The commonly used medications known as selective serotonin reuptake inhibitors or SSRIs have been found to be useful in treating a variety of conditions like:
- major depression
- dysthymic disorder
- anxiety disorder
- obsessive-compulsive disorder
- post-traumatic stress disorder
- and premenstrual dysphoria
SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. These symptoms tend to become more common with age. SSRI medications include escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline.
Research indicates these sexual side effects are quite common. 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).
About 35% to 50% of people with untreated major depression experience some type of sexual dysfunction prior to treatment. So, in some cases, sexual difficulties may stem not from the SSRI, but rather from the underlying depression.
Another study revealed that sexual dysfunction was problematic in 21% of patients whose depression remitted with citalopram treatment compared with 61% of those whose depression did not remit.
What can be done?
The following interventions can be considered in persons who develop sexual side effects following treatment with SSRIs:
1. Rule out other possible causes of sexual problems
Depressive symptoms are associated with impaired sexual functioning. Alcohol use, substance use, cardiac disease, diabetes, other medications can also be contributing factors for the sexual problems.
2. Switching to a lower risk antidepressant
Lower risk antidepressant include bupropion, agomelatine, mirtazapine, vortioxetine and moclobemide. Bupropion, which affects both norepinephrine and dopamine, can sometimes improve sexual response.
3. Lowering the dose of antidepressant
Sexual side effects may subside at a lower, although still therapeutic, dose.
4. Taking a drug holiday
Depending on how long the drug usually remains in your body, you might stop taking it for a few days—for example, before a weekend, if that's when you hope to have sex. However, there is always a chance that this might cause a relapse, especially if it is one of the drugs that leaves your system relatively rapidly.
5. Adding a drug
For some men, taking sildenafil (Viagra) or tadalafil (Cialis) can alleviate SSRI-induced erectile dysfunction.
For women, these drugs have not been proven to be helpful. However, men and women may both benefit from adding bupropion to their treatment. This medication has been found to counter SSRI-induced sexual dysfunction, boost sexual drive and arousal, and increase the intensity or duration of an orgasm.
6. Consider psychosexual counselling
Even when physical issues or medication are at the root of sexual problems, psychological issues often become interwoven.
A few episodes of erectile dysfunction may cause a man to withdraw from sex and his partner to feel rejected. These issues can lead the couple to retreat further from intimacy.
Another issue that many couples encounter is their mismatch in sexual interest. Hypoactive sexual desire disorder (HSDD) is a common, but not frequently discussed, sexual health condition. People with HSDD 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. People with the condition are distressed by their lack of desire, which they often report has a profoundly negative impact on their relationships.
