If you have ever experienced mild, moderate or severe depression you know that it affects your entire body. Your thoughts and movements feel heavy and sluggish. Even in milder cases of depression it’s an effort to move, to concentrate or to feel enthusiasm for anything.
When it comes to sex, though, the picture isn’t that straightforward.
Depression and sex
Undertake a quick internet search and you’d be forgiven for thinking that depression kills sex lives. In fact, some people find that sex is the one thing that provides comfort and solace. Some men even report an increase in sex drive, partly driven by the same needs. So the fact that you can maintain a sex life does not mean you don’t have depression.
In most cases, however, the symptoms of depression, which include fatigue, aches and pains, and a lack of energy, mean that interest in sex diminishes or disappears entirely. Unfortunately, the most commonly prescribed antidepressants tend to be the worst offenders when it comes to low sex drive in both men and women.
Antidepressants that cause sexual side effects
The Mayo Clinic identifies the following antidepressants as the most likely to cause sexual side effects:
- Citalopram (Celexa)
- Desvenlafaxine (Pristiq, Khedezla)
- Duloxetine (Cymbalta)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Isocarboxazid (Marplan)
- Paroxetine (Paxil, Paxil CR, Pexeva)
- Phenelzine (Nardil)
- Sertraline (Zoloft)
- Tranylcypromine (Parnate)
- Venlafaxine (Effexor XR)
Antidepressants identified as least likely to cause sexual side effects are:
- Bupropion (Wellbrutin XL, Wellbrutin SR, Apllenzin, Forfivo XL)
- Mirtazapine (Remeron)
- Selegiline (Emsam) This is used as a skin patch.
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
Sexual side effects in men and women
Men may experience difficulties in achieving or maintaining an erection as well as problems in achieving orgasm. Women may experience delayed lubrication and orgasm. In both men and women, the desire to engage in sexual intercourse may be greatly lessened or non-existent.
The causes of sexual dysfunction may partly be due to depression itself. However, where sexual dysfunction appears to result from antidepressant medication, possible reasons relate to serotonin and dopamine. Antidepressants whose action is to increase the amount of serotonin in the brain (SSRIs) is also thought to depress sexual desire. As serotonin increases so dopamine, a neurotransmitter associated with pleasure and reward, may decrease. Decreased dopamine levels could account for lower sexual arousal.
There is no single, approved remedy for overcoming antidepressant-induced sexual dysfunction. What follows is a general round-up of some of the suggestions I have uncovered:
Time: If you’re taking antidepressants it can take several weeks before the therapeutic effects take hold and side effects diminish. Some people find once things have settled, their sex life improves. (Consider asking your doctor about switching the time antidepressant medication is taken to see if this helps.)
Viagra: The pill famous for helping men achieve and maintain an erection has been used in various trials, with both men and women, with mixed results. Fibanserin (Addyi), meanwhile, was first approved by the FDA in 2015 for use in women who experience low sexual desire. Although not approved for antidepressant-induced sexual dysfunction, the controversial “female viagra” looks destined to be prescribed for that very reason, according to this article in Scientific American.
Dosage variation: With the approval of your doctor, small variations in antidepressant medication may have some positive effects with regard to sexual function. If this is not successful, then switching to an alternate antidepressant may be considered.
Lifestyle: It may feel counter-intuitive to exercise when your mood is very low, but even a modest amount of exercise can lift the spirits and improve wellbeing. A healthy diet is another important factor to consider.
Updated by: Jerry Kennard