Antidepressants & Sex: “Got a Minute?”

“I really thought using antidepressants was the answer. Sure I feel better, but the sexual side effects are one heck of a price to pay!”

***3.31.21: Posted an update to this piece. Be sure to read Antidepressants & Sex: What you need to know.

Here’s what a chipur reader shared with me in an email last week…

After 20 years of not being able to have normal sex on account of, first, tricyclics, then Nardil, then Prozac, then Zoloft, Cymbalta, etc; I am waiting more than eagerly, but without undue optimism, to gulp down this new antidepressant (she’s referring to Viibryd).

I note two things: each time a new anti comes out, it’s touted as being less likely to cause SSEs (sexual side effects); and also, three percent of the test pilots reported SSEs, which is probably more like 99 percent in real life. As my psychiatrist says, when patients come in and tell him they don’t have SSEs; he asks them, “Are you TAKING the medicine??!!”

Oh well. I’ll try anything once! I’ll let you know what happens.

As the reader underscores, antidepressants (ADs) and sex aren’t always the most compatible lovers. Important subject matter, if you ask me. So let’s chat about it today and tomorrow.

So we can get right down to biz, here’s a link to the first in my Antidepressant Need-to-Know series. You’ll find all sorts of foundational information.

“Why do antidepressants cause sexual side effects?”

The best place to begin our chat is coming to understand why ADs cause sexual side effects (SSEs). The vast majority of ADs work to elevate levels of the neurotransmitter serotonin.

It’s thought that a rise in serotonin levels leads to a negative impact upon the desire and arousal phase of our sexual response cycle. The four phases of the cycle are desire, arousal, orgasm, and resolution.

The kind of negative impact we’re talking sure gets things off to a poor start, doesn’t it?

You say, “Well, I thought serotonin is all about feeling good.” You’re right. However, other factors come into play…

• Increased levels of serotonin take the wind out of the sails of the neurotransmitters dopamine and norepinephrine. Both are important players in our sexual response cycle.
• Serotonin seems to negatively impact the sexual organs. It’s about a decrease in sensation and levels of nitric oxide. Nitric oxide is believed to relax smooth muscle tissue and blood vessels. And that supports adequate blood supply to the sexual organs.

“What are the most common antidepressant sexual side effects?”

Here are the three most common AD SSEs…

1. Erectile dysfunction
2. Diminished sex drive
3. Delayed, less intense, or absent orgasm

But when (if) any of these present you can’t assume it’s your AD. Perhaps the sexual dysfunction is a symptom flare-up of your depression. Maybe it’s as a result of a conflict generated by a therapy session. And it could be a physical issue.

Talking things over with your physician, psychiatrist, and therapist is really important!

“How do antidepressants stack-up in terms of sexual side effects?”

Don’t make the mistake of believing all ADs are the same. And that sure as heck applies to SSEs. The best and the worst in terms of SSEs?

The ADs least likely to cause SSEs are bupropion (Wellbutrin), a norepinephrine dopamine reuptake inhibitor (NDRI) and mirtazapine (Remeron), a tetracyclic (TeCA).

The ADs most likely to cause SSEs are the selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft).

Of the SSRIs, fluvoxemine (Luvox) is thought to generate less bothersome SSEs.

Many of you know that a brand-new AD is due to hit pharmacy shelves sometime this summer. It’s vilazodone (Viibryd). Though it’s an SSRI, the manufacturer declares very few SSEs were reported during clinical trials. Here’s a link to a piece I wrote on Viibryd.

Wrap-Up

Let’s call it a day. We’re off to a great start, but much more to come. Tomorrow we’ll discuss what you can do to manage AD SSEs. And, yes, there are effective strategies and techniques.

But you won’t know any of them if you don’t come back. So come on, stop by…