Article Thumbnail

The Definitive Guide to Sex on SSRIs

While SSRIs and other antidepressants can lift your mood, the can’t always be said for your, you know, dick. Thankfully, there are plenty of options and ways to cope.

Medicable depression: Everyone’s doing it, but men are doing it less. 

According to a 2017 report by the National Center for Health Statistics, almost 13 percent of Americans are on antidepressants, which top the list of the most commonly prescribed drugs for people ages 20 to 59. But while women are twice as likely to use them as men are, some studies have found that it’s not because they’re the “sadder, more emotional gender” — as a 2017 report from Sweden revealed, men are actually more likely to be depressed, but report it less often and are prescribed medications to treat it at far lower rates as a result. 

You could fill a library with theories about why men’s depression is less medicated — it doesn’t always manifest as “sadness” in men; traditional gender roles prevent some guys from telling doctors and psychiatrists how they feel — but as Fredric Rabinowitz, a professor of psychology at California’s University of Redlands explained to Men’s Health, it could be because a lot of them just don’t want to deal with the sexual side effects

Who could blame them? 

Sexual dysfunction — a blanket term for anything that interferes with a person’s ability to enjoy sex or masturbation — is one of the most commonly reported side effects of antidepressants, and it’s typical for men to experience anything from delayed ejaculation to a total loss of interest in sex and masturbation while they’re on them. And while men aren’t the only ones who deal with these effects — women, trans and non-binary people experience their own variety at perfectly competitive rates — it’s easy to see why antidepressants might be a less-than-attractive option for guys who are already struggling with anxiety, low self-esteem and depression. 

That said, antidepressant use among men is increasing — and at a rapid rate. According to the CDC, 1 in 10 men are now popping depression pills, and as a result, the number of man-specific questions about how they’ll affect their sex lives have skyrocketed. On Reddit, guys wonder aloud if medications like Lexapro or Zoloft are to blame for their “whiskey dick,” and on Twitter, they make public announcements regarding their newfound lack of libido, always noting that the medication’s sexual side effects are “weird for a guy.”

But, what’s really happening when these drugs shit all over a depressed person’s sex drive, and what can be done about it? 

Glad you asked, because here’s a mostly-man-oriented-but-also-kinda-unisex guide to everything you’d ever want to know about sex — or the lack thereof — while on antidepressants. 

Why do antidepressants have so many sexual side effects?

When an antidepressant alters the levels of neurotransmitters in your brain, that change doesn’t just affect your mood. Rather, as sexual dysfunction specialist David Goldmeier explains, the effect is more universal. Any tissue or process modulated by that neurotransmitter can be affected, and sometimes, the result is less than desirable. 

Take serotonin, for example. Many antidepressants relieve feelings of sadness and anxiety by increasing the amount of serotonin floating around in your brain, but turning the serotonin up just so happens to turn other horny molecules like dopamine and testosterone down, leaving you happier — we hope — but less DTF. 

Other experts like psychiatrist David Baldwin believe antidepressants affect the areas of the brain that control reward and pleasure. As he explained to Metro, more cerebral side effects like a reduction in sexual interest may occur due to a dampening of the brain’s reward circuits, while more physical problems like erectile dysfunction, delayed orgasm or genital numbness may be a result of how the neurotransmitters affected by the drug function in peripheral nerves. 

Okay, but what’s all that going to do to my luscious body? 

According to the Mayo Clinic, the most common sexual side effects for both men and women are a change in the desire for sex, difficulty achieving orgasm and problems with arousal, comfort and satisfaction. Erectile dysfunction is also common in men, as is delayed ejaculation. 

Some people also experience numbness in their genitals or pain during sex and masturbation that wasn’t there before. Decreased vaginal lubrication, pleasureless or weak orgasms and difficulty getting and staying aroused are frequent side effects as well. Ask around, and you’ll find that, on antidepressants, a lot of people just aren’t as interested in sex as they used to be, can jack off forever without cumming and generally just feel sort of “blah” about things that used to thrill them. In fact, antidepressants are so good at extinguishing libido that they’re even used for chemical castration. 

The severity of these side effects varies person-to-person. In some cases, they ease up after your body adjusts to the medication. In others, they hang around or get progressively worse. Either way, none of them are particularly thrilling to deal with when you’re already depressed or working through other mental health issues. 

Wait, aren’t those just side effects of depression itself?

Bingo — that’s why it’s important to compare the side effects you think you’re experiencing to what your normal, baseline sexual functioning was like when you were depressed and unmedicated. If things haven’t really changed since you’ve started taking the drug, it’s probably the depression. If you’ve suddenly noticed a change in your sexual functioning or interests, it’s probably the drug (though, you might still be depressed, too). 

How many people does that happen to?

The prevalence of sexual side effects varies wildly depending on the medication and who you’re talking to, but according to an old, 2010 review of the literature, anywhere between 40 to 59 percent of people taking antidepressants will experience some form of sexual dysfunction during the course of their treatment. Both men and women experience sexual side effects, but men tend to report slightly higher rates of them — the same review found that 62 percent of men and 60 percent of women had something less-than-desirable going on downstairs during the course of their treatment. 

Though to be frank, the exact prevalence of these side effects doesn’t really matter for you and your weekend — the important takeaway here is that if you’re one of the many people experiencing a sexual side effect on an antidepressant, you’re far from alone. 

But I’m on antidepressants and not experiencing sexual side effects at all! 

Cue the applause! That’s also normal — plenty of people retain perfectly regular sexual functioning when they’re on antidepressants. Some people even say their sex life improves along with their mood and energy levels, even when they’re taking one of the more sexually bungling drugs. 

Which ones are the most sexually bungling? 

Hands down, selective serotonin reuptake inhibitors (SSRIs). That’s because they increase the amount of serotonin floating around in your brain, an effect that works wonders for your mood and anxiety levels but tends to dampen your sex drive by, again, lowering levels of other horny molecules like dopamine and testosterone. 

The SSRIs with the highest rate of sexual side effects are Zoloft, Prozac, Paxil, Celexa and Lexapro — around 40 to 65 percent of people will experience some form of sexual dysfunction when they’re taking one of these bad boys (though some studies estimate that number is much higher). Delayed ejaculation is the most common sexual side effect of SSRIs, and Celexa and Paxil seem to be locked in an eternal bear hug for which one causes it the most (this particular study crowns Paxil the Champion Cum Killer, so take that how you will). 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) aren’t exactly aphrodisiac material, either. Effexor, Pristiq and Cymbalta all fall into this category of antidepressant, and have only slightly lower rates of sexual side effects than SSRIs. 

But while SSRIs and SNRIs are the two most sexually disastrous flavors of antidepressant, tricyclic and tetracyclic drugs, as well as monoamine oxidase inhibitors (MAOIs), don’t score too highly on the “Good for Your Sex Life” scale, either — 30 to 40 percent of users have sexual side effects on these, as well. 

What’s it like to live with these side effects?

Jenni Skyler is a sex and relationship therapist and founder of the Intimacy Institute in Boulder, Colorado. She says her clients have a range of reactions to living with sexual side effects on antidepressants. Some say they like being on antidepressants because in some cases, it can put their sex drive more on pace with their partner’s. This makes them feel less sexually frustrated and like they’re not always being rejected, which has a positive effect on their well-being. 

On the opposite end of the spectrum, she says, the loss of baseline sexual functioning can make people feel “inadequate.” They don’t feel motivated to fuck, so their partner loses the motivation to try to fuck them, and they exist in a sort of “sexless dynamic” in which they’re “compromised erotically.” “For the most part,” she explains, “people really don’t like the side effects. But for those who’ve been on SSRIs and other antidepressants for a long time, they’re kind of used to it.” 

Reddit is full of sex-on-antidepressants accounts, but if you’re looking for more stories of what these side effects feel like and how they affect people’s sex life, 10 out of 10 dentists recommend you check out this thread

Ugh. Are there any antidepressants that won’t cause my penis to wilt?

Kind of. Wellbutrin and Serzone — which belong to an entirely different class of drugs than SSRIs or any of the other types listed above — have significantly lower rates of sexual side effects. But because the world is a bastard and you cannot win, even those drugs have been shown to cause some form of sexual dysfunction in some people (premature ejaculation, mostly). 

In addition to sounding like Elon Musk and Grimes’ next mutant spawn, Remeron, Viibryd and Trintellix have also been shown to cause lower rates of sexual dysfunction as well. Though, “low” is a relative term here — Remeron, for example, causes sexual side effects in 40 percent of its takers.

Wait, isn’t the Wellbutrin the “horny” one? I heard some people get more sexual when they take it. 

That’s actually a pretty accurate moniker. Wellbutrin is a norepinephrine-dopamine reuptake inhibitor (NDRI) that works in a completely different way than SSRIs like Zoloft, Prozac and Paxil, which means that for some people, it won’t make them anywhere near as sexually blah as other medications will. In fact, studies have reported that between 58 to 73 percent of men experience less orgasmic dysfunction, sexual arousal disorder and sexual desire disorder on Wellbutrin as compared to SSRIs. 

And you heard right: some people do get hornier — certain studies have even listed increased libido and desire as side effects of Wellbutrin. On Reddit, there’s also a whole thread of people who mutually agree that it make them so horny they’d “fuck a couch,” so let’s just say calling it the “horny one” isn’t too far off from what it is. 

But you’re dreaming if you think it doesn’t come with its own sexual side effects — as mentioned above, some people report that it makes them so excited and responsive that they start premature ejaculating

Speaking of premature ejaculation, don’t some antidepressants actually help with it?

Yeah, actually. For all their orgasm-squashing side effects, SSRIs can actually help people who have the opposite problem: getting off too quickly. “The biggest impact of SSRIs is delayed orgasm,” says Skyler. “People actually last longer when they’re on them. Now, if you don’t have a problem with premature ejaculation, you’re sort of like, ‘I want to have an orgasm. This is very frustrating.’ But for men who have premature ejaculation, a small dose of an SSRI can help.” 

But while Goldmeier says he treats plenty of premature ejaculators with SSRIs, Skyler says she “doesn’t love that approach” and doesn’t really use it in her practice. People are already overmedicated, she says, and premature ejaculation can be easily treated with other non-pharmaceutical approaches that come with less side effects and better results. 

What should I do if I’m experiencing one of these sexual side effects?

What course of action you take depends on what side effect(s) you’re having and which medication you’re on, but according to the Mayo Clinic, anyone who’s experiencing sexual dysfunction from their antidepressant should probably try this: 

  1. Wait a few weeks to see if your body re-equilibrates. In some cases, sexual side effects go away after your body gets used to the medication. If you feel alright otherwise, you might want to wait it out. 
  2. Adjust your dosage. Reducing the dosage of an antidepressant can bring your sex drive, erection and ability to cum back online (partially, at least). Talk to your doctor before you try this, though. 
  3. Try a different medication. Everyone reacts to medications differently, so the one you’re on just might not be for you. Ask your doctor about switching to something like Wellbutrin or Serzone that has a more mild sexual side effect profile. 

Goldmeier also recommends taking a short “medication holiday” under the supervision of your doctor. Skipping a dose once a week and having sex or masturbating on that day can help because there will be less medication in your bloodstream when you’re trying to F. If that’s not an option, having sex or masturbating before you take your pills can also help

What about Viagra or Cialis? Would those help?

If you’re having problems getting hard, yes. But it won’t make you hornier, and it definitely won’t make it any easier for you to cum. People tend to think Viagra is a cure-all for penis problems, but the only thing it really does is make it easier for you to get and stay hard when you’re already aroused. Goldmeier says Viagra and Cialis are actually important actors in the world of “responsive desire,” a concept developed by Come As You Are author Emily Nagoski that says arousal and desire will follow if you start with physical stimulation first. The spontaneous erection these drugs can bring can initiate that process and make it easier for desire to kick in later. 

In some cases, these drugs are also given to women (or people with vaginas) who are having antidepressant-related sexual side effects. That’s because the clitoris and vagina both contain erectile tissue, which is what Viagra and Cialis works on. 

What about just quitting cold-turkey? Should I stop taking my meds if I’m having sexual side effects?

First of all, never stop taking your medication without consulting your doctor first. That can cause your depression to worsen significantly and potentially increase suicidality

Assuming you’ve talked to your doctor about it though, it’s really the dealer’s choice. Like Skyler mentioned earlier, some people don’t mind the side effects or are actually happier living with dampened libidos. If those people are doing well on their medication otherwise — and they’re okay with having a sex life that looks different than it used to — then there’s really no real reason to stop. 

Other people feel like empty husks of themselves if they can’t be sexual in the ways they want. Some even get more depressed when that part of them goes offline. In that case, there’s no real reason to stay on that particular medication — if it’s making things worse for you, then by all means, talk to your doctor about stopping, lowering your dosage or switching to a different drug. It’s pretty common for that to happen — one 2016 review found that a little over 40 percent of men and 15 percent of women discontinue their antidepressant due to the sexual dysfunction it causes. 

However, be aware that stopping your medication — even under the guidance of your doctor — can cause your depression to worsen, if only temporarily. 

Will the side effects go away if I stop or switch?

Per Goldmeier: “Yes, in almost all cases.”

Rarely, though, side effects can still linger. This is especially common in men taking SSRIs, and the phenomenon even has its own name: Post-SSRI Syndrome. People dealing with this particular problem often deal with low desire, lack of arousal, numbness, weak orgasm, erectile dysfunction and, if they have a vagina, painful intercourse or difficulty lubricating. This happens in 5 to 15 percent of SSRI users and can last for months to years after a person stops taking a drug. 

Is this deflated boner going to affect my relationship?

Only if you let it. The first step to avoiding any adverse effects on your relationship is good communication. Let your partner know what drug you’re on and what side effects you’re experiencing so they don’t take it personally if you seem uninterested in sex, aren’t getting hard for them or can’t come when you fool around. Most of the time, says Skyler, people’s partner’s are pretty accommodating — if they know you’re depressed and that you need to be on medication, they’re more likely to be supportive of your mental health efforts than pissy that you’re not ejaculating as brilliantly as you used to. 

But that doesn’t mean — in any way — that your sex life has to end. 

I’m listening. How do I still have a sex life with all these side effects?

If you’re one of the many people whose sexual functioning isn’t the same as it was before they started taking antidepressants, it’s important to know that you can still have a perfectly full and satisfying sex life in your current state. As Skyler explains, it just comes down finding pleasure within the limitations of your new antidepressant body. “It’s a new normal,” she says. “We have to navigate what our bodies are capable of.”

For most people dealing with drug-induced sexual inertia, that “new normal” might look very different than it used to, and it definitely won’t look anything like what Skyler calls a “successful sex life according to Hollywood.” Instead, it’ll probably involve sex that’s more explorative and less orgasm-centered, different forms of sex you hadn’t considered before — BSDM or role-play, for example — and a departure from the “cum shooting out of a hard rod” style of boning that we’ve been programmed to prefer. 

Even if you can’t fuck like a Cialis-encrusted cock android for hours anymore, you can most definitely make out, spank, use sex toys, talk dirty, employ your hands, lick things, suck things, send nudes, dress up — deep breath — cuddle, caress, massage, flog, blindfold, tie up, watch porn — still going, here — read erotica, write erotica, sext and do whatever the shit feels good to you. Just because it’s not penetrative sex that ends in mutual orgasm, grunting and a weird amount of scalp sweat doesn’t mean it’s not sex. 

And if I still can’t summon the libido to do any of those things?

Goldmeier recommends seeing a therapist to talk about how you can adapt your relationship, getting your hormone levels checked or reassessing your depression to see how it’s affecting your life regardless of medication. 

Thanks for all the titillating word-vomit, but why don’t they just make an antidepressant that doesn’t put your dick to sleep?

They do. It’s called ketamine

In controlled, therapeutic amounts and under the supervision of a doctor, ketamine can be an incredibly effective treatment for severe depression and anxiety with few of the sexual side effects antidepressants bring. Cognitive behavioral therapy can also be as effective (or more so) than taking drugs (and the only side effect is listening to your therapist blab on about their kids for 20 minutes of your appointment). In fact, according to Goldmeier, mild-to-moderate depression is best treated with talk therapy, mindfulness training and physical exercise, none of which should impact your dick (or vagina, or butt, or neck, or aura, and so on). 

Beyond that, Skyler says there are some more natural approaches you can take. Taking regular GABA, Vitamin D and CoQ10 supplements has been shown to positively impact mood, as has eating more probiotics and starting up an anti-inflammatory diet. Bizarrely, saffron has shown some limited promise in alleviating sexual dysfunction, too (though it doesn’t appear to improve your ability to orgasm if you’re having trouble with that). 

Though, if you’re severely depressed, health food store stuff probably isn’t going to cut it, and you should talk to your doctor about starting a medication that’ll help you function without, er, causing you to lose function. 

What if I just don’t feel like fucking myself or anyone else for as long as I’m on this drug, or possibly ever again?

Be my guest. No one said you had to want to masturbate or have sex — it’s perfectly fine and normal to not want neither of those things, antidepressant or not. 

Any final nuggets of wisdom?

Goldmeier’s biggest piece of advice is to talk to your doctor if you’re having any of these side effects. There are so many options when it comes to dealing with sexual dysfunction on antidepressants that there’s really no reason to suffer on a drug that’s not working for you.