When you think ‘sexual dysfunction’, you probably imagine emergency room flyers for Viagra. The words ‘low sex drive’ might conjure up a dead-end marriage, two snotty children and a fold-out couch in the garage for dad. What you probably aren’t thinking of is your peers and pals on antidepressants, many of whom have to sacrifice their sexual functionality in order to medicate their illness.
Libido and sexual-dysfunction related side effects are among the most taxing for people on antidepressants. While the link between medicating depression and impacted sex drive is not necessarily obvious, sexual dysfunction is an incredibly common problem for patients on antidepressants. A 2015 meta-analysis from Medsafe NZ relayed that up to 80% of patients reported sexual dysfunction which emerged while on depression medication.
Lisa* is a student who has been taking antidepressants for just over a year. She described her medications, Amitriptyline and Nortriptyline, as ‘hugely affecting’ her sex drive: “I felt awful not having a sex drive while on the antidepressants. Sometimes it affected my partner, too. He didn’t feel like I was attracted to him anymore because I couldn’t orgasm. I didn’t even want sex. It was an awful, rough time.” Lisa struggled significantly with the sexual side effects of her medications, and at one point took a break from them to see if her libido would improve: “I actually stopped taking my antidepressants for about three months after a while to see if I felt better off them; to see if my sex drive improved, as I was getting sick of it. There was a massive difference; I felt like my old self again.”
Similarly to Lisa, Josh* sporadically skips doses of his medication, Escitalopram, specifically to have sex: “If my wife and I have a weekend without the two-year-old, I often end up stopping for a week because it’s nice to have the feeling and timing better; but then I start to feel sick, and have to go back on them.” Although Josh’s prescribing doctor told him nothing about the possibility of libido related side effects to his medication, Josh realised early on that his sex drive had changed, and brought up the topic in his six-month review. “I would’ve liked to know this was a side effect,” explained Josh; had he known, he would have wanted to explore options other than antidepressants early on.
Amy* received no information from her prescribing doctors either, leaving her feeling isolated, especially considering the stigma of sex. “I lied to my partner about how I felt when it came to sexual activity,” Amy explained. “There is such a stress on feeling good during sex, and enjoying everything, when there is sometimes barriers to this. I wanted badly to feel happy, but it cost me my ability to enjoy sex.” Amy never discussed her decreased sex drive with anyone while on her medication; she was embarrassed to bring it up with friends, and worried nothing would change even if she mentioned it to her doctor. Amy only started taking Citalopram last year, but has recently come completely off the medication, describing that she “just wanted to feel normal again.”
Not all patients find antidepressants reduce their sex drive; Meg* and Charlie* both found the opposite to be true. “Fluoxetine makes me SUPER HORNY,” explained Charlie, while Meg described that her medication “didn’t affect my sex drive… I was a horndog, but I was dry as the Sahara -- which could potentially just speak for the quality of men in Dunedin.”
Max started taking Fluoxetine at 13, so the majority of their sexual experiences have occurred while on the medication. They don’t mind having sex, but described it as similar to “eating when I’m not hungry”. Max’s sex drive has entirely disappeared since starting Fluoxetine, and since they started medication younger than many patients, they have struggled to understand attraction or experience sex for pleasure, leading to an atypical relationship to the concept of sex with a partner. “I never really knew what “normal” attraction was. Not feeling sexual, and in a desperate mindset to feel loved and held, I went out of my way to pretend to be a sexual being,” Max explained. They dislike the side effects of Fluoxetine so much that they regularly attempt to come off the medication; just this month they have tried skipping doses three times, in spite of the fact that this makes Max feel like they are going “off the rails”.
There are a significant amount of unknowns regarding the processes that cause depression or why antidepressants work. According to the UK National Health Services, antidepressants are thought to work by increasing neurotransmitters: chemicals in the brain, such as serotonin and noradrenaline, which are known to improve mood and emotion. Increasing neurotransmitters can interrupt pain signals, which is perhaps why some antidepressants can decrease libido. Moreover, there are many types of antidepressants, each with different effects. Lisa’s Amitriptyline and Nortriptyline are tricyclic drugs which alter the chemicals around the brain’s nerve cells, while Max and Charlie’s Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI), which increases Serotonin. As a result, is difficult to attribute just one cause to the abundance of sexual side effects that indiviudal patients, on a variety of medications, may experience. However, the answers with SSRIs may be known: SSRIs, some of the most common antidepressants, can influence libido and sex drive by dampening dopamine, a ‘feel-good’ monoamine neurotransmitter produced (in part) in response to sexual stimulation, to encourage us to keep at it ’till the job is done.
Of the eight people we spoke to, only one was forewarned by their doctor about the possible sexual side effects of antidepressants. Almost all of them described a definite stigma surrounding decreased libido, mentioning that they felt embarrassed, ashamed or isolated by their experience. To patients who find themselves experiencing sexual dysfunction on antidepressants, Healthline recommends either discussing the situation with a medical professional or giving your body a chance to adjust to an altered hormone balance. For Lauren*, whose doctor forewarned her of antidepressants’ sexual side effects, Escitalopram halved her sex drive until month three; since then, she has regained her full libido and is glad she persevered with the medication, saying “the way they were helping my mental health outweighed the impact they were having on my libido.” While antidepressants can certainly cause decreased or influenced libido, they do boast many benefits - including keeping some patients, like Max, on the rails.
*Names changed.