Navigating antidepressants and sexual side effects
Sexual dysfunction can have a serious impact on your mental health, relationships, and overall quality of life. When it comes to antidepressant medications, many patients worry that they will be forced to choose between treating their depression and maintaining a healthy, satisfying sex life. Dr. Holly Betterly MD, Board-Certified Psychiatrist in Weston, FL, provides insight into navigating the relationship between antidepressants and sexual dysfunction so that achieving recovery doesn’t have to feel like a trade-off.
This post is provided for educational purposes only, and does not constitute medical advice. If you have questions about your antidepressant medications, reach out to your doctor for more information.
Struggling with your mental health? Reach out for professional support. Dr. Betterly is a board-certified psychiatrist in Weston, FL dedicated to helping you overcome depression, anxiety, and OCD. She offers appointments at her office in Weston, FL, conveniently located in Weston Town Center, as well as via telehealth. Request an appointment today to start your journey to better mental health.
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How do antidepressants compare with respect to sexual dysfunction?
What is the best antidepressant for avoiding sexual dysfunction?
What are my options if I experience sexual dysfunction while taking antidepressants?
How do I talk about sexual dysfunction with my psychiatrist?
How do antidepressants compare with respect to sexual dysfunction?
Like all medications, antidepressants carry a risk of side effects. Unfortunately, many (if not most) antidepressants have the potential to cause sexual dysfunction. The good news: when it comes to treating depression, we have many different options available, and some may be a better choice than others if sexual dysfunction is a big concern.
Before we take a look at the data comparing antidepressants in terms of sexual dysfunction, it’s important to remember that people respond differently to medication. Because each person’s body is unique, it’s difficult to predict if a certain individual will experience a particular side effect while taking a medication, and if they do, to what extent it will impact them.
With that said, examining the research data can help us to make a more informed decision when it comes to weighing risks and benefits, and ultimately deciding if a medication is right for us. While some may decide that any risk of sexual side effects is a non-starter, others may be willing to accept a higher level of risk after considering all of the options on the table. Remember- you are in the driver’s seat when it comes to your mental health treatment, and your preferences matter!
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A 2001 study from the Journal of Clinical Psychiatry examined the incidence of sexual dysfunction among over one thousand participants taking antidepressant medications. The participants in the study had previously normal sexual function.
Some of the study findings:
Around 60% of participants experienced sexual dysfunction while taking antidepressant medications
Men experienced a higher rate of sexual dysfunction than women
The rate of sexual dysfunction differed depending on the specific antidepressant medication:
Citalopram- 72.7%
Paroxetine- 70.7%
Venlafaxine- 67.3%
Sertraline- 62.9%
Fluvoxamine- 62.3%
Mirtazapine- 24.4%
Nefazodone- 8%
Amineptine- 6.9% (not available in the USA due to abuse risk)
Moclobemide- 3.9% (not available in the USA)
Erectile dysfunction was less common than anorgasmia/delayed orgasm
The intensity of sexual dysfunction differed depending on the specific antidepressant medication
Paroxetine showed a higher intensity of erectile dysfunction that the other SSRIs
Mirtazapine showed a lower intensity of anorgasmia and delayed orgasm/ejaculation than the other antidepressants
A 2002 study from the Journal of Clinical Psychiatry examined the prevalence of sexual dysfunction among some of the newer antidepressants, including bupropion.
Compared to the 2001 study we reviewed above, this study found:
Lower overall prevalence of sexual dysfunction among patients taking antidepressants at 37%
Lower rates of sexual dysfunction among SSRIs, with paroxetine having the highest rate amongst the SSRIs at 43%.
A higher rate of sexual dysfunction for mirtazapine, at 41%
The lowest rates of sexual dysfunction in this study were for bupropion IR (22%) and SR (25%), which were not examined in the first study.
What are some takeaway points from looking at these two studies?
The rate of sexual dysfunction for a given medication can vary quite a bit from one study to the next, which goes along with our point from earlier that everyone responds differently to medications
SSRIs and SNRIs tend to have higher rates of sexual dysfunction
Bupropion and Nefazodone tend to have lower rates of sexual dysfunction
What is the best antidepressant for avoiding sexual dysfunction?
Unfortunately, there’s no one clear “best” option when it comes to antidepressants and sexual dysfunction, but some may carry a lower risk than others.
As we saw in the research studies we reviewed in the above section, SSRI medications tend to have higher rates of sexual dysfunction, bupropion and nefazodone tend to have lower rates, and mirtazapine may fall somewhere in the middle. However, it’s important to keep in mind that rates of sexual dysfunction can vary from one study to the next, as well as in the real world from one person to another. One person may get lucky and experience no sexual dysfunction while taking an SSRI, while another may get unlucky and experience sexual dysfunction while taking bupropion.
It’s also important to remember that some medications may not be an option for certain individuals depending on their unique health circumstances. For example, bupropion carries a warning from the Food and Drug Administration (FDA) that it should not be used in patients with seizure disorders, so patients with this condition would likely need to select a different option.
Having a conversation with your psychiatrist can help you to understand which medication options are on the table for you. From there, you can work together to weigh the risks and benefits of each option to figure out which one makes the most sense for you.
What are my options if I experience sexual dysfunction while taking antidepressants?
As discussed above, sexual dysfunction is unfortunately not uncommon among people taking antidepressants, with rates as high as two in every three people for certain medications. If you find yourself impacted by sexual dysfunction, know that you don’t have to “just live with it”- there are multiple options available. A discussion with your psychiatrist is the best way to figure out which options are available to you given your unique health circumstances.
A 2010 article from Drug, Healthcare, and Patient Safety provides a great overview of some of the options that psychiatrists may consider in managing sexual dysfunction, including:
Adjusting the dose of the medication
Switching to a different medication
Adding another medication to target sexual dysfunction
‘Wait and See’ if the symptoms improve with time
Cognitive Behavioral Therapy (CBT)
Reminder: Take your medications only as prescribed and speak with your doctor before making any changes to the way you take your medications.
If your psychiatrist has concerns that your sexual dysfunction may be due to a medical condition rather than your antidepressant medication, they may refer you to either your primary care doctor or a specialist doctor for further evaluation.
It’s also important to point out that medications aren’t the only option for treating depression. Evidence-based therapies, like Cognitive Behavioral Therapy (CBT), have been shown to be an effective option, as have a number of interventional techniques, such as Transcranial Magnetic Stimulation (TMS). A discussion with your doctor can help you to determine if non-medication treatments for depression may be an option in your situation.
How do I talk about sexual dysfunction with my psychiatrist?
Sexual dysfunction can be a sensitive topic for some people, and the thought of discussing their concerns with a psychiatrist can be intimidating. Sexual dysfunction associated with antidepressants is thought to be underreported because of these types of concerns.
It may help to remember that while this may be the first time that you are having this conversation, it most certainly isn’t your psychiatrist’s first time! As medical doctors, we understand the importance of healthy sexual function, and discussing sexual side effects is as commonplace for us as discussing any other side effect, whether it be a rash, headache, or high blood pressure.
That being said, discomfort about discussing sexual dysfunction can be a valid and legitimate concern. If you don’t feel comfortable bringing this topic up with your doctor in conversation, you may consider bringing along a copy of the Arizona Sexual Experience Scale (ASEX), available here, to get the conversation started. The ASEX was developed as a tool to screen for and quantify sexual dysfunction among patients with mental health conditions. It includes questions about different aspects of sexual functioning, which can help your psychiatrist to better understand your concerns.
Can depression impact sexual function?
For many people experiencing sexual dysfunction while taking antidepressants, it is not uncommon to find that the medication is the source of their struggles. It’s important to remember, however, that antidepressants aren’t the only cause of sexual dysfunction. Many medical and psychiatric conditions can also impact sexual functioning, including depression.
People living with depression often experience anhedonia, or a loss of interest in activities that they usually enjoy, including sex. They may find it difficult to experience pleasure, or experience significant fatigue and low energy which interfere with their sex drive or ability to perform. They may be struggling with feelings of low self-esteem, worthlessness, or other psychological factors which interfere with their interpersonal relationships. They may also experience a tendency to isolate and withdraw from loved ones, which may also impact interpersonal relationships.
If depression is contributing to sexual dysfunction, symptoms may improve when the depression is treated effectively.
