Table of ContentsView AllTable of ContentsSSRI and EDPost-SSRI Sexual DysfunctionMost Likely to Cause EDLeast Likely to Cause EDFrequently Asked Questions
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Table of Contents
SSRI and ED
Post-SSRI Sexual Dysfunction
Most Likely to Cause ED
Least Likely to Cause ED
Frequently Asked Questions
Sexual side effects—includinganorgasmia(failure to have an orgasm), genital anesthesia, lowlibido(low desire to have sex), anderectile dysfunction(ED)—are very common among patients who take selective serotonin reuptake inhibitors (SSRIs).Commonly prescribed SSRI antidepressants include Zoloft (sertraline) and Prozac (fluoxetine).
Until recently, experts have assumed thatsexual dysfunctionalways resolves after someone stops taking SSRIs. But recent research indicates that sexual side effects, including ED, can persist even after SSRI treatment stops.
This article discusses post-SSRI sexual dysfunction (PSSD), including causes, treatment, prevention, and more.
SSRI Side Effects and Erectile Dysfunction
Some examples of SSRIs include:
In general, SSRIs are safe and effective intreating depression. However, 25% to 73% of people who take SSRIs experience sexual side effects.In fact, most people who take an SSRI experience genital sensory changes within 30 minutes of taking the drug.
Sexual side effects of SSRIs may include:
Impact of Sexual DysfunctionPeople of any sex who take SSRIs report sexual dysfunction as a common side effect.Sexual dysfunction can have a significant impact on someone’s relationships, mood, emotional well-being, fertility, and quality of life.
Impact of Sexual Dysfunction
People of any sex who take SSRIs report sexual dysfunction as a common side effect.Sexual dysfunction can have a significant impact on someone’s relationships, mood, emotional well-being, fertility, and quality of life.
What Is Post-SSRI Sexual Dysfunction?
SSRIs have been prescribed to treat depression and other mental health disorders since 1987. In 2006, researchers began to formally investigate a condition known as post-SSRI sexual dysfunction (PSSD) syndrome.
Patients with PSSD continue to experience sexual side effects like genital numbing, erectile dysfunction, and low libido even after they stop taking SSRIs.In rare cases, sexual dysfunction may persist for decades and even get worse over time.
Antidepressants Most Likely to Cause ED
Many of the most popular SSRIs—such as Zoloft,Prozac, Lexapro, and Paxil—have sexual side effects. Some SSRIs are more likely than others to cause ED.
Zoloft Side Effects in Men
Zoloft is a commonly prescribed SSRI.Zoloft side effects in men may includedelayed ejaculation, penile anesthesia, reduced sexual desire, and difficulty sustaining an erection.
However, research indicates that Zoloft is somewhat less likely to cause erectile dysfunction or post-SSRI sexual dysfunction than some other SSRIs.
Lexapro Side Effects in Men
Lexapro is usually prescribed to treat depression orgeneralized anxiety disorder(GAD).Lexapro sexual side effects include ED, delayed and diminished orgasm, and reduced sexual desire. Lexapro is somewhat more likely to cause sexual side effects than Zoloft.
Learn more aboutLexapro vs. Zoloft.
Paxil Side Effects in Men
Paxil is prescribed to treat MDD and various other mental health conditions, includingpost-traumatic stress disorder (PTSD)andobsessive-compulsive disorder (OCD).
Paxil sexual side effects in men include ED, low libido, anorgasmia, and genital anesthesia. In women, Paxil may also cause inadequate lubrication.
Research suggests that Paxil is the SSRI most likely to cause ED and other kinds of sexual dysfunction. It’s a last-choice treatment for many healthcare providers if sexual dysfunction is a concern.
Prozac Side Effects in Men
Prozac is commonly prescribed to treat MDD, OCD, andpanic disorder.Prozac’s sexual side effects may include ED, low libido, penile anesthesia, and anorgasmia. However, sexual dysfunction is slightly less common with Prozac than with other SSRIs.
SSRIs and Sexual ArousalIt’s unclear exactly why SSRIs can lead to sexual dysfunction. Some research suggests that serotonin plays a role in the regulation of hormones and other neurotransmitters (such as testosterone and dopamine) that affect sexual arousal.
SSRIs and Sexual Arousal
It’s unclear exactly why SSRIs can lead to sexual dysfunction. Some research suggests that serotonin plays a role in the regulation of hormones and other neurotransmitters (such as testosterone and dopamine) that affect sexual arousal.
SSRIs Best for Avoiding Sexual Dysfunction
Because SSRIs are so effective in treating depression, many people want to continue taking them despite sexual side effects.
Some evidence from older studies suggests that Luvox (fluvoxamine) may cause fewer sexual side effects than Zoloft and other SSRIs.However, it still causes a significant number of sexual side effects. Luvox is usually prescribed for OCD, but healthcare providers prescribe it “off-label” to treat symptoms of depression as well.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin andnorepinephrinereuptake inhibitors (SNRIs) are another class of antidepressants. In addition to MDD, SNRIs are prescribed to treat anxiety disorders andchronic nerve pain.
Examples of common SNRIs include:
Studies indicate that SSRIs and SNRIs lead to similar sexual problems, including abnormal ejaculation, painful ejaculation, and post-SSRI sexual dysfunction.
What to Know About SSRIs vs. SNRIs
Cymbalta Side Effects in Men
Cymbalta (duloxetine) is prescribed to treat symptoms of depression, anxiety, and chronic pain. Cymbalta sexual side effects include ED, delayed orgasm, and loss of interest in sex. These side effects are especially pronounced among people who respond well to the drug overall.
Tricyclic and Tetracyclic Antidepressants (TCAs and TeCAs)
Tricyclicandtetracyclicantidepressants(TCAs and TeCAs) such as Pamelor (nortriptyline), Anafranil (clomipramine), and Elavil (amitriptyline) were part of the “first generation” of antidepressants. For many years, they were considered the first-line treatment for depression.
In recent years, they have been largely abandoned in favor of SSRIs due to a higher frequency of severe side effects.
Because they work similarly to SSRIs, TCAs and TeCAs can also cause delayed ejaculation, low libido, and erectile dysfunction.
Monoamine Oxidase Inhibitors (MAOIs)
Monoamine oxidaseinhibitors (MAOIs), first developed in the 1950s, are a strong class of antidepressants. Examples of MAOIs include:
About 40% of people who take MAOIs experience sexual side effects, including delayed orgasm andlow libido.
Antidepressants Least Likely to Cause ED
While many antidepressants cause erectile dysfunction, some prescription medications can help to ease the symptoms of depression while avoiding sexual side effects.
Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)
In comparison to SSRIs, SNRIs, and other antidepressants, NDRIs are significantly less likely to cause sexual dysfunction. In fact, some research suggests that Wellbutrin can even improve sexual function and increase libido. While you can take Wellbutrin on its own, some healthcare providers prescribe it as an adjunct therapy to counteract the sexual side effects of SSRIs.
Other Antidepressants
There are several other antidepressants that are less likely to cause erectile dysfunction and long-term sexual side effects. These include:
Summary
SSRIs are prescription medications that are used to treat depression and other mental health conditions.
While SSRIs are generally safe and effective antidepressants, they often cause sexual side effects. Sexual side effects from SSRIs may include erectile dysfunction, low libido, and anorgasmia, as well as genital anesthesia and abnormal ejaculation.
In some cases, the sexual side effects of SSRIs can persist even after you stop taking the medications. This is a condition known as PSSD.
Common SSRIs include Zoloft, Lexapro, Prozac, and Paxil. Of these, Paxil is the most likely to cause sexual dysfunction. Other common antidepressants, such as SNRIs, TCAs, and MAOIs, also frequently lead to sexual dysfunction.
Research suggests that NDRIs such as Wellbutrin do not have the same sexual side effects as other antidepressants. Viibryd, Trintellix, Remeron, and Emsam are also less likely to cause erectile dysfunction.
Sexual dysfunction can be stressful and challenging to navigate, especially if you’re already managing depression symptoms. If you are experiencing sexual side effects from SSRIs, talk to your healthcare provider about changing your dose or trying a different antidepressant.
How to Increase Sex Drive: A Combined Approach
Frequently Asked QuestionsThere is evidence that dopamine reuptake inhibitors, such as Wellbutrin (bupropion), are less likely to cause sexual dysfunction than other antidepressants.There is even some evidence that Wellbutrin could increase libido and arousal. SSRIs and SNRIs are most commonly associated with sexual side effects.Between 25% and 73% of people who take SSRIs experience sexual dysfunction. Sexual side effects may include loss of libido, erectile dysfunction, and delayed or diminished orgasms. More rarely, SSRIs may lead to genital anesthesia or painful ejaculation.Sexual side effects are common with Zoloft (sertraline). Many people who take sertraline to treat depression experience diminished orgasms, erectile dysfunction, and delayed ejaculation. Others experience a loss of libido and reduced overall interest in sex.For most people, erectile dysfunction from antidepressants is not permanent. Many people see a gradual return of their libido and sexual function after they stop taking SSRIs.However, some people may experience post-SSRI sexual dysfunction syndrome, in which sexual side effects persist for months or even years.
There is evidence that dopamine reuptake inhibitors, such as Wellbutrin (bupropion), are less likely to cause sexual dysfunction than other antidepressants.There is even some evidence that Wellbutrin could increase libido and arousal. SSRIs and SNRIs are most commonly associated with sexual side effects.
Between 25% and 73% of people who take SSRIs experience sexual dysfunction. Sexual side effects may include loss of libido, erectile dysfunction, and delayed or diminished orgasms. More rarely, SSRIs may lead to genital anesthesia or painful ejaculation.
Sexual side effects are common with Zoloft (sertraline). Many people who take sertraline to treat depression experience diminished orgasms, erectile dysfunction, and delayed ejaculation. Others experience a loss of libido and reduced overall interest in sex.
For most people, erectile dysfunction from antidepressants is not permanent. Many people see a gradual return of their libido and sexual function after they stop taking SSRIs.However, some people may experience post-SSRI sexual dysfunction syndrome, in which sexual side effects persist for months or even years.
22 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Health Publishing.When an SSRI medication impacts your sex life.National Library of Medicine.Commonly prescribed antidepressants and how they work.Healy D.Post-SSRI sexual dysfunction & other enduring sexual dysfunctions.Epidemiol Psychiatr Sci. 2019;29:e55. 2019;29. doi:10.1017/S2045796019000519Clevenger SS, Malhotra D, Dang J, Vanle B, IsHak WW.The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder.Ther Adv Psychopharmacol. 2018;8(1):49-58. doi:10.1177/2045125317737264Atmaca M.Selective serotonin reuptake inhibitor-induced sexual dysfunction: current management perspectives.Neuropsychiatr Dis Treat. 2020;16:1043-1050. doi:10.2147/NDT.S185757National Alliance on Mental Illness.Sertraline (Zoloft).Jing E, Straw-Wilson K.Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review.Ment Health Clin. 2016;6(4):191-196. doi:10.9740/mhc.2016.07.191National Alliance on Mental Illness.Escitalopram (Lexapro).National Alliance on Mental Illness.Paroxetine (Paxil).National Alliance on Mental Illness.Fluoxetine (Prozac).Smucny J, Park M.Which antidepressant is best to avoid sexual dysfunction?.Am Fam Physician.2004;69(10):2419-2420.National Alliance on Mental Illness.Fluvoxamine (Luvox).Indiana Family & Social Services Administration.Health & safety: psychiatric medications - SSRIs and SNRIs.AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W.Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital.Neurosciences (Riyadh). 2020;25(1):55-60. doi:10.17712/nsj.2020.1.20190058Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L.Management strategies for antidepressant-related sexual dysfunction: A clinical approach.J Clin Med. 2019;8(10):1640. doi:10.3390/jcm8101640St Luke’s.Tricyclic and tetracyclic antidepressants for depression.Higgins A, Nash M, Lynch AM.Antidepressant-associated sexual dysfunction: impact, effects, and treatment.Drug Healthc Patient Saf. 2010;2:141-150. doi:10.2147/DHPS.S7634Hypersomnia Foundation.Norepinephrine-dopamine reuptake inhibitors (NDRIs).Yasin W, Ahmed SI, Gouthro RV.Does bupropion impact more than mood? A case report and review of the literature.Cureus. 2019;11(3):e4277. doi:10.7759/cureus.4277Viibryd.Side effects & safety.Trintellix.What are sexual side effects?.Asnis GM, Henderson MA.EMSAM (deprenyl patch): how a promising antidepressant was underutilized.Neuropsychiatr Dis Treat. 2014;10:1911-1923. doi:10.2147/NDT.S59107
22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Harvard Health Publishing.When an SSRI medication impacts your sex life.National Library of Medicine.Commonly prescribed antidepressants and how they work.Healy D.Post-SSRI sexual dysfunction & other enduring sexual dysfunctions.Epidemiol Psychiatr Sci. 2019;29:e55. 2019;29. doi:10.1017/S2045796019000519Clevenger SS, Malhotra D, Dang J, Vanle B, IsHak WW.The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder.Ther Adv Psychopharmacol. 2018;8(1):49-58. doi:10.1177/2045125317737264Atmaca M.Selective serotonin reuptake inhibitor-induced sexual dysfunction: current management perspectives.Neuropsychiatr Dis Treat. 2020;16:1043-1050. doi:10.2147/NDT.S185757National Alliance on Mental Illness.Sertraline (Zoloft).Jing E, Straw-Wilson K.Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review.Ment Health Clin. 2016;6(4):191-196. doi:10.9740/mhc.2016.07.191National Alliance on Mental Illness.Escitalopram (Lexapro).National Alliance on Mental Illness.Paroxetine (Paxil).National Alliance on Mental Illness.Fluoxetine (Prozac).Smucny J, Park M.Which antidepressant is best to avoid sexual dysfunction?.Am Fam Physician.2004;69(10):2419-2420.National Alliance on Mental Illness.Fluvoxamine (Luvox).Indiana Family & Social Services Administration.Health & safety: psychiatric medications - SSRIs and SNRIs.AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W.Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital.Neurosciences (Riyadh). 2020;25(1):55-60. doi:10.17712/nsj.2020.1.20190058Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L.Management strategies for antidepressant-related sexual dysfunction: A clinical approach.J Clin Med. 2019;8(10):1640. doi:10.3390/jcm8101640St Luke’s.Tricyclic and tetracyclic antidepressants for depression.Higgins A, Nash M, Lynch AM.Antidepressant-associated sexual dysfunction: impact, effects, and treatment.Drug Healthc Patient Saf. 2010;2:141-150. doi:10.2147/DHPS.S7634Hypersomnia Foundation.Norepinephrine-dopamine reuptake inhibitors (NDRIs).Yasin W, Ahmed SI, Gouthro RV.Does bupropion impact more than mood? A case report and review of the literature.Cureus. 2019;11(3):e4277. doi:10.7759/cureus.4277Viibryd.Side effects & safety.Trintellix.What are sexual side effects?.Asnis GM, Henderson MA.EMSAM (deprenyl patch): how a promising antidepressant was underutilized.Neuropsychiatr Dis Treat. 2014;10:1911-1923. doi:10.2147/NDT.S59107
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Harvard Health Publishing.When an SSRI medication impacts your sex life.National Library of Medicine.Commonly prescribed antidepressants and how they work.Healy D.Post-SSRI sexual dysfunction & other enduring sexual dysfunctions.Epidemiol Psychiatr Sci. 2019;29:e55. 2019;29. doi:10.1017/S2045796019000519Clevenger SS, Malhotra D, Dang J, Vanle B, IsHak WW.The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder.Ther Adv Psychopharmacol. 2018;8(1):49-58. doi:10.1177/2045125317737264Atmaca M.Selective serotonin reuptake inhibitor-induced sexual dysfunction: current management perspectives.Neuropsychiatr Dis Treat. 2020;16:1043-1050. doi:10.2147/NDT.S185757National Alliance on Mental Illness.Sertraline (Zoloft).Jing E, Straw-Wilson K.Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review.Ment Health Clin. 2016;6(4):191-196. doi:10.9740/mhc.2016.07.191National Alliance on Mental Illness.Escitalopram (Lexapro).National Alliance on Mental Illness.Paroxetine (Paxil).National Alliance on Mental Illness.Fluoxetine (Prozac).Smucny J, Park M.Which antidepressant is best to avoid sexual dysfunction?.Am Fam Physician.2004;69(10):2419-2420.National Alliance on Mental Illness.Fluvoxamine (Luvox).Indiana Family & Social Services Administration.Health & safety: psychiatric medications - SSRIs and SNRIs.AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W.Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital.Neurosciences (Riyadh). 2020;25(1):55-60. doi:10.17712/nsj.2020.1.20190058Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L.Management strategies for antidepressant-related sexual dysfunction: A clinical approach.J Clin Med. 2019;8(10):1640. doi:10.3390/jcm8101640St Luke’s.Tricyclic and tetracyclic antidepressants for depression.Higgins A, Nash M, Lynch AM.Antidepressant-associated sexual dysfunction: impact, effects, and treatment.Drug Healthc Patient Saf. 2010;2:141-150. doi:10.2147/DHPS.S7634Hypersomnia Foundation.Norepinephrine-dopamine reuptake inhibitors (NDRIs).Yasin W, Ahmed SI, Gouthro RV.Does bupropion impact more than mood? A case report and review of the literature.Cureus. 2019;11(3):e4277. doi:10.7759/cureus.4277Viibryd.Side effects & safety.Trintellix.What are sexual side effects?.Asnis GM, Henderson MA.EMSAM (deprenyl patch): how a promising antidepressant was underutilized.Neuropsychiatr Dis Treat. 2014;10:1911-1923. doi:10.2147/NDT.S59107
Harvard Health Publishing.When an SSRI medication impacts your sex life.
National Library of Medicine.Commonly prescribed antidepressants and how they work.
Healy D.Post-SSRI sexual dysfunction & other enduring sexual dysfunctions.Epidemiol Psychiatr Sci. 2019;29:e55. 2019;29. doi:10.1017/S2045796019000519
Clevenger SS, Malhotra D, Dang J, Vanle B, IsHak WW.The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder.Ther Adv Psychopharmacol. 2018;8(1):49-58. doi:10.1177/2045125317737264
Atmaca M.Selective serotonin reuptake inhibitor-induced sexual dysfunction: current management perspectives.Neuropsychiatr Dis Treat. 2020;16:1043-1050. doi:10.2147/NDT.S185757
National Alliance on Mental Illness.Sertraline (Zoloft).
Jing E, Straw-Wilson K.Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review.Ment Health Clin. 2016;6(4):191-196. doi:10.9740/mhc.2016.07.191
National Alliance on Mental Illness.Escitalopram (Lexapro).
National Alliance on Mental Illness.Paroxetine (Paxil).
National Alliance on Mental Illness.Fluoxetine (Prozac).
Smucny J, Park M.Which antidepressant is best to avoid sexual dysfunction?.Am Fam Physician.2004;69(10):2419-2420.
National Alliance on Mental Illness.Fluvoxamine (Luvox).
Indiana Family & Social Services Administration.Health & safety: psychiatric medications - SSRIs and SNRIs.
AlBreiki M, AlMaqbali M, AlRisi K, AlSinawi H, Al Balushi M, Al Zakwani W.Prevalence of antidepressant-induced sexual dysfunction among psychiatric outpatients attending a tertiary care hospital.Neurosciences (Riyadh). 2020;25(1):55-60. doi:10.17712/nsj.2020.1.20190058
Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L.Management strategies for antidepressant-related sexual dysfunction: A clinical approach.J Clin Med. 2019;8(10):1640. doi:10.3390/jcm8101640
St Luke’s.Tricyclic and tetracyclic antidepressants for depression.
Higgins A, Nash M, Lynch AM.Antidepressant-associated sexual dysfunction: impact, effects, and treatment.Drug Healthc Patient Saf. 2010;2:141-150. doi:10.2147/DHPS.S7634
Hypersomnia Foundation.Norepinephrine-dopamine reuptake inhibitors (NDRIs).
Yasin W, Ahmed SI, Gouthro RV.Does bupropion impact more than mood? A case report and review of the literature.Cureus. 2019;11(3):e4277. doi:10.7759/cureus.4277
Viibryd.Side effects & safety.
Trintellix.What are sexual side effects?.
Asnis GM, Henderson MA.EMSAM (deprenyl patch): how a promising antidepressant was underutilized.Neuropsychiatr Dis Treat. 2014;10:1911-1923. doi:10.2147/NDT.S59107
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