Which Antidepressants Are Without Sexual Side Effects?

Sexual Side Effects Caused by Antidepressants

Sexual side effects are common among people who take antidepressants. These effects can develop soon after starting antidepressants and may last for as long as the medication is taken.

The severity of sexual side effects varies depending on the individual and the specific type and dose of antidepressant. These reactions may be mild for some people or may ease off as the body adjusts whils others may have to deal with it for an extended period.

It’s important to note that some antidepressants are more likely to cause sexual dysfunction than others. Keep in mind that everyone is different, and individual responses to medications may vary. If you’re concerned about sexual side effects, it’s best to talk to your healthcare provider. They can help you find the right antidepressant that suits your needs.

Common sexual side effects from antidepressants may include:

• Decreased interest or desire for sex
• Difficult to maintain an erection
• Delayed or not able to reach orgasm
• Reduced genital sensation

Which Antidepressants Have the Least Sexual Side Effects?

Some antidepressants may have fewer sexual side effects than others. Therefore, it is important to know which antidepressants have the least reactions that may affect your quality of life, your relationships, and your mental health.

It’s important to note that most antidepressants have a risk of sexual side effects. Antidepressants with the least reported sexual side effects include:*

• Bupropion (Wellbutrin XL, Wellbutrin SR) 

Wellbutrin is a norepinephrine and dopamine reuptake inhibitor (NDRI) that may increase the levels of norepinephrine and dopamine in the brain. It is used to treat depression, seasonal affective disorder, and smoking cessation. It may cause insomnia, dry mouth, tremor, and seizures.¹

• Mirtazapine (Remeron)

Mirtazapine (Remeron) is noradrenaline and a specific serotonergic antidepressant that enhances the effects of norepinephrine and serotonin in the brain. It is used to treat depression, anxiety, and insomnia. It may cause drowsiness, weight gain, increased appetite, and sexual dysfunction.

• Vilazodone (Viibryd)

Vilazodone (Viibryd) is a serotonin reuptake inhibitor and partial serotonin receptor agonist (SPARI) that works by increasing and modulating the effects of serotonin in the brain. It is used to treat depression and anxiety. It may cause nausea, diarrhea, headache, and sexual dysfunction.

• Vortioxetine (Trintellix)

Trintellex is a serotonin modulator and stimulator (SMS) that works by affecting various serotonin receptors in the brain. It is used to treat depression and anxiety. It may cause nausea, vomiting, sexual dysfunction, and abnormal bleeding.

*These medications have a black box warning, the most serious kind of warning from the FDA for the risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Which Antidepressants Have the Most Sexual Side Effects?

Sexual side effects are more closely associated with some antidepressants because of their mechanism of action on certain neurotransmitters in the brain. Antidepressants that increase serotonin levels include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) which tend to cause more sexual side effects than other antidepressants.²

SSRIs

SSRIs are antidepressants that increase serotonin in the brain. Although antidepressants are effective in treating depression and other mental disorders, these drugs can also cause sexual problems. Common signs of sexual dysfunction may include low desire, arousal issues, and orgasm difficulties.

Commonly prescribed SSRIs include:

• citalopram (Celexa)*
• escitalopram (Lexapro)*
• fluoxetine (Prozac)*
• paroxetine (Paxil)*
• sertraline (Zoloft)*
• fluvoxamine (Luvox)

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

SNRIs

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a type of antidepressant that helps improve mood by increasing the levels of certain chemicals in the brain. They are commonly used to treat conditions like depression, anxiety, and fibromyalgia. However, it’s important to know that SNRIs can sometimes cause sexual side effects more often than other antidepressants; 36% to 43% of people taking SNRIs experienced sexual problems.³

Commonly prescribed SNRIs include:

• venlafaxine (Effexor XR)*
• desvenlafaxine (Pristiq)*
• duloxetine (Cymbalta)*

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants (TCAs) are a type of medication used to treat conditions like depression, obsessive-compulsive disorder, and chronic pain. They work by affecting certain chemicals in the brain to help reduce symptoms.

While TCAs can be helpful for some people, they are not usually the first choice for treating depression because they can have more antidepressant side effects and a higher risk of overdose. One important thing to consider is that TCAs can cause more sexual side effects compared to other antidepressants. In a study, it was found that up to 70% of people taking TCAs reported experiencing sexual problems.⁴

Tricyclic antidepressants (TCAs) include:

• amitriptyline*
• nortriptyline (Pamelor)*
• clomipramine (Anafranil)*
• Amoxapine
• Clomipramine
• Desipramine
• Doxepin
• Imipramine
• Nortriptyline
• Protriptyline
• Trimipramine

*These medications have a black box warning, the most serious kind of warning from the FDA for risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant developed. They work by blocking the enzyme monoamine oxidase, which breaks down the neurotransmitters norepinephrine, serotonin, and dopamine in the brain.

MAOIs are not first-line treatments for depression because they have more side effects than newer antidepressants and they have severe interactions with many other medications.

Monoamine Oxidase Inhibitors (MAOIs) include:

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)
• selegiline (Emsam)

*These medications have a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

What Strategies Can Help With Antidepressant Sexual Side Effects?

Sexual side effects due to antidepressants may impact your quality of life, relationships, and mental health. It’s important to talk to your doctor if you experience any sexual side effects while taking antidepressants. Your doctor may be able to adjust your medication or prescribe a different one that has fewer sexual side effects. Other strategies that may help reduce the likelihood of experiencing sexual side effects which include taking the medication at a different time of day, reducing the dose, or taking a drug holiday. It’s important to note that you should never stop taking your medication without first consulting your doctor.

Wait & See Approach

The wait-and-see approach is a method to address treatment-emergent sexual dysfunction caused by antidepressant medication. It refers to the approach of giving time for the sexual side effects to improve or resolve on their own without any specific intervention. Although widely used by physicians, it is considered the least effective method.

Some patients may experience a partial or complete improvement in their sexual dysfunction within a few weeks or months, while others may only see temporary improvement for a few days before it returns. However, it is important to note that the majority of patients, around 80%, do not experience any improvement in sexual side effects even after six months of treatment. Therefore, while waiting for spontaneous remission can be an option, it is not a reliable or guaranteed solution for addressing antidepressant-induced sexual side effects.⁵

Consider Switching Antidepressants

Switching antidepressants as a strategy can be helpful in dealing with sexual side effects. Several antidepressants may have fewer sexual side effects than others. Anti-anxiety drugs such as bupropion (Wellbutrin), mirtazapine (Remeron), vilazodone (Viibryd), and vortioxetine (Trintellix) are reported to have a lower rate of sexual side effects than selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Switching antidepressants is done with caution and under the guidance of your doctor, as different antidepressants may have different effects on your mood, anxiety, and other symptoms of depression. Switching antidepressants may also cause withdrawal symptoms or interactions with other medications.

Talk to a Therapist

Psychotherapy can help with the sexual side effects of antidepressants by addressing the underlying psychological factors that may be contributing to sexual dysfunction. It can also help individuals develop strategies to manage the side effects.

Online therapy platforms can be a good option for someone with sexual side effects because they offer the convenience of receiving therapy from the comfort of your own home. This can be especially helpful for individuals who may feel embarrassed or uncomfortable discussing sexual issues in person.

Reducing the Dose

Lowering the dose of your antidepressant may reduce the severity of sexual side effects, but it may also compromise the effectiveness of your treatment. Therefore, you should always consult with your doctor before changing your dose and monitor your mood and symptoms closely.

Using Drug Holidays

This means skipping or stopping your antidepressant for a short period of time, such as a weekend or a few days, to allow your sexual function to recover. However, this strategy is risky and not recommended, as it may cause withdrawal symptoms, relapse of depression, or loss of response to the medication. You should always take your medication exactly as prescribed and talk to your prescriber if you are interested in changing your dose or how often you take your medication.

Using Additional Medications

This means adding another medication to your antidepressant to counteract the sexual side effects. For example, some studies have suggested that bupropion (Wellbutrin), aripiprazole (Abilify), phosphodiesterase 5 inhibitors (such as Viagra, Cialis, or Levitra), and some herbal supplements (such as ginkgo biloba or maca) may improve sexual function in some people with antidepressant-induced sexual dysfunction.

However, these medications may also have their own side effects, interactions, or contraindications, so you should always consult with your doctor before trying them and use them with caution.⁶