Will Antidepressants Wreck Your Sex Life?

Seventy percent of people taking certain antidepressants complain of negative sexual side effects — but a new drug, and a few intimacy boosters, could help change that.

By Madeline Vann, MPH

Medically reviewed by Pat F. Bass III, MD, MPH

What sets Viibryd — an antidepressant recently approved by the FDA — apart from other depression medications on the market? Unlike most antidepressants, this one comes without any apparent sexual side effects.

Back in the 1950s, when antidepressants were first introduced to treat depression, physicians and patients didn’t talk much about sexual repercussions — this first generation of drugs had manyunpleasant side effects. So when a new class of medications, selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), came to the market, their fewer side effects were enthusiastically welcomed.

But it didn’t take long for patients to feel the brunt of SSRIs in the bedroom. Today, as many as 70 percent of patients taking certain antidepressants will say — if asked — that they have experienced changes in their sexual lives, from loss of sensation to lack of desire.

The sexual side effects of antidepressants may include:

• Lowered libido
• Reduced genital sensitivity
• Delayed or absent orgasm (for both men and women)

The reasons for these sexual side effects are not fully understood. One theory is that SSRIs appear to interfere with nitric oxide, which plays a leading role in arousal and sexual response, resulting in lowered libido.

Experts acknowledge that it can be hard to tell whether sexual side effects come from medication or from the depression itself, which can also have an effect on sex drive. However, while depression may cause a lack of interest in sex, it typically does not cause physical difficulties with achieving orgasm or ejaculation.

5 Ways to Revive Your Sex Drive

There are several ways you can improve your sexual life whilemanaging depression:

• Try other treatments. Treating depression is essential to your long-term quality of life. If you’re concerned about problems with antidepressants and sex, talk to your doctor about other treatment approaches, such as cognitive behavioral therapy.
• Lube up. For women, vaginal dryness can be a sexual side effect of antidepressants. A water-based vaginal lubricant may make sex more comfortable.
• Fool around. You may find that spending more time becoming aroused during foreplay helps overcome a delayed physical response.
• Talk it out. “We've found that people who communicate with their partners about their antidepressant side effects and who stay sexually active are less likely to let temporary problems become permanent,” says Tierney Lorenz, a researcher in the Sexual Psychophysiology Lab at the University of Austin in Texas.
• Get physical in other ways. Lorenz says she and her team are studying one potential cure for sexual side effects of antidepressants — exercise. “In the lab, we've found that exercising for 20 minutes before watching a sexual film doubled measures of sexual arousal in women taking antidepressants.” Consider working out as a couple — a romantic walk or an invigorating hike could put you in the mood.

Other Options for Antidepressants

If lifestyle approaches aren’t doing the trick, consider one of these medication-related strategies:

• Ask your doctor about a different dosing schedule. “If you aren't taking an extended-release tablet, you can try taking the meds at night just before sleep,” says Lorenz. “That way, the effect of the drug during the daytime will be lessened.”
• Think about erectile dysfunction medications. Drugs known as PDE-5 inhibitors, such as sildenafil (Viagra), can be taken before you have intercourse and are effective in countering lowered libido. Although sildenafil is often thought of as a man’s medication, it has shown some promise in helping to improve women’s sexual response as well.
• Rebalance changing levels of serotonin and dopamine. Your doctor may recommend daily doses of either buspirone (Buspar, Vanspar) or bupropion (Wellbutrin), both of which could counter the sexual side effects of SSRI antidepressants.
• Switch antidepressants. People who take only bupropion to treat their depression are significantly less likely to report sexual side effects than people taking SSRI antidepressants. Another option is nefazodone (Serzone), although this medication appears to have a slightly higher risk of liver damage. In January, the U.S. Food and Drug Administration approved the use of vilazodone (Viibryd) for depression treatment, which results in lowered libido in only about 4 percent of patients who take it.

Talk to your partner and your doctor to find the best option for you. And one word of caution: Don’t stop taking antidepressants on your own. Follow your doctor’s guidance for cutting back and ultimately stopping medication so that your depression can be resolved.