Antidepressants: Which cause the fewest sexual side effects?

adminSeptember 26, 2024

I’m worried about the sexual side effects from antidepressants. What can be done to prevent or lessen such side effects?

Answer From Nick Allen, M.D.

Sexual side effects are common with antidepressants, so your concern is understandable. Effects on sexual function can include:

A change in your desire for sex.
Trouble with lubrication or erection.
Problems with sexual comfort and satisfaction.
Not being able to reach an orgasm.

All antidepressant medicines have the potential to cause sexual side effects. Medicines that affect serotonin carry the highest risk. How severe sexual side effects are depends on the person and the specific type and dose of antidepressant.

For some people, sexual side effects are minor or may ease up as their bodies adjust to the medicine. For others, sexual side effects continue to be a problem.

Antidepressants with the lowest rate of sexual side effects include:

Atypical antidepressants bupropion (Wellbutrin SR, Wellbutrin XL, others), mirtazapine (Remeron), vilazodone (Viibryd) and vortioxetine (Trintellix).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) desvenlafaxine (Pristiq), duloxetine (Cymbalta, Drizalma Sprinkle) and levomilnacipran (Fetzima).
Monoamine oxidase inhibitor (MAOI) selegiline (Emsam), an MAOI that you stick on your skin as a patch.

Antidepressants most likely to cause sexual side effects include:

Selective serotonin reuptake inhibitors (SSRIs) citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft). Paroxetine has the highest risk of sexual side effects.
Serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR).
Tricyclic and tetracyclic antidepressants amitriptyline, nortriptyline (Pamelor) and clomipramine (Anafranil). There are fewer studies of sexual side effects in this class of antidepressants, but clomipramine carries the highest risk of sexual side effects.
Monoamine oxidase inhibitors (MAOIs) isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). Phenelzine may have a greater risk of sexual side effects than tranylcypromine.

If you’re taking an antidepressant that causes sexual side effects, your doctor or other healthcare professional may recommend one or more of these options:

Wait a few weeks to see if sexual side effects get better.
Adjust the dose of your antidepressant to lower the risk of sexual side effects. Always talk with your healthcare professional before changing your dose.
Switch to another antidepressant that may be less likely to cause sexual side effects.
Add a second antidepressant or another type of medicine to counter sexual side effects. For example, adding the antidepressant bupropion may ease sexual side effects caused by another antidepressant.
Add a medicine to improve sexual function, such as sildenafil (Viagra), tadalafil (Cialis), vardenafil and avanafil (Stendra). These medicines are approved by the U.S. Food and Drug Administration (FDA) to treat sexual problems in men only. Limited research suggests that sildenafil may improve sexual problems caused by antidepressants in some women. More information is needed to know that it works and is safe in women.

The FDA has approved new medicines flibanserin (Addyi) and bremelanotide (Vyleesi) for women with certain kinds of sexual problems. But it’s not clear if these are effective and safe in combination with antidepressants. Talk with your treatment team about these options.

Stopping medicine because of sexual side effects is a common problem, and for most people this means depression returns. Work with your healthcare professional to find an antidepressant or combination of medicines that will lessen your sexual side effects and keep your depression under control.

If you’re pregnant or trying to become pregnant, tell your healthcare professional, as this may change the type of antidepressant that’s right for you.

Be patient. Everyone reacts differently to antidepressants, so it may take some trial and error to identify what works best for you.

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