Antidepressants Sex Drive
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Antidepressants Sex Drive
Part of HuffPost Wellness. ©2022 BuzzFeed, Inc. All rights reserved.
Antidepressants Can Lower Your Sex Drive. Here's How To Fix It.
Experts break down everything you need to know.
Jun 1, 2018, 07:06 PM EDT | Updated Jun 5, 2018
Your brain might be to blame for your lack of sex drive.
The dip in your libido might not last.
Men are more likely to experience a change in their sex drive.
Be mindful of other factors that could get in the way.
Chat with a physician about tweaking your medication.
Above all, be honest with your doctors about the issue.
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Part of HuffPost Wellness. ©2022 BuzzFeed, Inc. All rights reserved.
For the more than 16 million Americans living with depression, antidepressants are often an option in providing some relief from their symptoms. However, as with any new medication, side effects are common. And that means for some, sex is impossible.
Antidepressants, particularly selective serotonin reuptake inhibitors, or SSRIs, have been shown to impact one sex’s drive ― with symptoms like reduced libido, delayed ejaculation, erectile dysfunction and an inability or delayed ability to reach orgasm. But there’s no definitive answer on how common those issues are for users. The results of studies vary widely, with the estimated of number of people affected ranging from 25 percent to 73 percent of those who take the drugs, according to Ash Nadkarni, associate psychiatrist at Brigham and Women’s Hospital in Boston.
This doesn’t mean that all hope is lost or that you should necessarily find alternative methods of mental health treatment. As with most health-related medication, knowledge is power. Below, experts break down what you need to know about antidepressants and your sex drive, and what you can possibly do about it:
Nadkarni said the potential sexual impact of SSRIs may lie in specific chemical occurrences in the brain.
“Pathways of sexual desire involve serotonin, but also chemicals such as dopamine and norepinephrine,” she said. “Dopamine is linked to the intense passion and arousal of romantic love, while norepinephrine is associated with the heightened attention and motivation of desire. Serotonin-enhancing antidepressants blunt sexual desire by reducing the capacity of dopamine and norepinephrine, or excitatory pathways, to be activated.”
Despite serotonin’s ability to lessen sexual desire, Nadkarni noted that in some instances, the chemical can also increase desire. It really varies depending on the person and the type of depression medication one is taking. For instance, some medications, including Viibryd and Wellbutrin , have been lauded for their lack of sexual side effects.
The changes antidepressants can cause in one’s sexual desire or experience of sex aren’t always permanent. It can also be difficult to determine whether depression or antidepressants are the reason for someone’s decreased sexual drive, according to John Christman, a psychiatrist at Zucker Hillside Hospital in Glenn Oaks, New York.
“When people are depressed they tend to be less social and interactive, and of course, that can have its effects in terms of libido,” Christman said. “It’s interesting because we always warn patients before starting antidepressants that one side effect of the medication can be sexual dysfunction. However in many patients their sexual performance improves because they’re less depressed.”
The sexual improvement felt by some patients beginning antidepressants isn’t necessarily the experience of all. Christman explained that sexual dysfunction is the most commonly experienced side effect of antidepressants, especially in men. Those who experience sexual dysfunction as a result of their antidepressants may consider stopping their medication, but Christman cautions against that.
“I tell most of my patients to try your best to wait it out,” he said. “If you give the medication a little bit of time, in many cases, the dysfunction will improve.”
So, what can you do about all of it? Here are a few solutions:
Sometimes, it’s not just your medication coming into play. Nadkarni said it’s important to be aware of other possible causes of sexual side effects, including age, alcohol usage, other medications or any leftover symptoms of depression.
There are multiple ways of working through any sexual side effects, including switching medications, incorporating an additional medication, or taking a day off from your medication. But this “drug holiday,” as Christman calls it, should only be done with the approval and supervision of your doctor.
“Wait the symptoms out and many times it does get better,” Christman said. “It’s very important to have conversations with your doctor if you’re experiencing side effects. Don’t feel embarrassed. Sexual activity is normal human behavior not to be stigmatized.”
Before you reconsider taking antidepressants, or attempt to stop using them if side effects arise, you should speak with your physicians who prescribed you the medication.
Those on antidepressants and experiencing a decreased sex drive also may want to consider speaking with a sex therapist.
“I suggest joint couples or sex therapy sessions (separate from the person with depression’s personal therapy) so you can feel like you’re both being heard, and so you can work together as a team on your sex life,” sex therapist Vanessa Marin said. “The tricky thing about these situations is that you have to make the space for both of your experiences. It’s understandable for the person with depression to be disinterested in sex, and it’s understandable for the partner to still want sex. You may have to be patient for a while, and you may have to get creative about other ways to experience intimacy and sexual satisfaction.“
How you choose to address any side effects that might arise from taking a depression medication remains up to you. And keep in mind that not every person will have the same experience.
“If you do have the side effects sometimes with time it will go away, and if it still doesn’t go away there are things you can do,” Christman said. “Not everybody gets the side effects, and you should not let the sexual side effects be a stumbling block in seeking treatment. It’s something to be discussed with your doctor, and it’s something you can treat together.”
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Posted November 1, 2012
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Depression is a very common, potentially fatal illness ( suicide ). Antidepressants usually help, but they have a distressing downside, sexual side effects: loss of erotic interest, arousal and erection problems, and particularly trouble having orgasms. Fortunately, one antidepressant rarely causes sexual side effects, Wellbutrin (bupropion).
Wellbutrin is just as effective as the most popular class of antidepressants, the SSRIs (Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox). Its nonsexual side effects are no worse, and it’s unlikely to cause sexual side effects. But doctors rarely prescribe it. Therein hangs a tale of bad luck and drug company prudery in the era before Viagra.
In the mid-1980s, North Carolina-based Burroughs-Wellcome (now Glaxo Wellcome) contracted with several laboratories to study Wellbutrin’s side effects in hopes of winning Food and Drug Administration approval. One study raised a red flag. At high doses, Wellbutrin’s original formulation triggered seizures in four-tenths of 1 percent of users, four people per 1,000. That’s not many, but it was three times the seizure risk of other antidepressants, and the FDA has nightmares about car wrecks caused by seizures behind the wheel. The study results were reported in the medical press, and suddenly, doctors viewed Wellbutrin as too risky to prescribe.
Burroughs-Wellcome scrambled and came up with a new slow-release (SR) formulation that causes seizures in only one-tenth of 1 percent of users, comparable to the seizure risk of Prozac and Paxil, and lower than the risk associated with Zoloft, Luvox, and Celexa. But the damage was done. Wellbutrin was tainted, and despite a massive advertising campaign, doctors did not change their minds. (The name, Wellbutrin, was so toxic that when the drug was shown to help smokers quit, it was released under a different name, Zyban.)
Meanwhile, around the time of the seizure scare, a dozen years before Viagra’s approval, Burroughs-Wellcome also contracted with a noted sex researcher, Theresa Crenshaw, M.D., (now deceased) to investigate Wellbutrin’s side effects. Crenshaw, the coauthor of the medical text, Sexual Pharmacology, found that it caused fewer sexual side effects than other antidepressants—and that some users reported sexual enhancement. “Our study,” Crenshaw told me in an interview shortly before her death, “was the first well-controlled clinical trial to demonstrate an improvement in sexual function due to drug treatment.”
An astonished Crenshaw rushed to tell Burroughs-Wellcome that Wellbutrin was more than just another antidepressant. It was a potential bonanza, a pill that, for some, improved sex. Oddly, Burroughs-Wellcome showed no interest. Or not so oddly. Before Viagra, the drug industry had always steered clear of anything sexual. In Crenshaw’s words, “They were prudes.”
Wellbutrin languished both on pharmacy shelves and as a focus of research. But in the mid-1990s, low-libido became recognized as a problem, and researchers showed renewed interest in Crenshaw’s earlier report. Several more studies showed that Wellbutrin caused fewer sexual side effects than SSRIs, and that SSRI users who also took some Wellbutrin reported fewer sexual side effects and better sexual functioning.
If you’re currently taking an SSRI and suffering sex problems because of it, ask your doctor about the possibility of switching to Wellbutrin. Or ask about taking a low dose of Wellbutrin (75 mg) in addition to your SSRI two hours before sex. Unfortunately, few doctors know that Wellbutrin is an effective substitute for SSRIs, one that causes few sexual side effects and may even enhance sexual satisfaction.
If you switch to Wellbutrin, or add it to your treatment regimen, the only unusual side effects are somewhat more risk of tremor, which can be scary. Fortunately, after a few months, tremors usually subside.
Ashton, A.K. et al. “Bupropion as an Antidote for Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction,” Journal of Clinical Psychiatry (1998) 59:12.
Clayton, A.H. et al. “A Placebo-Controlled Trial of Bupropion SR as an Antidote for Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction,” Journal of Clinical Psychiatry (2004) 65:62.
Crenshaw T.L. et al. “Pharmacologic Modification of Psychosexual Dysfunction,” Journal of Sex and Marital Therapy (1987) 13:239.
Demyttenaere, K. and L. Jaspers. “Review: Bupropion and SSRI-Induced Side Effects,” Journal of Psychopharmacology (2008) 22:792.
Labbate, L.A. et al. “Bupropion Treatment of Serotonin Reuptake Antidepressant-Associated Sexual Dysfunction,” Annals of Clinical Psychiatry (1997) 9:241.
Modell, J.G. et al. “Effect of Bupropion SR on Orgasmic Dysfunction in Nondepressed Subjects: A Pilot Study,” Journal of Sex and Marital Therapy (2000) 26:231.
Modell, J.G. et al. “Comparative Sexual Side Effects of Bupropion, Fluoxetine, Paroxetine, and Sertraline,” Clinical Pharmacology and Therapeutics (1997) 61:476.
Rowland, D.L. et al. “Bupropion and Sexual Function: A Placebo-Controlled Prospective Study of Diabetic Men with Erectile Dysfunction,” Journal of Clinical Psychopharmacology (1997) 17:350.
Safarinejad, M.R. “Reversal of SSRI-Induced Female Sexual Dysfunction by Adjunctive Bupropion in Menstruating Women: A Double-Blind, Placebo-Controlled, Randomized Trial,” Journal of Psychopharmacology (2010) epub ahead of print.
Seagraves, R.T et al. “Buproion Sustained Release for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women,” Journal of Clinical Psychopharmacology (2004) 24:339.
Seagraves, R.T. et al. “Bupropion SR for Treatment of Hypoactive Sexual Desire in Nondepressed Women,” Journal of Sex and Marital Therapy (2001) 27:303.
Michael Castleman, M.A. , is a San Francisco-based journalist. He has written about sexuality for 36 years.
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