Balancing the benefits and harms of medications can be quite a challenge. Doctors have known for decades that SSRI-type antidepressant drugs such as fluoxetine (Prozac) or paroxetine (Paxil) can affect sexual interest and performance (Journal of Sex & Marital Therapy, Fall 1997). Unfortunately, patients are still left in a quandary when they experience lower sex drive from taking an antidepressant they need to function. What can they do?
Lower Sex Drive While Taking Fluoxetine:
Q. I’ve been on fluoxetine for two years to treat depression. Now my sex drive has completely gone. I tried lowering my dose, but due to mental fuzziness and confusion I had to return to the higher dose again.
This whole situation is killing me. I feel sexless. I’m in a beautiful relationship with a wonderful man I love very much. He is very understanding and patient, but I fear that I will lose him over the lack of sex.
I’ve even contemplated ending the relationship, but I don’t want to lose the love of my life just because I need an antidepressant. Do you have a solution to suggest?
Antidepressants and Sex:
A. Many antidepressants lower sex drive and interfere with sexual pleasure. There is even a medical name for this condition: treatment emergent sexual dysfunction (TESD).
The official prescribing information for drugs like fluoxetine minimizes this problem. For example, the DailyMed data on fluoxetine (Prozac) suggests an incidence of 3 to 11 percent. Studies in healthy volunteers, on the other hand, indicate that between 50 and 80 percent of people taking this medication report sexual dysfunction (Journal of Clinical Medicine, Oct. 7, 2019). One real-world study found that approximately 80 percent of patients on antidepressants reported sexual problems (Archives of Sexual Behavior, April 2019).
Other Therapeutic Options:
A few antidepressants may be less likely to lower sex drive. Ask your doctor whether bupropion or mirtazapine would be options for you. They act on different neurochemicals than the selective serotonin re-uptake inhibitors such as fluoxetine. Some experts suggest that vilazodone (Viibryd) might also be less likely to interfere with sexual enjoyment (Therapeutic Advances in Psychopharmacology, Jan. 2018). Others recommend a trial of desvenlafaxine (Pristiq) (Journal of Clinical Medicine, May 21, 2019). Switching from one antidepressant to another could be disruptive, though, so you and your doctor will need to work closely to get the right balance of benefit without undue harm.