Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are widely used in the treatment of depression and anxiety disorders. While they can be highly effective in managing these conditions, they are also known to have side effects, one of which is the potential to affect sexual desire or libido. Let's explore the ways in which antidepressants can impact libido and the underlying mechanisms involved.
Decreased Libido
One of the most common sexual side effects of antidepressants is a decrease in sexual desire or libido. In fact, a 2010 study found that nearly 25–75% of people taking an SSRI, and 58–70% of people taking an SNRI reported having some type of sexual side effect.This can manifest as a reduced interest in sexual activity or a lack of sexual thoughts. The exact cause of this decrease is not fully understood, but it is believed to be related to the way SSRIs increase serotonin levels in the brain. SSRIs work by blocking the reuptake of serotonin in the brain, leading to higher levels of this neurotransmitter. While this can help alleviate symptoms of depression and anxiety, it can also interfere with sexual desire and function. Antidepressants also have differing effects on sexual function, presumably due to variations in their pharmacological properties. SSRIs may exert untoward effects on sexual functioning both through central (neurotransmitter) and peripheral (neurotransmitter and vascular) effects. The central effects involve the impact of these drugs on neurotransmitter levels in the brain, while the peripheral effects relate to their impact on neurotransmitter levels in the body and the vascular system. In men, increased serotonin levels can lead to decreased libido and inhibited ejaculation. In women, high levels of serotonin can cause a decrease in sexual desire and difficulty reaching orgasm.
According to another study, 72% of women taking antidepressants report problems with sexual desire, with 83% having issues with sexual arousal and 42% experiencing difficulty having an orgasm.
Vaginal Dryness and Anorgasmia
Vaginal dryness is a common side effect of SSRIs in women. This condition can make sexual intercourse uncomfortable and less enjoyable. SSRIs can cause this by inhibiting the production of nitric oxide, which is the main mediator of both the male and female sexual arousal response. This leads to complaints of vaginal dryness and diminished genital sensation. Some antidepressants, such as SSRIs, can reduce the amount of lubrication your body produces. Anorgasmia, or the regular difficulty reaching orgasm after ample sexual stimulation, is another side effect of SSRIs in women. This condition can be distressing and can lead to decreased sexual satisfaction. SSRIs can cause anorgasmia by interfering with the neural pathways in the female sexual response cycle. This interference is due to the increased serotonin levels caused by SSRIs, which can inhibit these neural pathways.
Solutions
Luckily, there are several ways to improve libido while using SSRIs. By working with your healthcare provider, you can try adjusting your dosage, changing the timing of the medication in the day, switching medications, and trying a new medication to help counter effects.
References
Baldwin, D. S., & Foong, T. (2013). Antidepressant drugs and sexual dysfunction. British Journal of Psychiatry, 202(6), 396–397. https://doi.org/10.1192/bjp.bp.112.110650
Cherney, K. (2014, March 14). Managing Antidepressant Sexual Side Effects. Healthline. https://www.healthline.com/health/erectile-dysfunction/antidepressant-sexual-side-effects
Fink, J. (2021, February 9). Serotonin and Sexual Desire in Women. Healthgrades. https://www.healthgrades.com/right-care/sexual-health/serotonin-and-sexual-desire-in-women
Reisman, Y. (2020). Post-SSRI sexual dysfunction. BMJ, m754. https://doi.org/10.1136/bmj.m754
Schimelpfening, N. (2023, April 6). 6 Tips For Coping With Sexual Side-Effects From Antidepressants. Verywell Mind. https://www.verywellmind.com/how-to-reduce-sexual-side-effects-1067490
The impact of SSRI medication on sexual functioning. (n.d.). Bristol CBT. Retrieved February 19, 2024, from https://www.bristolcbt.co.uk/publications/psychosexual-articles/the-impact-of-ssri-medication-on-sexual-functioning/
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