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Antidepressants & Sex: 10 Tips for Bliss

“Jessica’s been great during my anxiety disaster. But since I started an antidepressant, I can’t cut it in bed. How much is she supposed to take? What can we do?”

What a tough spot to be in. You’ve been diagnosed with depression and/or anxiety and you begin taking an antidepressant.

It’s been a few weeks and you’re beginning to feel better. Suddenly your sex-drive takes the last train for the coast. And even when you talk yourself into giving it a go, you can’t climax. Worse yet, you’re a man and you can’t even work up an erection.

Antidepressants & Sex: Incompatible Lovers

Some 40% of those using antidepressants (ADs) report sexual side effects (SSEs). We began a series yesterday on the subject and got started with some solid information – why ADs cause SSEs, the most common SSEs, and the ADs that generate the least and most SSEs.

Here’s a link to the piece.

Well, today we’re going to wrap-up the series by chatting about what can be done to manage the sexual side effects of antidepressants.

10 Tips for Bliss

Dr. Edward Ratush is a practicing psychiatrist in New York City. One of his specialties is the elimination/management of the side effects of psychotropic medications.

I came across his 10 antidepressant sexual side effects management tips and I’d like to share them with you. I’ve done some editing and put in my two-cents…

  1. If climax issues (delayed, less intense, absent) are a problem, sit-back and grab some perspective. You may believe you’re unable to climax, but it may only be a matter of delay. To prove the point, time how long it takes to climax in self-pleasure. Compare it with your climax time during partner activity. Okay, it may take longer, but you’ve assured yourself it’s an issue of delay, not absence. The idea is to keep your worries from altering reality (you never do that, right?).
  2. Communicating your concerns with your partner is essential. If she/he truly cares about you, hanging in there with you ought to be a cinch. Work together! And in terms of giving it a go – as Dr. Ratush points out, “You don’t necessarily need to experience desire to be physically aroused.” So even if you think you aren’t in the mood, have at it and let the sex itself turn you on.
  3. Switch medications. As we discussed in yesterday’s piece, the selective serotonin reuptake inhibitors (SSRIs) are the worst when it comes to SSEs. And some of the SSRIs are more challenging than others. Dr. Ratush suggests switching from Prozac to Zoloft or Celexa to Lexapro. Naturally, you’re going to have to chat with your psychiatrist or physician.
  4. Knock-down the dose a notch or two. You could have the best of both worlds – continued symptom relief with little or no SSEs. Again, touch-base with your psychiatrist or physician.
  5. Hang in there for a time. It’s quite possible the SSEs will subside or stop.
  6. Be creative with your timing. Sexual dysfunction may not be as severe a few hours before your next scheduled dose. They could be much worse two hours after. Take advantage of times when you’re more sexually excitable. If you don’t already know these times, chart your pattern.
  7. Ask you psychiatrist or physician if there’s a medication or supplement that can reverse your SSE issue(s).
  8. Use a sexual enhancer. Typically, enhancers work to improve excitement via desire or blood flow. Of course, these medications may have their own side effects. Nonetheless, chat with your psychiatrist or physician.
  9. Do a sexual warm-up. It’s a technique of arousal generation that intentionally doesn’t lead to climax. The idea is the process of getting aroused will increase your ability to generate sex-necessary hormones later in the day or later in the week.
  10. Change your perspective. For some people, SSEs can be a welcomed change. For example, a man who’s prone to premature ejaculation may find it glorious to experience delayed climax. Another angle – think back to when you weren’t taking meds. Did you feel sexy and energetic in the midst of your depression and/or anxiety? Likely not. But after addressing your situation, you’re interested in sex again. Why else would you be worried about how your meds are affecting your sex life? Sure, your perceived lowered sex-drive may upset you. But consider how you felt before. In a way, your libido has actually increased.

That’ll Do It

I can’t think of too many people who wouldn’t panic in the face of sexual dysfunction. “My life is over!” Of course, it’s terrifying to think depression and/or anxiety equate to the end of the world, as well.

Neither is the case.

And when it comes to antidepressants and sexual side effects – according to Dr. Ratush, “In the end, you don’t have to sacrifice your sex-life in order to have some sanity.”

Here’s a link to Dr. Ratush’s website.

  • Actually, many guys take SSRIs to delay themselves, seemingly its a desired side effect for some though understandably not for all men.

    You are right to suggest switching. There is a good study somewhere on Google Scholar with a graphical comparison of IELT (intra ejaculatory latency time) and the differences between SSRI drugs are quite startling.


    • Chris – I really appreciate your visit and comment. Excellent confirmation and direction (not to be confused with erection). chipur readers – Chris’ website is direct and can help lots of men – and relationships. Sharing and relief are what chipur is all about…

      • Found the study. From worst to best – paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine (Luvox).

  • Mr.X

    “Use a sexual enhancer. Typically, enhancers work to improve excitement
    via desire or blood flow. Of course, these medications may have their
    own side effects. Nonetheless, chat with your psychiatrist or physician.”  What medications are suggested?  I have been on zoloft for some time and have found it to work great as a mood stabilizer but I am unable to climax with my wife (who is taking it personally, despite our conversations).  I have a psychiatrist that I will speak with soon and wanted to know what medicinal (prescribed) options there are before speaking with him as I have already tried the majority of the above suggestions.

    • Shorty

      Orinthine and Arginine, Horny Goat weed. Some say Wellbutrin, that didn’t do it for me.

      • Good info, Shorty. Gotta’ help someone out there. Thanks…

  • Alexiel

    I was on antidepressants Effexor for 4 months, to treat seasonal depression. I never orgasimed or climaxed once for 4 months since the day I first swallowed my first dosage. My interest in sex never decreased, I had as much interest in sex after, as before the anti depressants. During those 4 months. My partner and I tried vibrates like the Lelo2. Usually after 4 hours of trying EVERYTHING we’d be exhausted and give up. After 4 months, he said he felt like a failure sexually. We stopped having sex and our relationship became more of a friendship. I was so unhappy with this when were were going to get married shortly. As a result the marriage is now on hold. He couldn’t enjoy me when I couldn’t enjoy myself. I stopped the antidepressants. Now I’m trying a different antidepressent, Celexa I’ve only been on it 1 week and already it’s the exact same thing. I can’t physically be stimulated to pleasure. Even though I’m mentally ready, and want. When I’m not on antidepressants, It takes me less then 15 minutes to climax, Usually I’ll have multiple orgasims that last up to 1 hour, that heighten after each orgasim until I climax as much as 4 times in a row. I usually had sex with my partner every day, and multiple times a day on weekends. I find this so relaxing and it makes me feel good. It makes my partners and I relationship feel fulfilled. We love each other. He gets as much pleasure out of making me climax repeatedly, as he does from his own climax. Over time when I can never climax I get pent up, and frustrated and angry at everyone. It’s not fair that everyone else can have the pleasures I don’t. I’d like to be able to orgasm at least once a month y’know? Why can’t I be happy and enjoy sex. Why must it be one or the other? Miserable and physically enjoy sexual pleasure or, happy, with no physical sexual pleasure available no matter how hard I try.

    • Hi Alexiel! Thank you so much for stopping-by Chipur and contributing. Your very frank sharing is much appreciated. I know you speak for millions. No doubt, a very frustrating dilemma – one many of my clients share with me. Dang, why can’t we have the best of both worlds – feeling on the up and up and being able to enjoy sex in our personally desired doses? Wish I could wave a magic wand, though some have shared some coping strategies in comments here. I can assure you researchers are working on that effective antidepressant sans the sexual side effects – if for no other reason than the billions to be made in profits. Hey, Alexiel – thank you, again, for your visit and participation. Please come back…

    • Maryam

      Hi there alexiel… Yes zoloft kills libido..for 4 years of marriage i was suffering from pain during intercourse and zero desire and i was so depressed thinking whats wrong with me until i read about welbutrin and switched to it and left goodness i felt horny for the first time in 4 years and i was crazy was amaaazing but recently had to switch back to zoloft due to my panic attacks and back to zero libido again..mixing zoloft and welbutrin didnt work..all ssris i tried and i cant feel anything with my husband..just wellbutrin

      • Hi, Maryam! I sure appreciate your visit and contribution. Not only will your comment help Alexiel, but so many others who will be stopping by.

        Man, so sorry using Wellbutrin didn’t work out for you – and those panic attacks. What a crushing disappointment, I’m sure. I’m wondering if you’ve tried therapy, which often works so well for panic – and other anxiety disorders. Here’s a link to a great website – Beyond Meds. Perhaps you can find some alternatives there

        Again, thank you for your visit and participation, Maryam. Please come back…

  • Bea Cakes

    Yeah, the side effects are enough to make me so no. Why bother trying if the only thing we get is sore from all the work? Even when other stimulation doesn’t help. I think this is one reason that those of us that are on anti-depressants get divorced in the end. Intimacy starts to fail when we feel better. Though, in most cases the anti- depressant doesn’t work that well anyways.

    • Hey, Bea Cakes…

      Appreciate your visit and participation. Hope you come back.


  • Nikki St. Clair

    I’m 17 and I’ve been taking 10 mg of Lexapro since I was 14. I’ve also been dating my boyfriend for a little less time than that. We’re monogamous and such, and we’re planning on getting married after college. My sex drive is ok, but I have a really hard time orgasming, when it happens it’s amazing, though I still enjoy sex without. I don’t know how to take to my doctor about because I’m so young. and I know I’m young, but we practice safe sex: condoms every time, and I’m going to go on birth control as soon as my mom can make me an appoint for the gyno since she’s busy with work. There’s a lot of girls at my school that are slutty, but I’m not one of them. My boyfriend takes care of me and he doesn’t hurt me or anything.

    • Hi, Nikki!

      Welcome to Chipur. I appreciate your visit and willingness to share so openly. In doing so, you’ve provided a bit of identity, as well as information, for the next person that stops-by who’s walking in your shoes.

      What I think you’re saying is, you believe Lexapro is the reason you’re struggling with orgasm, and you’re hesitant to chat options with your doc because you’re afraid s/he will pass judgment on you for being sexually active at 17. Don’t know if the prescriber is a primary care doc or psychiatrist, but I’ll bet s/he has heard it before. So as difficult as it may be, I encourage you to bring the issue up at your next appt. Heck, schedule an appt specifically to discuss the matter. Your doc is there to help you, not judge you. And if that’s how s/he rolls, it’s time for a new doc. Yes, be assertive in getting the attention you need and deserve. (And PLEASE continue to do all you can to avoid pregnancy.)

      Thank you for stopping-by and contributing, Nikki. Please visit again. Oh, and “slutty?” I’m sure you aren’t.


  • Bazza

    I have been on 10mg of lexapro for about two months. Two days after i started found I couldnot come. I was disconcerted but not upset. Googled and explained to wife. She is happy cos I still make her come but she doesnot have to clean herself up. I masterbate and come that way. I am comfortable with that as i still have sexual feelings. It might be different on a higher dose or if we were younger (we have 4 teenage children).

    • Appreciate your visit and participation, Bazza. Hey, we all gotta’ do what we gotta’ do. Necessity is the mother of invention. Right?


  • Dany

    Both my girlfriend of 1 year and I have both been on Zoloft for a couple months now and both of us have experienced difficulties orgasming. As much as it sucks, it’s actually improved our relationship and our sex.
    We agreed as soon as we realized the symptoms were due to the medication to always communicate with each other about what is/is not working in bed. Sure it takes longer, but it’s opened up a whole new world of communication we didn’t have before.

    • Hey, Dany!

      Thank you for visiting Chipur and taking the time to contribute. It’s a very important component of the mission here. The more points of view/tips we can accumulate, the more good stuff available for those who stop-by.

      Seems as though you and your girlfriend are making the best of a somewhat challenging situation. And the very best part is, the two of you have chosen to communicate – and it’s brought you closer together. I like it!

      You take care, Dany, and come see us again. Always appreciate upbeat participation…


  • Dan Lokemoen


    • Well, I think I catch your drift, Dan – and appreciate your visit and comment…


  • BlasianLady

    I came across this page for some input for my husband. He has anxiety, stems from his childhood and is currently taking Citalopram. He doesn’t have depression, just the anxiety. The meds help him, but, there were times he wouldn’t be able to ejaculate. Lately though, it has amplified. We had sex four times this month, two of those times, he was simply unable to ejaculate at all. It’s starting to affect him emotionally, we are trying to have a baby, and with this happening more frequently, we’re missing my fertility window more often now. He gets erections, the blood flow isn’t the problem. It’s ejaculation. He asked me tonight to see if I can find some info, advice, ANYTHING, to help bring back his ability to ejaculate.

    • Hey, BL. Thank you for visiting and participating. Glad you stopped-by.

      Yeah, welcome to the world of antidepressants, right? Especially SSRIs. You know, it’s just going to be the elephant in the (bed)room – at least for now. Tons of great input in the comments above. The only thing I’d add, BL, is talk to his doc about a med change. Problem is, though, the antidepressants with the fewest sexual side effects – Wellbutrin, Remeron, Viibryd – aren’t really known for anti-anxiety action. The other angle is the pressure he (and you) no doubt feel about performance, especially given fertility windows and all. Perhaps there’s a way to creatively lessen the pressure – ongoing chats, assorted “slow down” techniques during intimacy, etc. Wish I had the miracle cure to share, but I sure as heck don’t.

      Keep us posted on discoveries/progress, okay? And again, thank you for visiting…