Do Antidepressants Cause Sexual Side Effects, and What Can You Do?

Yes. Antidepressant sexual side effects can include lower desire, arousal problems, delayed or absent orgasm and erectile difficulty, especially with SSRIs and SNRIs. They vary by medicine and by person, and depression itself can also affect sex, so the cause is often mixed. This article explains how antidepressants may change sexual function, which options exist, what to tell your prescriber, and which symptoms need urgent care.

Do antidepressants cause sexual side effects?

They can. Sexual side effects are among the better-known effects of several antidepressant classes, especially the selective serotonin reuptake inhibitors (SSRIs) and the serotonin-norepinephrine reuptake inhibitors (SNRIs). Not everyone who takes these medicines has a problem, and the experience differs widely from one person to the next. For a general overview of how these medicines are used, see MedlinePlus (NIH): Antidepressants.

For a medicine-specific look at one of the most prescribed SSRIs, see our article on Sertraline (SSRIs): Uses, Side Effects, and What to Know. This page focuses on sexual function only.

What sexual changes can you notice?

Sexual function has several parts, and an antidepressant may affect one or more of them:

• Desire: less interest in sex or fewer sexual thoughts.
• Arousal: in people with a penis, trouble getting or keeping an erection. In people with a vulva, reduced lubrication or less genital sensation.
• Orgasm: delayed orgasm, a weaker orgasm, or no orgasm at all.
• Ejaculation: delayed ejaculation is often reported with SSRIs.
• Sensation: some people describe feeling emotionally "flat" or numb during sex.

These changes can begin within the first weeks of treatment or appear later. In many cases they continue as long as the medicine is taken, though some people notice improvement over time. Outcomes vary.

Why might this happen?

The mechanism is not fully understood, and several factors probably contribute. Serotonin is involved in mood, and it also appears to influence sexual response in the brain and spinal cord. Raising serotonin activity may dampen desire and delay orgasm. Effects on other chemical messengers, such as dopamine, and on nitric oxide, which helps blood flow to the genitals, have been proposed as additional contributors. These ideas are still being studied, so no single explanation should be treated as settled.

Is it the medicine or the depression?

This is a fair question, because depression and anxiety can lower desire and energy on their own. You can read more about these conditions at MedlinePlus (NIH): Depression and MedlinePlus (NIH): Anxiety. Other factors can also play a part:

• Relationship stress or changes in how close you feel to a partner.
• Other medical conditions, such as diabetes, heart disease or hormonal changes.
• Menopause, which can affect desire and comfort (see MedlinePlus (NIH): Menopause).
• Other medicines, including some blood pressure drugs.
• Alcohol, which can affect arousal and orgasm (see MedlinePlus (NIH): Alcohol).

A useful clue is timing. If sexual problems began or clearly worsened after you started or changed a medicine, the medicine may be contributing. If they were present before treatment, depression or another factor may be involved. A clinician will review your history and medicines, may examine you, and may check conditions such as diabetes, thyroid problems or hormone changes when relevant.

Do some antidepressants carry less sexual risk?

Medicines differ. Cochrane reviews such as Sertraline versus other antidepressive agents for depression focus on overall effectiveness and tolerability, so they do not settle the question of sexual function.

Clinical reviews generally describe bupropion as associated with fewer sexual side effects than SSRIs. Evidence for mirtazapine is more limited (see Mirtazapine versus other antidepressive agents for depression), and it can still cause sexual problems. Agomelatine, available in some countries, has also been studied (Agomelatine versus other antidepressive agents for major depression), again mainly for overall effectiveness. Individual responses vary, and each drug has its own other risks. For example, bupropion can lower the seizure threshold, and its label lists seizure disorders and eating disorders as contraindications, so a prescriber will want to know about any such history before choosing it. A switch is a decision for you and your prescriber, because the best choice depends on your diagnosis, other conditions and past response.

What can you do about it?

Do not stop or change a prescribed antidepressant on your own. Stopping suddenly can cause discontinuation symptoms and can raise the chance that depression returns, more so with some medicines than others. Instead, tell your prescriber about the problem so they can decide which approach fits you. Options a clinician may discuss include:

• Waiting and monitoring. For some people, mild symptoms ease after several weeks.
• Adjusting the dose. A prescriber may decide whether a lower dose is reasonable, balancing symptom control against side effects. Do not skip doses or reduce the dose on your own: short drug holidays can cause withdrawal-like symptoms and relapse, and this can be more noticeable with some medicines, such as paroxetine and venlafaxine. Switch and add-on options also carry their own risks, described below, so discuss each one with your prescriber.
• Changing the timing. Some prescribers discuss when a dose is taken, but evidence is limited and skipping doses can cause discontinuation symptoms, so never try this without your prescriber.
• Switching to a different antidepressant with a lower reported chance of sexual effects.
• Adding a second medicine. Some clinicians try adding another medicine, such as bupropion, buspirone or an erectile dysfunction drug, although evidence is limited for several of these options and interactions are possible. Each addition has its own risks and label cautions. Bupropion can cause seizures, and the risk is dose-related and higher in people with a seizure history, an eating disorder, or abrupt alcohol or sedative withdrawal. Erectile dysfunction drugs have the nitrate and blood pressure cautions described below. These should be started only by a prescriber who knows your full history.
• Treating other causes. Addressing alcohol use, sleep, other medicines, or hormonal changes can help.
• Counseling or sex therapy. Talking with a therapist, alone or with a partner, can help with desire, communication and anxiety about performance.

Drug-safety note: Erectile dysfunction medicines such as sildenafil, tadalafil, vardenafil and avanafil are contraindicated with nitrate heart medicines (for example nitroglycerin or isosorbide) and with riociguat, a medicine for certain lung conditions, because the combination can cause a dangerous drop in blood pressure; this is described on their drug labels. Alpha-blockers (some prostate and blood pressure medicines) and other blood pressure drugs can add to that drop and cause dizziness or fainting, so a prescriber may need to adjust how they are used together. These medicines can also cause a prolonged erection (priapism). Any erection lasting 4 hours or longer, painful or not, needs emergency care now, because delayed treatment can damage the penis. Sudden vision or hearing loss after taking one of these medicines also needs emergency care. Priapism has also been reported with some antidepressants, such as trazodone. Tell your prescriber and pharmacist about every heart medicine, prostate medicine and supplement you take before starting any of these drugs.

Safety cautions for antidepressants

Antidepressants carry a boxed warning on the drug label, the strongest type of label warning, about an increased risk of suicidal thoughts and behavior in children, adolescents and young adults through age 24, particularly early in treatment or after a dose change. Anyone starting or changing an antidepressant, and their family, should watch for new or worsening depression, agitation, panic, acting on dangerous impulses, unusually elevated or manic behavior, or thoughts of self-harm, and report them promptly. Teen-specific information is at MedlinePlus (NIH): Teen Depression. If you have thoughts of harming yourself, call or text the 988 Suicide and Crisis Lifeline at 988, and call 911 if you have a plan or intent or have already harmed yourself.

Sexual side effects can also lead people to skip doses quietly. Skipping or stopping abruptly can cause discontinuation symptoms such as dizziness, irritability, "electric shock" sensations, nausea and sleep trouble, and it raises the chance of relapse. Bringing up the problem openly is safer, and any taper should be planned with your prescriber.

Alcohol, other antidepressants, MAOI medicines and some supplements can interact with antidepressants. Other serotonin-affecting products, including St. John's wort, tramadol, triptan migraine medicines and linezolid, can add to the risk, so do not start any supplement or add-on medicine without asking your prescriber or pharmacist. Bupropion, whether prescribed alone or as an add-on, can lower the seizure threshold, so tell your prescriber about any seizure history, eating disorder, heavy alcohol use or sudden alcohol or sedative withdrawal. A rare but serious reaction called serotonin syndrome can cause agitation or confusion, tremor, muscle twitching or stiffness, diarrhea, high fever, rapid heartbeat and heavy sweating, and severe or worsening signs need emergency care. Taking more antidepressant than prescribed can also be dangerous. For an accidental extra dose, even if you feel well, call Poison Control at 1-800-222-1222, and they will tell you whether you need emergency care. Call 911 for a seizure, fainting, confusion, trouble breathing or any intentional overdose, and call or text 988 for crisis support. Tell your prescriber and pharmacist about everything you take, including alcohol, before any change.

How to bring it up with your prescriber

Many people feel embarrassed, but clinicians hear about this often. It may help to prepare a few points:

• When the problem began compared with when you started or changed the medicine.
• Which part is affected: desire, arousal, orgasm or ejaculation.
• Whether you had any sexual difficulty before treatment.
• All other medicines and supplements you take, plus alcohol and recreational drug use.
• How much it bothers you and your partner.

Telling your clinician about the effect lets them decide what is appropriate. If your mood has improved on the current medicine, they may prefer to keep it and add another strategy. If it has not, a switch may be easier to justify.

Do sexual effects ever last after stopping?

For most people, symptoms are reported to improve after the medicine is stopped or changed under medical supervision. A small number of people report persistent sexual symptoms after stopping an SSRI or SNRI. This is sometimes called post-SSRI sexual dysfunction. It is not well understood, how often it happens is uncertain, and research is ongoing. If symptoms persist, a clinician can look for other treatable causes.

Sexual side effects and weight or other effects

Sexual symptoms are only one possible effect of these drugs. If you are also worried about weight changes, see our article Do Antidepressants Cause Weight Gain? Other medicines in the same family have their own effects, which are covered on their individual pages.

When to Seek Medical Care