Chances are, you or someone you know takes antidepressants to treat conditions such as anxiety and depression.
2018 saw over 70,000,000 antidepressant prescriptions dispensed and the Mental Health Foundation describes depression as being the ‘predominant mental health problem worldwide’.
It’s common knowledge that most medications come with a plethora of unwanted side effects, but few acknowledge that some of the most commonly prescribed antidepressants include side effects that can get in the way of your sex life.
The majority of antidepressants prescribed for first-time users are called SSRIs (selective serotonin reuptake inhibitors), which include household name drugs like Citalopram, Fluoxetine and Sertraline. SSRI side effects include low sex drive and difficulty achieving orgasm in both men and women, as well as difficulty obtaining or maintaining an erection in men and reduced natural lubrication for women.
Professor of Psychiatry David Baldwin tells Metro.co.uk: ‘Around 45% of patients will describe either a worsening of an existing sexual difficulty or the development of a new difficulty in the early stages of antidepressant treatment.
‘A reduction in sexual interest may be the result of a central effect of antidepressants on centres relating to reward and pleasure, whereas problems such as delayed ejaculation or difficulties in achieving orgasm probably result from effects on peripheral nerves.’
David explains that both SSRIs and SNRIs (Serotonin and norepinephrine reuptake inhibitors) are most likely to cause these issues. However, less frequently prescribed antidepressants such as Agomelatine, Bupropion and Vortioxetine seem less likely to pose these problems.
Ben is 25 and has been prescribed a selection of medications to combat anxiety and depression for the past decade, having suffered with various mental health illnesses as a teenager. Over the past ten years he’s chopped and changed his medication, often stopping the treatment because of the sexual dysfunction he’s experienced as a side effect of the drugs.
He now lives in Leeds with his long-term girlfriend Hannah* and chatted to us about the difficulties of balancing the treatment with a healthy sex life, as well as the problems he faced when single.
‘When I was single, I would have to make a conscious decision that if I wanted to take medication to improve my mental health then I wouldn’t be able to go out and have sex with someone,’ Ben tells us. ‘This was really difficult when I was 18 and going out with friends four times a week. You know, it’s something you want to do, and you often feel like caving into it.’
He’s been with Hannah for nearly two years now, and the support he’s received from his girlfriend has encouraged him to stay on a course of medication – despite the continuing issues with sex.
‘I’m now on medication to improve my mental health for both of us, because I’m luckily with someone who loves me and doesn’t want me to feel suicidal,’ he says.
‘But obviously, these side effects are still a negative in the relationship. It’s really hard because even if your partner says, “I honestly don’t care”, you still care, and you know that, really, they do care.
‘No matter how much they say they’re not bothered, you have to admit that they wouldn’t be in a relationship with you if they didn’t want to have sex with you – or at least I hope they wouldn’t!’
When asked if the sexual issues ever put a strain on the relationship, Ben responds: ‘No, but that’s because we both talk about it and we’re very open and honest about the way it makes us feel. But earlier on in the relationship I think we both definitely felt a strain.’
Londoner Lilly, 23, is recently single and believes that the issues she’s had with her sex life contributed to her relationship ‘fizzling out’.
‘I started taking Sertraline nearly two years ago and noticed the physical effects on my body after about a month or so,’ she explains. ‘My depression meant that I wasn’t interested in having sex anyway, but the medication caused more physical effects on my body, as well as a lack of attraction and complete disinterest in sex.’
Lilly stopped taking her medication after a year of treatment, partly due to feeling better and partly to get her libido back. But did she feel like she’d had to choose between her mental and sexual health?
‘Yeah, 100%. I often felt the pressure to have sex, and I sort of thought to myself “ok, I’ll do this now and then I don’t have to think about it for a while”.
‘That made me feel a little bit more like a normal, functioning human being but I shouldn’t have had to make that choice.’
Why aren’t these problems being addressed?
Both Lilly and Ben say they didn’t feel like telling their GP about their sexual dysfunction whilst taking antidepressants.
While Lily ‘googled it and just saw that it was normal and to be expected’, and Ben felt uncomfortable talking to his GP about the issues, both kept to themselves and, in some cases, abandoned their medication for the good of their sex life.
Metro.co.uk reached out to a specialist in sexual dysfunction, David Goldmeier, to ask what can be done if you’re faced with these issues or feel deterred from treating depression because of these side effects.
David says: ‘SSRIs often affect sexual desire and ability to orgasm – which are not easy to help.
‘However, men who have erectile disfunction often respond well to Viagra or Cialis. You can consult with a doctor about taking a “medication holiday” once a week, as SSRIs are retained in the brain over two weeks so missing one dose shouldn’t cause problems.’
It’s worth noting that, as with many side effects, sexual issues as a result of antidepressants may fade after a few weeks of taking medication.
If they stick around despite attempts at different medication or dosage, it might be time to look at alternative treatments.
It’s vital that you talk to a medical professional before making any changes, and don’t rush into the decision to put your mental wellbeing at risk or stop taking medication for any reason.
Professor Baldwin says: ‘Many patients will become less troubled by sexual difficulties over time, as their mood brightens and interests increase.
‘A reduction in the daily dosage can be helpful, as well as switching to a medication which is known to be less likely to cause problems, but these should only be done on the advice of a doctor.
‘If someone doesn’t want to start an antidepressant because of a fear of developing sexual problems they should discuss potential treatment with a drug which is known to be less likely to cause difficulties or psychological treatments such as CBT.’
*Names have been changed.
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