Let’s Talk about Sex

What You Should Know about Sexual Issues Caused by SSRIs

SSRIs, or selective serotonin reuptake inhibitors, are a group of medications often prescribed for depression and anxiety disorders. Common SSRIs include Lexapro, Zoloft, Prozac, and Paxil. Although these medications are called “selective,” they can actually impact many systems throughout the body, leading to unwanted side effects. Some of these side effects are sexual issues.

It’s important to talk openly about sexual side effects. A 2016 review of literature found that 58% of people taking an SSRI reported sexual problems when asked about it directly by a physician; however, only 14% of people brought it up on their own.¹ This means if we don’t start normalizing this conversation, we might miss out on essential info.

So, let’s talk about it. Here’s what you should know about sexual issues caused by SSRIs.

1. It’s common.

It’s hard to estimate exactly how common sexual side effects of SSRIs are for many reasons. Mental health issues themselves can cause sexual dysfunction, so sometimes it is hard to dissect what is caused by the illness and what is caused by the medication. Sexual behavior can also be influenced by many social and cultural influences, which can also impact reporting, and, as mentioned above, sexual side effects are generally prone to underreporting. Lastly, many of the studies on this topic have had some weaknesses.

For these reasons, the estimates for the occurrence of SSRI-related sexual side effects vary from about 30% all the way to almost 80%. The current best estimate is that about half of the people who take SSRIs experience some kind of sexual side effect.^2,3

Regardless of whether the actual number is the lowest estimate or highest estimate, it is clear that this is a common side effect. So common, in fact, that some doctors even harness these side effects to help men experiencing premature ejaculation.

2. It comes in many forms.

SSRIs can cause dysfunction at pretty much every stage of a sexual encounter. Some people experience a lower sex drive or experience difficulty being sexually aroused, including getting an erection. Others have difficulty maintaining an erection or have decreased genital sensitivity (what some people have called “genital numbness”). SSRIs can also impact orgasms, either making it more difficult to achieve orgasm or creating a pleasureless or even painful orgasm.

3. It may last in rare cases.

Some people experience sexual issues even after they stop using their SSRI. This is called post-SSRI sexual dysfunction (PSSD). PSSD has been reported in case studies and shown to happen in larger studies.

Nevertheless, it is not well researched. There is still so much that needs to be learned about this condition. We do not know how often it occurs, what (if anything) puts someone at increased risk of getting it, or what treatments might help it. All we know is that it exists (and is not just sexual symptoms related to ongoing depression) and that it seems like a very small proportion of people who take SSRIs experience it.^4,5

4. It needs to be talked about.

If your doctor does not directly ask you about sexual symptoms – both related to your illness and your medication – here is, not only your permission, but your encouragement to bring it up!

It’s important to bring up because there may be different treatment options that may allow you to still enjoy sex. Also, depending on how long you have been symptom-free and taking your antidepressant, it may be a good time to slowly taper off of the medication. If your doctor is unaware of the side effects you are experiencing, they may be less likely to suggest or understand the importance of coming off of the medication.

It is also important for us to collectively talk about this issue because more and more young people are taking SSRIs. It is not uncommon for a person who started taking the medication in childhood to become a young adult who assumes they are “just not that into sex” without realizing it may be the impact of medication.

Just like every medical intervention, the decision to take SSRIs comes down to an individual weighing risks and benefits, and sex should be a part of that equation.

Facts:

1. Jing, E. and Straw-Wilson, K. Sexual dysfunction in selective serotonin inhibitors (SSRIs) and potential solutions: A narrative literature review. Ment Health Clin. 2016. 6(4):191.
2. Balon, R. SSRI-Associated Sexual Dysfunction. The American Journal of Psychiatry. 2006. 163(9):1504.
3. Montejo, A., et al. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. J Clin Med. 2019. 8(10):1640.
4. Peleg, L.C., et al. Post-SSRI Sexual Dysfunction (PSSD): Biological Plausibility, Symptoms, Diagnosis, and Presumed Risk Factors. Sex Med Rev. 2022. 10(1):91.
5. Ben-Sheetrit, J., et al. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry. 2023. 22(1):15.