A common side effect that people rarely mention
Sexual side effects are common, and they are among the least discussed. Many people assume the change is their fault, or that it is simply the price of feeling better. Often it is neither. It is a known effect that a prescriber can help with.
MedlinePlus lists sexual problems, such as a lack of desire or ability to have sex, among the most common side effects of antidepressants. The NHS describes the range: low sex drive, difficulty reaching orgasm, vaginal dryness, and difficulty getting or keeping an erection. Cleveland Clinic lists sexual dysfunction among the common side effects of selective serotonin reuptake inhibitors (SSRIs), and explains that serotonin plays a role in regulating libido.
How common is it? Cleveland Clinic cites one study in which between 37% and 65% of people with depression developed sexual side effects associated with their antidepressant. Not everyone has them, and they vary from medicine to medicine and person to person.
Other medicines that can play a role
Antidepressants get the most attention, but they are not the only ones. The International Society for Sexual Medicine (ISSM) lists several types of drugs that might lower libido in some people:
- Antidepressants, including SSRIs and tricyclics
- Antipsychotics
- Benzodiazepines, sometimes taken for anxiety or sleep
- Beta-blockers, used for blood pressure and other conditions
- Opioid pain medicines
- Birth control pills, which can influence hormones and libido
- Finasteride, and estrogen-containing drugs in men
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) adds that erectile dysfunction can be a side effect of many prescription and over-the-counter medicines, including antidepressants, antihistamines, blood pressure medicines and diuretics, chemotherapy and hormone medicines, some pain relievers and sedatives. Neither list is complete, and a medicine appearing on one does not mean it is the cause of what you are experiencing.
Why you should not stop or change a medicine on your own
When a side effect is upsetting, the urge to skip doses or quit can be strong. Health sources are consistent that this is not safe to do alone:
- MedlinePlus says you should never change your dose or stop an antidepressant on your own, and reminds readers that there are also risks in not treating depression.
- The ISSM notes that some drugs cannot be stopped abruptly and need a weaning period, and that any change should be made under a doctor's guidance.
- The NHS advises talking to your doctor if you want to stop an antidepressant, so you can agree on a plan to reduce the dose gradually.
- Cleveland Clinic notes that stopping an SSRI suddenly can lead to discontinuation symptoms.
The same caution applies to other prescriptions, such as blood pressure medicines. Your prescriber knows why the medicine was chosen and what the alternatives are. Decisions about medication belong to you and that clinician, together.
How to raise it with your prescriber
Bringing up sex with a doctor can feel awkward. It may help to write down what has changed and when it started. Questions you might ask:
- Could this change be related to my medication, or to something else?
- Is this likely to ease as my body adjusts?
- Are there other options, such as a different dose or a different medicine, and what are the trade-offs?
- Should anything else be checked, such as hormones or another health condition?
According to the ISSM, sometimes changing either the dose or the medication can help, and a doctor can also look at other contributors to low desire, such as hormonal changes, stress or depression. Cleveland Clinic describes options a provider might consider, including adjusting a dose, switching medicines, recommending talk therapy, or suggesting practical aids such as lubricants.
It is not always the medicine
Sorting out cause can be tricky, because the condition being treated may affect sex too. Cleveland Clinic notes that depression itself commonly lowers desire and can change arousal and orgasm. If you are taking an antidepressant, it may be hard to tell where the illness ends and the side effect begins. How Depression, Anxiety, and Stress Affect Sexual Desire explains that side of the picture.
Other health conditions can be involved as well. The NIDDK notes that erectile dysfunction may be a symptom of another health problem, and that conditions affecting blood vessels, nerves or hormones can lead to it. That is another reason to let a clinician look at the whole picture rather than assuming a medicine is to blame, or that it is not.
A simple record can help. Noting when you started or changed a medicine, when you first noticed a sexual change, and anything else that shifted around the same time, such as stress, sleep or a new health issue, gives your prescriber something concrete to work with.
The emotional side
Sexual side effects can bring their own distress: feeling caught between your mood and your sex life, worrying that a partner will feel rejected, or feeling embarrassed to bring it up at all. A partner may wonder whether the change is about them.
If you have a partner, it can help to tell them that a medicine may be playing a part. Hearing "this may be a side effect, and I am looking into it" is very different from silently noticing that something has changed. It turns a private worry into a shared problem you can work on together.
Therapy does not replace the conversation with your prescriber, and it is not the place to make medication decisions. What therapy can offer is room to sort out the feelings, prepare for that conversation, and talk with a partner about what is happening. Psychotherapy for intimacy and sexual concerns can be part of individual therapy or couples therapy; ask which format fits your situation when you call. Is It Physical or Emotional? looks at how the two usually overlap.