Depression & Sex: SSRI Side Effects, Depression & ED
Depression can cause you to lose interest in activities you once enjoyed, including sex. Certain antidepressants can also affect your sex drive or your ability to have an orgasm.
A healthcare provider can help you manage both depression and low libido. Depression and Sex
Depression can affect every aspect of your life, including sex.
Low self-esteem, feelings of hopelessness and physical fatigue can lower your libido (sex drive). Depression can also lead to:
Why is sex tied to depression?
Depression affects sex because of biology. It starts with chemicals in the brain called neurotransmitters. Neurotransmitters communicate between your brain, where sexual desire starts, and your sex organs. When your brain thinks desire, your body responds by increasing blood flow to the sex organs. Increased blood flow triggers arousal through an erection or vaginal lubrication.
In a person with depression, the sex-related chemicals are balance. As a result, sexual desire is low or missing. Low levels of some of these chemicals can also dull pleasurable feelings.
The biology behind depression and sexual dysfunction is clear. But the ways depression affects our relationships and outlook on life are more complicated. Sexual challenges may follow certain symptoms of depression:
- Inability to experience pleasure.
- Loss of interest in activities.
- Low energy levels.
- Mood swings.
- Reduced self-esteem.
Antidepressants, or depression medicines, are highly effective in easing depression. But many of these drugs come with sexual side effects.
Selective serotonin reuptake inhibitors (SSRIs) are an example. SSRIs work by boosting levels of the brain chemical serotonin. Increased serotonin can help improve mood. But it can also prevent normal communication between the brain and sex organs. SSRIs may make it difficult for a man to get an erection or ejaculate. These drugs can also prevent a woman from having an orgasm.
Other antidepressants focus on different chemicals in the brain. Drugs that increase dopamine or norepinephrine are less ly to have sexual side effects.
If you think you’re experiencing sexual problems because of depression, talk to your healthcare provider. In some cases, sexual problems can actually cause depression, rather than the reverse. A thorough review of your health history, symptoms and current medications can shed some light.
It’s important to rule out other health conditions that can contribute to depression or sexual dysfunction. Your provider may perform a physical exam or run tests to check for:
- Gynecologic conditions in women.
- Hormone imbalances.
- Nutritional deficiencies.
- Thyroid disease.
- Urologic conditions in men.
Depression is often treated with antidepressants. But certain antidepressants, such as SSRIs, can actually make sexual dysfunction worse. Before starting an antidepressant, talk to your healthcare provider about its sexual side effects.
Antidepressants affect everyone differently, so it’s important to find the right medicine and the right dosage for you. Always consult your healthcare provider before:
- Adjusting the dose of an antidepressant.
- Changing antidepressants.
- Stopping antidepressants.
Antidepressants known to negatively affect desire, arousal or orgasm include:
Antidepressants that are less ly to cause sexual side effects include:
Can I treat depression without medication?
Some people may find relief from depression without medication. If you’re concerned about the sexual side effects of medication, talk to your healthcare provider. Alternative therapies for depression include:
- Herbal or dietary supplements.
The best ways to prevent sexual problems from depression or antidepressant medication include:
- Avoid drugs, alcohol and tobacco, all of which can affect sexual function.
- Stay healthy by exercising, eating a balanced diet and maintaining a healthy body weight.
- Talk openly and honestly with your partner about what you’re feeling, mentally and physically.
- Work with your healthcare provider to choose medications with the fewest known sexual side effects.
With the right treatments, most people can successfully manage depression and still enjoy a healthy sex drive. Start by treating the depression, then focus on improving sexual function
Contact a healthcare provider right away if you experience severe depression or thoughts of suicide. You can call the National Suicide Prevention Lifeline at 800.273.8255.
This hotline connects you to a national network of local crisis centers for free and confidential emotional support.
The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911.
A note from Cleveland Clinic
Your physical and mental health go hand in hand. Depression can not only affect your sex life, but also your ability to be intimate and open in relationships. If you’re experiencing depression, try to keep the lines of communication open. Talk with your sexual partner, friends and family members. A strong support system is an important part of any mental health treatment plan.
Last reviewed by a Cleveland Clinic medical professional on 12/11/2020.
Which Antidepressant Is Best to Avoid Sexual Dysfunction?
Am Fam Physician. 2004 May 15;69(10):2419-2420.
In patients being treated for depression, which antidepressants have a low risk of sexual side effects?
Bupropion (Wellbutrin), nefazodone (Serzone), amitriptyline (Elavil), and moclobemide (Manerix, a reversible inhibitor of monoamine oxidase type A not available in the United States) have been shown to cause less sexual dysfunction than selective serotonin reuptake inhibitors (SSRIs).
[Strength of recommendation: B, individual randomized controlled trials (RCTs)] Among SSRIs, fluvoxamine (Luvox) may cause less sexual dysfunction than sertraline (Zoloft).
[Strength of recommendation: B, single RCT] No other differences between or within classes of antidepressants have been demonstrated in RCTs.
The incidence of sexual side effects between different antidepressants in adults with depressive or anxiety disorders has been reported by 25 RCTs, most of which were included in two recent descriptive systematic reviews.
1,2 [References 1 and 2—Evidence level 1A] Bupropion led to less sexual dysfunction (or to more sexual satisfaction) than sertraline or fluoxetine in four trials.
The number needed to harm (NNH), that is, the number of patients who have to take the drug for one patient to experience sexual dysfunction, ranged from two to 17, depending on the type of dysfunction.1,2 Nefazodone led to less sexual dysfunction (or to more sexual satisfaction) than sertraline in two trials (NNH: two to seven).
1–3 [Reference 3—Evidence level 1B] Moclobemide led to less sexual dysfunction than four SSRIs in one trial (NNH: five) and to greater sexual desire than doxepin (Adapin) in one trial (number needed to treat: eight).2–4 [Reference 4—Evidence level 1B] The acompanying table1–4 summarizes the different adverse sexual effects and the agents that cause them.
There were no other consistent differences between classes of antidepressants. One trial reported less sexual dysfunction resulting from amitriptyline than from sertraline (NNH: seven), but numerous trials have not shown differences between clomipramine (Anafranil) and other SSRIs.
1,2 One trial showed less sexual dysfunction resulting from fluvoxamine than from sertraline (NNH: six), but no differences between other SSRIs have been demonstrated.
1,2 Limitations to many of the published studies include small sample sizes, failure to control for baseline differences in sexual function between groups of patients, and lack of uniform means of inquiring into sexual adverse effects.
Guidelines issued by the American Psychiatric Association5 (APA) and the American College of Physicians–American Society of Internal Medicine6 (ACP–ASIM) do not provide specific recommendations regarding which antidepressant to prescribe to minimize sexual dysfunction. [References 5 and 6—Evidence level 1A] The APA notes that SSRIs can carry a risk of sexual side effects, whereas the ACP–ASIM states that the data are insufficient to estimate incidence rates, thus making quantitative comparisons among antidepressants impossible.
Bupropion appears to be the best antidepressant for use in patients who are concerned about drug-related sexual dysfunction.
Amitriptyline may be a less expensive and suitable alternative, but it has other worrisome adverse effects.
Nefazodone may have a low incidence of sexual dysfunction, but it has been associated with hepatotoxicity and was withdrawn from the Canadian and European markets. Moclobemide is not available in the United States.
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1. Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002;36:1577–89….
2. Montgomery SA, Baldwin DS, Riley A. Antidepressant medications: a review of the evidence for drug-induced sexual dysfunction. J Affect Disord. 2002;69:119–40.
3. Ferguson JM, Shrivastava RK, Stahl SM, Hartford JT, Borian F, Ieni J, et al. Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry. 2001;62:24–9.
4. Philipp M, Tiller JW, Baier D, Kohnen R. Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults. The Australian and German Study Groups. Eur Neuropsychopharmacol. 2000;10:305–14.
5. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000;157(4 suppl):1–45.
6. Snow V, Lascher S, Mottur-Pilson C. Pharmacologic treatment of acute major depression and dysthymia. American College of Physicians-American Society of Internal Medicine. Ann Intern Med. 2000;132:738–42.
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