How Antidepressants Impact Your Sex Life: Tips for Improvement

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You’ve recently started taking an antidepressant, which has been a game-changer in helping you feel like life is worth living and more open to responding to your friends’ texts. However, you may notice that your sex life has been affected by this change.

More than 10% of people in the United States use antidepressants, with around 8.6 million people in England also taking them. The number of people on antidepressants has increased since the Covid-19 pandemic. Unfortunately, data on global antidepressant usage is not readily available.

Dr. Jonathan Alpert, the Dorothy and Marty Silverman Chair of the department of psychiatry and behavioral sciences at the Albert Einstein College of Medicine in New York City, mentioned that some individuals experience an improvement in their sexual function when being treated for depression. This could be due to the fact that depression can impact interest in sexual activity, enjoyment, and pleasure, similar to how it affects other activities that bring us joy.

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However, for a significant number of individuals taking these medications, around 40% to 60%, they do not have the same experience. Dr. Alpert mentioned that the sexual side effects they encounter vary widely. Some may notice a decrease in libido or difficulty becoming aroused, while others may struggle with issues related to genital sensitivity, lubrication, achieving orgasm, satisfying orgasms, or ejaculation.

Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, added that some individuals may even experience multiple symptoms simultaneously. Dr. Streicher also serves as the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

Experts have pointed out the challenging dilemma of choosing between reducing feelings of depression and anxiety, while also not being able to fully engage in a dimension of life that is crucial for mental well-being. This struggle can be distressing, they noted.

Streicher emphasized the significant ripple effect that this dilemma can have, leading to issues such as low self-esteem, increased depression or anxiety, as well as feelings of anger or frustration.

Couples may experience feelings of guilt, shame, or worry when they question if sexual dysfunction is linked to their relationship or sexual abilities, rather than being caused by medication side effects, explained Alpert.

It's important to understand why these side effects occur and to learn about the available treatment options.

Understanding sexual dysfunction caused by antidepressants comes down to the role of neurotransmitters, blood flow, and the muscular system, all of which are regulated by the brain - which is considered the most crucial sex organ according to experts.

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One type of antidepressant that is often linked to sexual issues is selective serotonin reuptake inhibitors (SSRIs). These medications help with depression by raising levels of serotonin in the brain.

Serotonin plays a crucial role in libido and arousal, according to Streicher. Libido is your basic desire for sexual activity, while arousal is when you become mentally or physically stimulated by sexual cues.

Although serotonin can improve mental well-being, it can also decrease libido and mental arousal. This effect is similar to the emotional numbness that some people feel when taking SSRIs, which not only reduces feelings of depression but also dampens overall emotions. Scientists are still working to unravel this paradox.

To experience physical arousal and orgasm, it is important to have increased blood flow to the genitalia. This increased blood flow makes nerve endings in these areas more sensitive, ultimately leading to muscle contractions and orgasm. According to Streicher, these signals are sent to the brain when these factors are in play.

Experts have noted that a higher level of serotonin can inhibit these functions, not only in the brain but also in other areas of the body involved in sexual activity. This inhibition in other body areas may be caused by SSRIs binding to alpha-1 adrenergic receptors, which are present in blood vessels in various parts of the body. These receptors are responsible for controlling the constriction and dilation of smooth muscle fibers in the walls of blood vessels.

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According to Alpert, serotonin plays a crucial role in a wide range of physiological activities. It is present in various parts of the body such as the brain, spinal cord, genitalia, and nerves around blood vessels. This is why antidepressants that target serotonin are believed to have effects on multiple levels.

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Since not everyone taking these medications experiences sexual dysfunction even with higher levels of serotonin in the body, there may be underlying factors — such as genetics — making some people more prone to being negatively affected, Streicher said.

There are some treatments that might help with medication side effects, but it's important to remember that you should not try to fix it on your own. Your prescribing doctor is the best person to work with to address any issues. They will prescribe medication based on your specific needs and medical history, and it's safer to work with a professional rather than trying to adjust your medication plan yourself.

If you've recently started taking an antidepressant, your doctor may advise you to wait a few weeks to see if the side effects improve as your body gets used to the medication. However, this relief only occurs in about 1 out of 5 people, according to Alpert.

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Sometimes, a doctor may adjust the medication plan to help with mental well-being while avoiding sexual side effects. For example, lowering the dose of SSRI medication can be beneficial, according to Alpert.

Another strategy is the idea of a 'drug holiday,' where the medication is temporarily stopped for a couple of days each week to improve sexual function. Streicher also mentioned that some individuals plan when to take their medications in relation to when they anticipate being sexually active.

Both methods must be done carefully with a doctor to avoid withdrawals or the return of mental health symptoms, Alpert advised.

A common solution is switching to bupropion, also known as a norepinephrine-dopamine reuptake inhibitor (NDRI). Bupropion is preferred for its positive impact on sexual function as it increases dopamine levels in the brain, supporting sexual desire and response. In some cases, doctors may also consider adding another medication to the existing treatment to better manage or alleviate dysfunction.

Non-psychiatric medications can sometimes serve as a remedy for the sexual side effects of antidepressants. These medications work on the same mechanisms to provide relief.

Experts may prescribe medications like sildenafil or phosphodiesterase type 5 inhibitors to address general sexual dysfunction. These medications help by promoting the dilation of blood vessels and muscle relaxation in genital areas. This counteracts the blood vessel constriction caused by high levels of serotonin, similar to how blood pressure medications are prescribed for sexual dysfunction.

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Researchers are currently conducting clinical trials on a topical sildenafil to enhance arousal and orgasm for individuals with clitorises, as mentioned by Streicher.

Trying out different medications can be a bit of a guessing game, with no sure way to know what will be effective or how quickly, according to Streicher.

If your psychiatrist agrees, one alternative could be to stop taking medication altogether and explore other methods of managing your mental health.

Sex toys, also known as sex "tools," can assist in enhancing the experience of sex by facilitating arousal and orgasm, rather than solely focusing on increasing pleasure.

According to Streicher, when neurological endings are less sensitive, increasing stimulation can be beneficial. This is why vibrators can be particularly helpful for individuals with clitorises. Research has shown that clitoral sensitivity to vibration deteriorates at a slower rate compared to sensitivity to light touch among this group.

The conditions that may necessitate the use of antidepressants can be severe and even life-threatening. According to Alpert, it is important not to let the fear of potential sexual side effects deter you from seeking out mental health treatments. "There are many options available to help," he emphasized.

Editor's P/S:

Antidepressants can