how these medications work and more in our full guide to ED medications and treatments.
Using other medication in combination with your antidepressant. In certain cases, your healthcare provider may recommend using a second medication at the same time as your current antidepressant. Medications like Wellbutrin (bupropion) and Buspar® (buspirone) are often prescribed alongside SSRIs and other antidepressants as augmentation agents to reduce sexual side effects.
After making changes, it’s important to keep in contact with your healthcare provider. Keep them informed and updated if you have persistent sexual side effects that don’t seem to improve after making the recommended changes.
Antidepressants and Sex Drive: Final Takeaways
Whether you’re single, in a relationship or somewhere in between, there’s no shame in admitting your mental health is tied at least loosely to sexual function and the ability to enjoy some sexual activity whenever it’s available. So medications that fool with that — like those that create antidepressant-induced dysfunction — are arguably not really treatment options for your mental health at all.
Finding the right treatment for depression means finding one that allows you to enjoy life, so if you’re not doing so because of sexual side effects, keep the following in mind:
Many antidepressants, including SSRIs, SNRIs and tricyclic antidepressants, may cause sexual side effects such as a loss of libido, difficulty reaching orgasm and erectile dysfunction. These effects occur in men and women, although the precise side effects can vary from person to person.
In men, common sexual side effects associated with antidepressants include a reduced libido, difficulty becoming sexually aroused, delayed orgasm, erectile dysfunction (ED), difficulty reaching orgasm and delayed ejaculation. Other potential side effects include things like painful ejaculation, priapism, loss of sensation or penile anesthesia.
If you’re prescribed an antidepressant and notice changes in your sexual desire or performance, talk to your healthcare provider. Most of the time, sexual side effects caused by antidepressants can be treated by making changes to your medication usage, dosage and/or habits.
The risk of sexual side effects can vary between antidepressants. Some antidepressants have a high risk of causing sexual side effects, while others have little to no risk, or may even have a positive effect on sexual interest and performance.
Sexual side effects seem to be most common with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).
On the other hand, sexual side effects seem to be less common with norepinephrine and dopamine reuptake inhibitors (NDRIs) and norepinephrine reuptake inhibitors (NRIs).
If you have depression and experience sexual issues, they might not be caused by your medication.Many people with untreated depression experience some form of sexual dysfunction before treatment, making sexual issues quite common.
We can also help with other sexual health problems problems like sexual performance anxiety with our online therapy and online psychiatry programs, and help you explore the most common ED treatments. If you want to investigate Viagra (sildenafil) or Cialis (tadalafil) we can also prescribe them, along with Stendra (avanafil) and our chewable ED meds hard mints.