Depression is hard enough when it doesn’t affect your intimate life. But it can be downright devastating when its treatment also strips us of that one vital pleasure. Antidepressants cause sexual dysfunction in many users, but there are solutions. Some people find it’s a side effect that wanes over time if they wait it out, while others may need to switch to a different antidepressant or add a new one to their regimen. A switch in sexual routine or dosing time may help some people. But whatever we do, we shouldn’t have to choose between easing our depression and having satisfying sex. Fortunately, there are options.
Know the Odds
Sexual dysfunction strikes a fair number of people who take antidepressants. Depending on the study and the medication, reports show that 25% to 73% of people on antidepressants experience issues with libido, erection, ejaculation or orgasm. Overall, men are 62% more likely to experience sexual side effects when on antidepressants, with women close at 60%. The numbers were even higher in those using clomipramine (Anafranil), with a whopping 93% of men and women experiencing difficulty reaching orgasm.
But these numbers may not be what they first appear to be. According to American Family Physician, 70% of people with untreated depression report a loss of sexual interest. People taking antidepressants may continue to struggle with varying degrees of depression, so antidepressants may sometimes take the blame when continued depression is the real culprit.
Wait it Out
Mayo Clinic advises waiting out some side effects, since they may disappear as the body adjusts to treatment. It may also take time to see any improvement in mood, which could also be affecting libido. The best course is to consult a doctor about setting a reasonable timeframe to monitor side effects. If an antidepressant is responsible for sexual dysfunction despite waiting, it may at some point be necessary to revise the game plan.
Switch it Up
Some antidepressants are more likely to affect sexual function than others. The worst offenders include:
- Selective serotonin reuptake inhibitors (SSRIs), such as Celexa, Lexapro, Prozac, Paxil and Zoloft.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include Cymbalta, Pristiq, Effexor XR and Khedezla.
- Monoamine oxidase inhibitors (MAOI) like Marplan, Emsem, Parnate and Nardil.
- Tricyclic and tetracyclic antidepressants, including amitriptyline, Pamelor and Anafranil.
Those taking one of these types of antidepressants may need to switch to one that’s less likely to cause sexual dysfunction, such as mirtazapine (Remeron) or vortioxetine (Trintellix). Selegiline (Emsam), which is a skin patch, may be less likely to affect libido.
Perhaps the best option to consider is bupropion (Wellbutrin). This antidepressant may actually increase libido and orgasm intensity in both men and women.
Add Something Else
Patients may not want to chance losing any progress they've made on a current regimen, but may also not want to live with a lackluster sex life. They may be able to rectify the problem by adding to an existing regimen rather than starting over with something new.
Men who experience problems with erections might try sildenafil (Viagra) or tadalafil (Cialis). Another option for both men and women may be buspirone (BuSpar). Though typically used to treat anxiety, BuSpar may increase libido and make it easier to orgasm.
Try Changing up a Routine
Harvard Health suggests initiating sex at different times during the day to see if the timing of either sex or antidepressant ingestion is playing a role. For example, medications taken right before bed might have a greater impact than those taken in the morning. And if morning sex is possible, then it may be better to change sexual routines versus dosing times.
Mental and sexual health are dependent on one another and are equally important. We all deserve to feel like ourselves in every aspect, including who we are in the bedroom. Recognizing their interdependence and mutual importance will go a long way, but getting a professional to help strike the right balance is probably key.