Antidepressant Sexual Side Effects: What to Ask Your Prescriber

If your mood has settled on an antidepressant but your desire, arousal or ability to climax has dropped, you are dealing with one of the most common side effects in this drug class, and you are not the only one. A 2006 review says up to 70% of people with depression may have sexual dysfunction and calls it a recognized side effect of antidepressants. Which drug you take changes your odds, so the most useful step is to bring specific questions to your prescriber. The rest of this page gives you the research to ask them.

How common are sexual side effects of antidepressants?

Common enough that researchers treat them as a core problem. A 2009 meta-analysis in the Journal of Clinical Psychopharmacology pooled studies that asked directly about sexual functioning, because patients who are not asked tend to scarcely report these effects. Across the drugs that caused significantly more sexual dysfunction than placebo, the rates ranged from 25.8% to 80.3% of patients. A 2023 clinical review in the British Journal of Nursing calls sexual side-effects of psychotropic medication “very common” and says they “cause distress.”

Which antidepressants cause the most sexual side effects?

The 2009 meta-analysis ranked the drugs that caused significantly more sexual dysfunction than placebo, in decreasing order of impact, and found no significant difference from placebo for six others. Use the chart as a starting point for your conversation, not a verdict on any one drug.

The other reviews fill in the picture. The 2006 review names tricyclic antidepressants, SSRIs and venlafaxine as most likely to cause sexual dysfunction, and non-serotonergic antidepressants and duloxetine as least likely. The 2014 review says treatment with SSRIs and SNRIs is associated with sexual dysfunction, and that bupropion, mirtazapine, nefazodone and vilazodone have been associated with less of it compared with SSRIs.

The two reviews do not fully agree on duloxetine. The 2006 review places it among the least likely, while the 2009 meta-analysis found it significantly higher than placebo. That is a good question to put to your prescriber if you take it. The meta-analysis also notes that open-label studies and differing questionnaires could reduce the significance of its findings.

Which antidepressants cause erectile dysfunction?

The 2009 meta-analysis measured total sexual dysfunction, plus desire, arousal and orgasm problems. So the chart above is not an erectile dysfunction ranking. The 2014 review lists erectile difficulties among the sexual problems associated with depression and its treatments. If erections are your main problem, name that specifically at your appointment and ask which of your symptoms the drug may be linked to.

Erectile dysfunction also has causes outside antidepressants. The MedlinePlus erectile dysfunction page says “ED can be a sign of health problems,” such as clogged blood vessels or nerve damage from diabetes, and warns that if you don’t see your doctor, “these problems will go untreated.” The same page says getting more exercise, losing weight or stopping smoking may also help. The NIDDK erectile dysfunction page adds that research shows a healthy diet can lower the risk of developing ED or improve ED symptoms.

How long do sexual side effects last, and do they go away?

They may ease over time. The MedlinePlus antidepressants page says side effects are “usually mild and may get better over time as your body gets used to the new medicine.” That is a general statement about side effects, and it does not give a timeline for sexual ones.

Sometimes they do not go away. The 2023 review says sexual side-effects “can persist even after the medication has been withdrawn,” and it draws attention to ethical issues around post-SSRI sexual dysfunction (PSSD). The abstract of that review does not show how long these effects last, so timing for your own situation is a question for your prescriber. If your prescription is escitalopram, which the 2009 meta-analysis found significantly higher than placebo, the same question applies.

Do not change your dose or stop the medicine on your own. MedlinePlus says you should never stop taking an antidepressant without your provider’s help, because stopping too fast may make depression come back.

How do you counteract sexual side effects of antidepressants?

MedlinePlus says that if side effects bother you, your provider may suggest ways to manage them while you see whether the antidepressant works for you, and that you may need to change antidepressants if they bother you too much. The research points to a few options your prescriber can weigh.

• A different antidepressant. The 2014 review says some antidepressants “have been used in the treatment of SD induced by SSRIs and SNRIs.” Bupropion, mirtazapine and nefazodone stand out in both reviews. If bupropion is on your list, our bupropion for adhd guide covers its side effects and questions to ask.
• Medicines the research calls “antidotes.” The 2006 review says pharmacological options include antidepressants less likely to be associated with sexual dysfunction, and what it calls “antidotes” for the affected part of sexual functioning. Ask your prescriber which, if any, fit your situation.
• Switching to tiagabine. A trial registered on ClinicalTrials.gov (NCT00174850) planned to switch people with SSRI-induced sexual dysfunction to tiagabine. The registration lists 30 planned participants and a status of completed. A registration describes a study; it is not a result.

Any change should come from your prescriber, who can weigh these options against the reason you take the medicine. MedlinePlus notes there are also risks from not treating depression, and that your provider can help you think through the pros and cons of all your options.

Why am I hornier on antidepressants, and can they cause hypersexuality?

The research here describes sexual side effects as problems: lower desire, trouble with arousal, and difficulty reaching orgasm. The MedlinePlus antidepressants page lists “sexual problems, such as a lack of desire or ability to have sex” among common side effects, and it does not show an increase in sex drive.

If you have noticed a change in your sex drive, in either direction, that worries you or feels out of your control, tell your prescriber. MedlinePlus advises that if you notice changes that worry you, such as unusual changes in your mood or if you start acting differently, you should “call your provider right away.” For questions about what triggers hypersexual urges, how to recognize hypersexuality in someone, or how to manage urges, a doctor or therapist who works with sexual health is the right person to ask.

What should I ask my prescriber at my next appointment?

Research on this problem has long argued for raising it routinely. The 2006 review says patients “need routinely to be asked about sexual function to identify problems early,” and warns that if sexual dysfunction is ignored it may maintain the depression, compromise treatment outcome and lead to non-compliance. So bring it up even if it feels awkward. Bring a short list:

• Which drug am I on, and where does it fall in the chart above?
• When did my desire, arousal or orgasm change, and does it line up with a dose change or a new medicine?
• Could a dose change, a different antidepressant or a combination help, and what are the trade-offs?
• How long should we wait before we decide whether to change anything?
• Could another health issue be part of this, including the conditions that erectile dysfunction can signal?
• What warning signs mean I should call you right away?

Tell your prescriber about everything you take, including over-the-counter medicines, supplements, alcohol and recreational drugs. MedlinePlus says to be honest about recreational drugs and alcohol, and the 2023 review notes that antidepressants “can have severe interactions with many other substances.” If you use cannabis, or are thinking about it for anxiety or sleep, say so, and read our cannabis and mental health guide for the research on both sides.

By the Global MH Summit Research Team

This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.