SSRI Users Often Have To Choose Between Sex And Better Mental Health

The first time my mental health really crumbled was when I was 15. I lost my appetite along with any interest in socializing and couldn’t get through a single school day without crying.

My dad (who is a psychologist) refused to consider medication despite my pleas and instead helped me find a therapist. For years, I was able to get by with a combination of therapy and other tools I learned that helped me avoid that permanent sinking feeling in my stomach that sucks away all my perspective, leaving me to dwell on future fears and insecurities and lose any ability to stay present.

But finally in spring 2021, after two weeks of feeling queasy and bouts of sobbing for no obvious reason, I finally asked my therapist about medication. She connected me with a psychiatrist, who agreed that I could benefit from an SSRI (the widely used category of antidepressants known as selective serotonin reuptake inhibitors).

SSRIs are prescribed to treat a variety of disorders including major depressive disorder, anxiety disorders, and many other psychological conditions. They’re the most commonly prescribed antidepressants and include sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac), and citalopram (Celexa), to name a few. One article from 2020 estimated that 37 million people take SSRIs in the US every year; 1 in 8 people reported taking SSRIs at some point in the past 10 years.

My psychiatrist mentioned the potential side effects, including sexual dysfunction, but I was desperate to feel better and to be honest, didn’t really believe that anything could take away my sexual desire. I was wrong.

Up to 80% of people taking SSRIs experience side effects like issues with arousal, libido, orgasm, and ejaculation. The solutions for these sexual side effects are often limited and have considerable drawbacks. Many people are prescribed these medicines by their general practitioners, who may not tell them about the potential for sexual side effects. Others start taking the medication before they are sexually active or too young to really think about the impact on relationships and quality of life in general.

We asked people on SSRIs to share their stories of dealing with sexual side effects and what — if any — solutions they’ve found for coping with them. (In some cases, people have asked that we use their first names only to protect their privacy.)

Some people aren’t even sure what their pre-SSRI libido was like

Kelsey, 24, and Sara, 26, both started taking SSRIs before they were sexually active, making their struggles with the side effects all the more confusing since they had no pre-drug comparison to make.

Kelsey was diagnosed with depression in high school and immediately put on an SSRI, which led to the sexual side effects she still deals with to this day. For years she feigned interest in and satisfaction with sex until she finally began to think something was legitimately wrong. After a thorough internet search, she realized the SSRI could be impacting her libido, but since she’d been medicated from such a young age, she still didn’t know what her “normal” sex drive was supposed to be or what she could do about it. Her doctor never mentioned the possible side effect, likely because she was so young when starting taking it. This year, she finally sought out professional help to address the impact on her sex life.

Sara, who is now a nurse, had also never had sex when she started taking an SSRI. About six months after starting the drug, she found that her libido became nonexistent, her genitals had minimal sensation, and it was nearly impossible to become sexually aroused.

“It took me a while to figure out what the issue was — it wasn’t unreasonable to think maybe the heterosexual college men I was sleeping with weren’t incredible,” Sara said. “I remember googling asexuality and then being confused because I certainly had sexual desires and was as arousable as any other teen before.”

Some doctors don’t take sexual side effects seriously

Only about 20% of doctors who prescribe SSRIs discuss the potential of sexual side effects of medication with patients, said Jordan Rullo, a clinical health psychologist and certified sex therapist with a private practice in Salt Lake City.

And even that number might be an overestimate, she said.

“Most providers simply don’t have time and even maybe, beyond time, they haven’t had training on this topic. Most med schools do not teach future physicians and medical providers about sexual health,” she said. “You don’t have the training and you don’t have the time and they’re not giving patients a heads up, and that means they can’t make an informed decision.”

Rullo, whose specialty is sexual functioning issues, said that part of the problem is a shortage of psychiatrists, which inhibits many people from getting specialist treatment. Even if you are able to get and can afford an appointment with a psychiatrist, it may still be only a 15-minute consultation before being diagnosed and prescribed an SSRI, leaving no time for discussion of side effects.

Given these limitations, it often falls to primary care doctors to prescribe SSRIs, who are also limited on time to discuss side effects or ask patients about their sexual health.

Many people who do find the courage to broach the topic with their doctors felt that their symptoms were completely minimized.

Sara, the 26-year-old nurse studying to be a nurse practitioner, started bringing up her sexual issues with her providers when she was 21. Each time, she felt like they blew off her concerns or told her that anxiety was the cause of her low libido.

Depression can also affect your sex drive

Though it’s common for people to blame their medication, it’s possible that their sexual function wasn’t great beforehand due to depression itself.

“Decreased sex drive is common [in people with depression],” said Dr. Melissa Shepard, a psychiatrist and assistant professor at Johns Hopkins School of Medicine. “People have more difficulty with their libido, low desire, low arousal, difficulty with orgasm and ejaculation. It doesn’t seem like that would be so connected with your mood state, but it really is.”

About 50% to 70% of people who are depressed have sexual issues like a lack of libido even without taking medication, Rullo said.

Sam, 26, was barely able to function due to depression, let alone muster the energy to have sex. She and her partner struggled with how to navigate their sex life (or lack thereof) and ultimately agreed that an antidepressant would be a good step to improve her quality of life.

However, after starting an SSRI, any sex drive she did have disappeared completely.

“The meds made a considerable and noticeable difference in my depression and anxiety, and I had more energy and was in a better mood so my brain said, ‘Oh, sex would be fun and nice,’ but my body physically just couldn’t get going and having an orgasm was a distant, far-off dream,” she said.

Sexual side effects can impact relationships and quality of life

Sexual function issues on their own can cause anxiety, depression, wreak havoc on relationships, self-esteem, body image, and more, according to Rullo.

Evan, 31, for example, never struggled with his libido until he went on an SSRI. He thought of himself as a sexual person even when his depression was at its worst, but now he feels that the medicine has stolen his desire and ability to enjoy sex. He’s afraid to date with no sex drive knowing that most people he encounters place significant value on a physical relationship.

“I know I need antidepressants for my mental health, but the cost is so steep it almost doesn’t feel worth it,” Evan said. “I don’t feel like myself any more. I’ve talked to my doctor, and his general consensus is that the benefits of Zoloft outweigh the negative side effects in my case. I’m not sure I agree.”

I have recently found myself in a similar boat. My mental health has improved since starting an SSRI just over one year ago, but I’ve become more and more frustrated by my lack of desire.

My current partner is the first person I’ve dated while on an SSRI, and it makes me sad that he’s never known me as the sexual person I was before. I also just miss that side of me.

Now, I feel trapped in a lose-lose situation — this medication is improving my quality of life and ability to maintain a healthy relationship, but it’s also hindering my sexuality enough to take a toll on my partnership. I feel like I have to choose between reliable sanity and a satisfying sex life.

Some people try changing medication

There are some steps you can take to help the problem. You can try switching to a different SSRI or a non-SSRI antidepressant drug like bupropion (Wellbutrin), or you can try adding the antianxiety drug buspirone (Buspar) to your SSRI treatment, which may help improve sexual issues.

One 2010 study noted that 73% of SSRI-treated patients had sexual side effects compared with just 14% of people taking bupropion, who even had some improvements in sexual function, including a stronger libido and ability to orgasm.

Shepard added that decreasing your dose or adding something like Viagra or Cialis to the medication regimen might make sense for some people.

What you shouldn’t do is just stop taking medication without your doctor’s supervision, as antidepressants can be lifesaving drugs.

Shepard said that sexual side effects are actually the most common reason that people stop their antidepressants without consulting their doctor, which is why she makes all of her patients aware that it could potentially be a problem and that she’s comfortable talking about it.

Sara tried switching SSRIs and then adding buspirone, but it didn’t revive her libido.

“Nothing really helped,” she said. She finally decided to stop her medication after six years and safely tapered herself off over the following two to three weeks.

“It’s entirely possible I’ll need medication again one day, and I’m so open to that — at the end of the day, Lexapro saved my life — but it would definitely need to be a different agent,” Sara said. “The SSRI made sense when I started, but the toll it took on my relationships, former and current, could no longer be justified.”

Shepard said she knows that it can be discouraging, but also believes that there’s almost always something that can be done to help if you’re willing to give it some time. Rullo strongly suggested seeing a sex therapist like herself if possible.

Why you should consider seeing a sex therapist

Rullo’s suggestions vary from patient to patient, but she recommends scheduling sex around times when you have the least amount of medication in your system (depending on the half life of the drug you’re on), using a vibrator for more intense stimulation if there’s less general sensation, moderately intense exercise (ideally shortly before sex) at least three times per week, or just creating more realistic expectations and reframing your perspective or redefining how you see sexual pleasure.

“What makes a sex therapist special is that we can treat the anxiety, but also there are likely other very sexual specific factors like sexual expectations, being able to communicate sexual health with your partner, and other sex-specific things that typically are a part of these multiple factors that are causing all of it,” Rullo said.

When working through her own psychological issues in therapy and going to couples therapy with her partner of five years was not helping Kelsey resolve her sexual dysfunction, her gynecologist referred her to a sexual specialist. The specialist did an exam and numerous tests but ultimately could not find anything physically wrong with her.

“She said switching to a different depression medication was an option, but I would have to be willing to take the risk that the switch might not be as impactful as my Zoloft is.”

Kelsey utlimately decided to choose her mental health over her sex life. “Here I am today, still with little libido, minimal interest, and have never orgasmed during sex with my partner. I have made the choice to not be depressed or anxious instead of sexually satisfied.”

Despite the fact that there is more research on SSRIs than any other class of antidepressants, Shepard said there are still a bunch of different theories on the sexual side effects with no proven cause or solution.

“Obviously it’s a huge issue with these medicines,” she said. “About 50% of people that take them, from all the research studies taken together, probably experience some sort of sexual dysfunction. So it’s something we want to work to try and eliminate.”

Until then, I’m personally depending on advice from the many, many others who are trying to balance the competing desires for mental wellness and sexual functionality, which then causes even more emotional distress.

Here are some of the tips from our readers that resonated with me:

“Be vocal with your doctor about your concerns and let them evaluate what your body needs.”“Advocate for yourself. Make sure that the doctor takes it seriously that your sexual health is an important part of mental and physical health, and this isn’t an issue that you should have to just endure.”“Every body is so different. Some might have sexual side effects from the mental disorder, some might have them from medication, some might have post-SSRI side effects for one month and someone else for three years. These experiences will not necessarily be yours! Keep paying attention to your own body and pursue whatever action or lack thereof is best for you.”“Be kind to yourself. Nothing is ‘wrong’ with you. I don’t have a ‘happy’ ending with this story in terms of finding the missing puzzle piece in my sexual life. But I am happy in the rest of my life, which was not the case before I started my SSRI.”

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