Antidepressants can affect sexual desire, arousal, orgasm and erections. These are common side effects, particularly with SSRIs. At the same time, depression, anxiety and stress can affect sexuality in similar ways, which means that antidepressants may instead improve sexual wellbeing as depression gets better.
Perhaps you feel better mentally since starting antidepressants, but no longer feel the same sexual desire. Perhaps the desire is still there, but your body responds differently to arousal, which can affect your ability to reach orgasm, get an erection or experience sexual pleasure.
When your sexual response is not working as you would like, it can bring frustration, sadness or worry. In a relationship, it can also lead to misunderstandings: Has my partner stopped finding me attractive? Is something wrong with our relationship? Will it always be like this?
The explanation is often more complicated. Antidepressants can affect your sex life, but the effects vary from person to person and do not necessarily mean that attraction or closeness has disappeared.
Can antidepressants reduce sex drive?
Yes. Antidepressants can cause sexual side effects. This is particularly true of SSRIs, a group of medicines commonly used to treat depression and anxiety.
SSRIs affect the brain’s signalling systems by increasing serotonin activity. This can help relieve depression and anxiety, but in some people it also affects the systems involved in sexual motivation, arousal and orgasm.
Sexual side effects may include:
- reduced or absent sexual desire
- difficulty becoming sexually aroused
- reduced sensitivity or weaker sexual responses
- difficulty reaching orgasm or taking longer to reach it
- being unable to reach orgasm
- erection difficulties
- delayed or absent ejaculation
- reduced vaginal lubrication or dryness
- less pleasure or satisfaction during sex
Not everyone experiences these difficulties. The type and extent of side effects can vary considerably between people, medicines and doses.
Which antidepressants can affect your sex life?
Sexual side effects are often associated with SSRIs, a group that includes sertraline, escitalopram, citalopram, fluoxetine, fluvoxamine and paroxetine.
SNRIs and some other antidepressants can also affect sexual function. Side effect profiles differ between medicines. SNRIs often have less impact on sexuality than SSRIs, but there are also differences between individual medicines and people within these groups. The effects therefore need to be assessed individually.
Around half of people treated with SSRIs experience some form of sexual side effect. These are recognised side effects, so questions about sexual function should be part of your doctor’s follow-up of treatment.
Is it the medication or the depression?
It is not always easy to tell.
Depression itself can reduce interest in things that used to bring joy or pleasure. Tiredness, worry, sleep difficulties, low self-esteem and a lack of energy can also affect desire and the ability to feel present during sexual experiences.
When medication reduces depression or anxiety, both desire and sexual function may therefore improve. At the same time, antidepressants can cause sexual side effects that resemble or add to existing difficulties.
Some useful questions to consider are:
- What were my sexual desire and function like before I started the medication?
- Did anything change after treatment began?
- Did the change happen after a dose increase?
- Has my mental health improved while my sex life has become more difficult?
- Does the change affect both sex with a partner and sexual experiences on my own?
Your answers may not provide a definite explanation, but they can make it easier to describe your situation to the person responsible for your treatment.
Sertraline and sex drive
Many people look specifically for information about sertraline and sex drive. Sertraline is an SSRI used to treat depression and several anxiety-related conditions.
For some people, treatment leads to reduced desire, difficulty reaching orgasm or changes in ejaculation. Others experience no negative effects at all. Some may instead find that their sex life improves as their depression or anxiety eases.
It is therefore not possible to predict exactly how sertraline will affect an individual. If you notice a clear change, raise it with the doctor responsible for your treatment.
Difficulty reaching orgasm while taking antidepressants
You may still feel desire and arousal but find it harder to reach orgasm. Orgasm may take much longer, feel less intense or not happen at all.
When this happens, it is easy to start trying harder. Sex can become focused on achieving a particular outcome. That pressure can, in turn, make it even harder to be present and experience pleasure.
It may help to shift your focus away from orgasm for a while. Closeness, touch and sexual pleasure do not have to follow a particular pattern or end in a particular way. At the same time, you should not have to simply put up with difficulties that affect your wellbeing.
Discuss the change with your doctor, particularly if it persists or makes you consider stopping treatment.
What can I do if antidepressants affect my sex life?
The most important step is not to change your dose or stop taking your medication on your own. Stopping suddenly can cause withdrawal symptoms and increase the risk of your mental health worsening, which may also affect your sexual health.
Start by contacting your doctor and explaining the side effects.
Depending on your situation, your doctor can assess whether treatment needs reviewing or adjusting. This may sometimes involve the dose, further monitoring or a change of medication. The right approach needs to be assessed individually and weighed against how well treatment is helping your depression or anxiety.
It may help to:
- write down when the changes began
- note whether the difficulties changed after a dose adjustment
- talk to your partner without blaming yourself or them
- explore closeness without pressure to have intercourse or reach orgasm
- seek support from a sexologist if the difficulties affect your self-esteem, relationship or sexual wellbeing
You do not have to wait until the problem feels overwhelming. If the change concerns you, that is reason enough to seek support.
When changes in desire affect your relationship
When someone’s desire changes, their partner often tries to understand why. If the possible effects of medication are not recognised, the change may be interpreted as a lack of love or attraction.
One way to help bridge the distance is to describe your experience without making promises:
“My lower desire is not because of you, and it does not mean I do not want to be close to you, even when I do not want sex.”
Try to separate closeness from expectations. If every hug might be interpreted as the start of sex, even everyday touch can begin to feel loaded. Talk about which forms of closeness feel comfortable and free from pressure for both of you.
Reduced interest in sex also needs to be respected. Nobody should feel pressured to have sex to avoid conflict, reassure a partner or prove that the relationship is still working.
How can a sexologist help?
A sexologist does not change your medication, but can help you understand and manage how these changes affect you and your relationships.
Sessions may focus on:
- changes in desire and physical responses
- worry, self-esteem or performance pressure
- difficulties talking to a partner
- differences in desire within a relationship
- other ways of experiencing closeness and pleasure
- couples sessions to build understanding within the relationship
Sometimes both medical follow-up and support from a sexologist are needed. Each serves a different purpose.
You should be able to talk about sexual side effects
Antidepressant treatment can be important and sometimes life-saving. The fact that a medicine helps does not mean that sexual side effects should be ignored.
You have the right to discuss how treatment affects your whole wellbeing – including desire, orgasm, erections, ejaculation, closeness and relationships. These concerns are neither superficial nor unimportant. Sexual health is part of health.
Do not change your treatment on your own. Contact your doctor for advice. If you would also like support with desire, sexuality or the effects on your relationship, you are welcome to book a session with a sexologist at CharlieCare.
Ninni Stålhammar, Auktoriserad Sexolog, Legitimerad barnmorska