How Antidepressants Can Affect Sex Drive

One of the most dreaded side effects of antidepressants is sexual dysfunction.

Many people who take SSRIs (like Lexapro and Zoloft) and SNRIs (like Effexor and Cymablta), which are the most commonly prescribed medications for depression, report loss of libido, problems with arousal, and absent or delayed orgasms. But this isn’t a simple cause-and-effect matter, since there may be overlapping explanations for sexual dysfunction. Depression itself tends to thoroughly sap our sex drive. And “pre-existing” problems in the bedroom can worsen feelings of depression. 

To make things murkier, the research to date doesn’t offer too much clarity. The most comprehensive studies of the last decade concluded that the incidence of sexual side effects from SSRIs ranges from 20 to 80 percent. That’s quite a range. 

“When a drug is developed, sexuality isn’t prioritized, it’s considered a quality-of-life issue,” says Tierney Lorenz, an assistant professor of psychology at the University of Nebraska-Lincoln. “And then the problem is ‘who funds that research?’ There just isn’t great funding for it.” 

Lorenz, who focuses on the interaction between women's mental, physical and sexual health and has studied antidepressant-induced sexual dysfunction, says that about 60 to 80 percent of people who take medication notice some kind of change in desire, arousal, or the ability to have an orgasm. About a third of those people report positive changes, meaning their sex lives improve once their depression begins to lift. Another third report negative changes that are resolved over time. The last third report ongoing negative problems. “Those are the numbers I see coming up again and again,” she says. 

The good news is that there are several ways to minimize, and often eradicate, this rather unsexy problem. Some antidepressants are known to have little to no sexual side effects, such as Bupropion (an NDRI branded Wellbutrin), Mirtazapine (or Remeron, a tetracyclic antidepressant) and Vortioxetine (a newer SSRI branded Trintellix). But if one of the more common medications is working well for depression, the consensus seems to be to stick with it, and add a second medication to counter any sexual side effects. Bupropion is a common add-on, and recent studies have indicated that Sildenafil (Viagra) can work for both men and women to improve sexual function.

“For SSRI-induced sexual dysfunction, using Viagra can increase dopamine activity in the sexual center of the brain,” says Dr. Chris Aiken, editor-in-chief of the Carlat Psychiatry Report. “There’s a stigma that it’s just for men.”

Dr. Aiken also touts the benefits of SAMe (S-adenosyl-L-methionine), a compound that is found naturally in the body and helps regulate hormones and maintain cell membranes. SAMe has been sold as a dietary supplement for many years, and while the evidence is still limited, it has shown promise in treating depression without major side effects. 

It may go without saying, but any decision about medication needs to be made in conjunction with your doctor. Most importantly, you need to find a doctor who is willing to help you find the treatment that offers you the best quality of life possible. 

“I've worked with patients who feel like they weren’t warned about the sexual side effects [of antidepressants]; it’s still a taboo subject,” says Lorenz. “If you have a doctor that makes you feel bad about prioritizing your sexuality, it’s worth to find another professional who will work with you on that journey of feeling good about your sex life.”

Lorenz is also a big proponent of behavioral and lifestyle adjustments that can have a big impact on sexual satisfaction. She suggests incorporating different practices, such as slowing down and having more foreplay, and experimenting with vibrators or lubricants, or anything that can increase sensations. If it’s an arousal issue, it can be really helpful to do 30 minutes of moderately strenuous exercise before sexual activity, which can help your body respond to simulation. 

“The majority of people who take antidepressant medications end up doing O.K.,” she adds. “They don’t have to live with sexual dysfunction.”