Sexual side effects are among the most common effects of SSRI antidepressants, and among the least often discussed. They are also one of the main reasons people stop taking a medicine that is otherwise working, usually without telling anyone why.
This is worth raising, and it is not an unusual thing to raise. Prescribers hear it regularly, and unlike some side effects there are often concrete options.
Common side effects and early adjustment effects
The effects fall into three areas, and someone may have one, two or all three:
- Desire. Reduced interest in sex, sometimes described as the thought simply not arising.
- Arousal. Difficulty becoming or staying aroused, including erectile difficulty and reduced lubrication.
- Orgasm. Delayed orgasm, reduced intensity, or being unable to reach orgasm at all. This is the most characteristic SSRI effect.
Genital numbness or reduced sensation is also reported.
Unlike nausea or headache, these usually do not fade with time. Waiting them out is the strategy people most often try and the one least likely to work, which is why raising them early matters.
Depression itself reduces sexual interest, which complicates the picture. If desire fell before the medicine started, the illness may be the larger factor, and treating it may improve things overall. If it changed clearly after starting or after a dose increase, the medicine is the more likely explanation.
Serious mood, behaviour or physical symptoms to take seriously
Sexual side effects are not dangerous in themselves. What makes them serious is the response they provoke: stopping an antidepressant abruptly and alone. That carries discontinuation symptoms and relapse risk, both avoidable. See stopping antidepressants.
Get urgent help for new or worsening thoughts of self-harm, whatever else is happening.
Some people report sexual difficulties persisting after stopping an SSRI. This is uncommon and not fully understood, but it has been recognised by medicines regulators and added to product information for this class. If it applies to you, it is worth reporting. See reporting a side effect.
Sexual, sleep, weight and emotional side effects
Options that exist, all requiring a prescriber rather than self-adjustment:
- A lower dose. These effects are often dose-related, and the lowest effective dose may be lower than what you are on.
- Switching to a different antidepressant. Rates vary considerably between medicines, and some are much less associated with sexual effects than the SSRIs.
- Adding a second medicine to counter the effect, used in some circumstances.
- Timing adjustments, which help some people and not others.
- Waiting, deliberately, if you are early in treatment and the illness is not yet under control. Sometimes the right answer is to revisit it in a few months rather than change course now.
Which applies depends on how well the medicine is working and how long you have been on it. There is a genuine trade-off here, and it is yours to weigh with information rather than to resolve by stopping.
See antidepressants and sexual side effects and medicines and sexual side effects.
Interactions, alcohol, pregnancy and other risk factors
Other contributors are worth ruling out before concluding the antidepressant is solely responsible: alcohol, other medicines including blood pressure treatments, thyroid problems, low testosterone, diabetes, relationship factors and sleep deprivation. A prescriber will usually consider these alongside the medicine.
What to ask your doctor before changing dose or stopping
Being specific helps, awkward as it is. Which of the three areas is affected, when it started relative to starting or changing the dose, and what it is costing you. That is more useful than a general statement, and it points towards different options.
- Is this likely to be the medicine, the illness, or something else?
- Would a lower dose still treat me adequately?
- Is there an antidepressant less associated with this?
- If we switch, how would we do it safely?
- Is it reasonable to wait, given how recently I started?
If raising it in person is difficult, writing it down and handing it over is a legitimate approach.
Related mental health medication guides
- Mental health medication side effects
- SSRI side effects
- Should I stop my mental health medication
- When to call a doctor
- Report a side effect in South Africa
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.