While antidepressants are often integral to managing depression, sexuality is an important piece of a healthy life for many people. Experiencing sexual side effects from antidepressants can be frustrating and disheartening, but there are ways to address them. Talking openly with a partner, doctor, or mental health care provider about sex may feel daunting, but it’s the first step to finding solutions. Here’s what you need to know about how depression and its treatment can affect your sex life, as well as some potential ways to address these challenges.
Coping With Sexual Side Effects of Antidepressants
Depression and antidepressant medications can cause symptoms such as low libido, vaginal dryness, and erectile dysfunction. People may also find it more difficult to have an orgasm, or may not have orgasms at all. Research indicates these sexual side effects are quite common. In fact, a meta-analysis of more than 14,000 people found that a diagnosis of depression carries a 50% to 70% risk for developing sexual dysfunction. The risk was slightly increased in people who were taking antidepressants (71% vs. 65% in people who were not being treated). Sexual dysfunction related to depression may be even more prevalent than the statistics show. People may feel embarrassed and reluctant to report sexual problems to their doctor or psychiatrist. Even when they do share these side effects, a connection between the changes in their sex life and depression or medication may not be made. Communication will be very important—not just with your partner, but with your health care team. For example, if you are considering a different medication, want to change your dose, or add a supplement, always talk to your doctor and/or psychiatrist before making changes.
Strategies and Next Steps
While these approaches can be a helpful place to start, they may not work for everyone. You may need to try more than one before you find something that effectively addresses your symptoms.
Ask About a Lower Dose
With your doctor’s guidance, you may be able to take a lower dose of your antidepressant. Some people find this change is enough to reduce the sexual side effects while still effectively treating their depression. Research has shown that some people with depression prescribed a standard dose of 20 milligrams of Prozac (fluoxetine) per day felt their symptoms were as well-managed when they only took 5–10mg a day. Plus, they experienced fewer side effects on a lower dose.
Have Sex Before You Take Your Pill
The timing of when you take your antidepressant may make a difference in your sex drive as well. Waiting until after you’ve had sex to take medications like Zoloft (sertraline) or tricyclic antidepressants may help reduce the sexual side effects, as you’re engaging in intimacy when the levels of the drugs in your body are lowest. Deciding when to take your medication will depend on many factors, such as your daily routine or other side effects you experience (such as nausea, which may be reduced if you take your pill with food, or trouble sleeping). When you’re deciding when to take your pill, make sure to factor your pattern of sexual activity into your scheduling. If you are most likely to have sex in the evening, it may help if you take your pill in the morning.
Try Different Medications
Certain types of antidepressant medications may be less likely to have sexual side effects. Trintellix is a depression medication that has been shown to involve fewer sexual side effects, for example. And Wellbutrin (bupropion), a norepinephrine-dopamine reuptake inhibitor (NDRI), works in a different way than selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft, and Paxil (paroxetine). In some cases, your doctor may want you to continue taking the medication you were originally prescribed for depression but add a second, like Wellbutrin as well. They may also recommend drugs that are specifically designed to treat sexual dysfunction. Research has shown that in addition to antidepressants, people who experience erectile dysfunction can benefit from medications such as Viagra (sildenafil) or Cialis (tadalafil) that are targeted to treat the disorder.
Take a “Medication Holiday”
If your doctor would prefer to stay on the same dose of your medication, you may be able to talk to them about taking periodic breaks or “drug holidays.” Some people find that scheduling a day or two off from taking certain antidepressants, such as Zoloft and Paxil, allows them to get relief from the side effects without interrupting the therapeutic benefits. However, this strategy may not work with every antidepressant. Prozac, for example, has a much longer half-life than most antidepressants, which means the level of the drug remains consistent in your body for an extended period of time after you stop taking it. The drug’s long half-life can be beneficial when you’re trying to stop or switch antidepressants (as it makes withdrawal symptoms less likely). But, it also makes taking a “holiday” from the medication more difficult.
Experiment With Alternatives
If you’ve tried making adjustments to your antidepressant or switching meds but the sexual side effects persist, you may want to shift your focus to other approaches. Methods for addressing the sexual side effects of antidepressants can also help if the symptoms you’re experiencing are being caused by depression. You may find these strategies even help you better manage your depression overall. Psychotherapy, acupuncture, nutritional supplements, and other alternatives may be worth trying. You can also encourage your partner to get in on some of these lifestyle changes. You might try exercising together to gear up for sex or incorporate new types of stimulation into your routine.
Consider Other Causes
If you’ve tried to address your sexual symptoms with multiple methods and aren’t seeing any improvement, it may be that there’s another cause. Hypoactive sexual desire disorder (HSDD) is a common, but not frequently discussed, sexual health condition. People with HSDD (now split into two disorders in the DSM-5: female sexual interest/arousal disorder and male hypoactive sexual desire disorder) experience no drive for sexual or intimate experiences. A person with HSDD does not pursue sexual closeness and many do not think or fantasize about sex. Low libido or lack of interest in sex is not always experienced as a problem; in fact, it can be a valid sexual identity for some people (asexuality). However, this is not the case for people with HSDD. People with the condition are distressed by their lack of desire, which they often report has a profoundly negative impact on their relationships. Sexual dysfunction can also be caused by certain behaviors. If you use alcohol or other substances, sexual side effects may be felt when you’re using and/or when you are withdrawing. Age-related changes, chronic illness or pain, and life stressors (such as having a new baby or starting a new job) can also impact your sex life. These factors may make it more challenging to cope with sexual side effects caused by depression or medications.
Talking With Your Partner
Communication is an important part of a healthy relationship. When you and your partner are dealing with sexual difficulties, it’s even more important that you can talk to each other. Discussing these topics may be emotionally intense and will require both of you to find (or make) time for the conversation, but it’s important that you do. Maintaining open dialogue is part of keeping your relationship strong. Every couple has their own way of communicating and each person in the relationship has a different style of expressing how they feel. Your individual emotional and sexual needs (as well as those of your partner) are unique, but you may find these general guidelines can help you both communicate more effectively.
Don’t Stay Silent
You might be hesitant to acknowledge the difficulties, but you won’t be able to work toward a solution until they are out in the open and up for discussion. Talking with your doctor or therapist first can help you figure out how to best approach the conversation with your partner when you’re ready.
Avoid Blame
Whether you are experiencing the symptoms of sexual dysfunction yourself or you are the partner of someone who is, do your best to keep blame out of the conversation. Avoid placing blame on the other person, but also resist the urge to blame yourself.
Be Honest
It can be difficult to express disappointment and frustration in a relationship, but these feelings can be even more sensitive when they’re about sex. You might think that keeping these emotions from your partner is saving their feelings, but ignoring your own emotional needs or playing them down isn’t healthy for you or your relationship.
Work Together
Depression can make someone feel very alone. When you love someone who is depressed you may feel isolated from them. If you and your partner are trying to work through sexual difficulties in your relationship that stem from depression, approach the problem solving from a team perspective. Remember, you are in it together. Reinforce your partnership often and in ways that are separate from sex.
Ask for Help
If you are struggling to communicate, you and your partner may benefit from relationship counseling. Having a trusted therapist create a safe space to openly share feelings and work on problems can make all the difference to couples who have had a hard time figuring it out on their own. A therapist can also act as a moderator and make sure each person gets a chance to share feelings and offer ideas. A therapist’s own knowledge and experience can also make them an invaluable resource for possible solutions.
