Over 70% of people taking antidepressants experience sexual side effects such as decreased libido, decreased arousal, and a lowered ability to orgasm—all of which fall into the category of sexual dysfunction. These effects are especially frequent with SSRIs, which are currently the preferred treatment for depression. Yet these significant effects often remain unaddressed, overlooked by patients and physicians in their desire to alleviate depression quickly and effectively.

Sex is a sensitive subject, and it can be very difficult to bring up for depressed individuals many of whom have grown used to living with inhibited sexual function. Depression itself often causes sexual dysfunction—up to 75 percent of depressed individuals report a loss of sexual desire. So a low sex drive may seem like something you just have to live with until it goes away—even if it never does.

But realize this: Along with the other oppressive symptoms of depression, a low sex drive can and should be improved. With the help of your doctor and the new medications and therapies now available, you may be able to finally to live your life as you should—free not only from depression but from its side effects as well.

What Antidepressants Cause Sexual Dysfunction?

Antidepressants work by altering the balance of chemicals in the brain. Of all the available treatments for depression, SSRIs, monoamine oxidase (MAO) inhibitors, and tricyclic antidepressants have all exhibited significant sexually inhibitory side effects. SSRIs such as Paxil, Zoloft, and Prozac have caused decreased sexual desire or arousal in around 40 percent of patients. 

But I Like My SSRI

SSRIs are also considered the most effective treatment currently available for depression, and have helped many individuals suffering from this disorder. So if you are otherwise satisfied with the SSRI that you have been prescribed, what can you do while continuing to use your current medication?

Modify your Current Medication

Since the balance of brain chemicals seems to be what governs the sexual side effects of antidepressants, altering the dosage of the medication that you are taking is an option that may alleviate sexual difficulties while adequately treating depression. Luckily, SSRIs are best suited for this. Drugs such as Prozac can maintain their medical effects within a certain dosage range, so moving your dosage to the lower end of that range may cause enough of an adjustment in the balance of chemicals in your brain to give you back your libido while still getting rid of your depression.

Another option is to take a “drug holiday.” Drug holidays are brief two-day breaks from medication. When Dr. Anthony Rothschild—the first to try this method—tested 30 couples who took weekends off their prescribed SSRIs, he found that about half of those who took Paxil and Zoloft noticed improved sexual function. However, those taking Prozac did not respond as well probably because Prozac remains in your bloodstream for a longer period of time.

Finally, you can also try altering the time at which you take your SSRI. Taking the dosage just before or after sex will ensure that the level of medication in your bloodstream is at its lowest point during intercourse, which may help eliminate decreased desire and arousal

However, sometimes decreasing the dose of an antidepressant or altering its administration can drastically decrease its effectiveness, putting you at risk for a relapse. But don’t give up hope; in such cases, there are other options. New therapies that can be prescribed instead of SSRIs may replace the older drugs as the best treatment for depression. At the very least, these new drugs may be administered in conjunction with an SSRI to modulate sexual side effects.

Adding or Changing Antidepressants

Of all the non-standard antidepressants available, Wellbutrin seems to the best alternative. Its sexual side effects are minimal; in fact, for some individuals it acts as a sexual stimulant. Studies comparing Wellbutrin—which is often cited as bupropion, its chemical name—to SSRIs found significantly lower occurrences of sexual side effects in individuals taking Wellbutrin. Other antidepressants that seem to have fewer sexual side effects include Desyrel, Remeron, Effexor, Cymbalta, and Serzone. However, Wellbutrin has also been shown to have a less inhibitory effect on desire, arousal and ability to orgasm than many of these, specifically Remeron (mirtazapine), Effexor (venlafaxine) and Serzone (nefazodone).

But Wellbutrin’s reputation may give you cause to consider. Though this drug does not produce serious side effects as consistently as traditional antidepressants do, when side effects do appear they can be strange and serious. One such side effect is especially frightening—seizures.

Some of the fear about seizures caused by Wellbutrin is carryover from old data. When Wellbutrin was first introduced, twice the maximum dose was shown to cause seizures in four in 1000 patients. More recent tests have shown the risk to be two in 1000, which is much less than even the preferred SSRIs. 

Still, the relative lack of research on the side effects of Wellbutrin and other non-standard SSRIs lends these drugs a level of unpredictability that makes doctors less likely to prescribe it except in cases where better-documented methods have failed.

Treating the Sexual Side Effects Themselves

There are also drugs available to strictly treat the sexual side effects of antidepressants. Such drugs can be divided up into three classes that each work with a different chemical: adrenaline (epinephrine), serotonin and dopamine. Stimulants such as Ritalin (methylphenidate) may also be helpful. 

Recent studies have begun pursuing drugs that increase blood supply to the genital area, which can combat sexual dysfunction caused by antidepressants. On the medical front, drugs such as yohimbine and Viagra are options that may help. For those who put stock in natural therapies, there is gingko biloba, which has been shown to increase blood flow. 

Just as non-standard antidepressants, research on methods to specifically treat SSRI-produced sexual dysfunction is limited, so the side effects of these therapies are not fully known. Still, if you are willing to take the risk, these options may give you back, or for the first time, the sexual capacity that you deserve. But before you decide on any medication, there is one important step you should take….

Talk to Your Doctor

It is understandable that people find it difficult to talk about their sexual needs to their physician. But physicians are people, too, and they are often just as uncomfortable with asking a patient for the details of their sex life as a patient is with giving them. Unfortunately, this don’t-ask-don’t-tell attitude about sexual function has led to a silence that can gravely inhibit the doctor-patient relationship and impair your physician’s ability to effectively treat you. It is crucial to your wellbeing that you find a doctor with whom you are comfortable discussing your sexual function and one who is comfortable discussing it with you.

If your doctor seems uneasy with altering your medications to alleviate your sexual dysfunction, switch doctors—preferably to a psychiatrist. Sometimes, family physicians or general medicine practitioners are less comfortable discussing the sexual side effects of psychotropic drugs because they do not feel that they have enough knowledge of the way the drug works. 

Psychiatrists, however, have a solid knowledge of the drugs used to treat depression and possess extensive experience prescribing them and dealing with their outcomes—even their sexual side effects. Whether you are sticking with your family doctor or changing physicians, make it your responsibility to bring up your sexual history and sexual function.

It is time for people suffering from depression to speak up. Be proactive; bring up the topic of your sexual function yourself. If you are willing to begin the conversation, your physician will most likely continue it. Your ease with the subject will allow your physician to freely ask you questions about the quality of your sexual experience so that he or she can determine what your baseline activity is and if any changes that have occurred. This dialogue with your physician is vital to managing and maintaining your sexual activity now and in the future—so start now!