by Nicole Evans M.D.

Created on: December 21, 2009

Antidepressants have a well deserved nasty reputation when it comes to sex.  Achieving an orgasm while on an antidepressant can become difficult or down right impossible (a condition called anorgasmia) for both men and women.  In fact, the antidepressant Prozac can actually be used to treat premature ejaculation. 

Many individuals erringly believe that they must either tolerate the frustrating sexual side effects of their antidepressant or stop the antidepressant altogether.  Unfortunately, discontinuing antidepressant medications is not an option for many individuals being treated for depression or anxiety.  For people reliant on antidepressants, there are ways to avoid the sexual side effects of psychotropic medications.  Methods to avoid these sexual side effects include:

-Adjust the dose of antidepressant:

The degree of sexual dysfunction associated with antidepressants can depend on the dose of the medication.  If you are on a decent sized dose you may try tapering to a smaller dose under your physician’s supervision.  Ideally, the sexual dysfunction will lessen and your depression will still be adequately treated.  However, the dose at which sexual side effects resolve may not be high enough to treat depressive symptoms in many people.

-Switch to a different antidepressant:

Some antidepressants cause greater sexual dysfunction than others.  You should work with your physician to determine whether you should try an antidepressant within the same class or switch to another class of antidepressants.  For example, the SSRI Prozac may cause more sexual dysfunction than the SSRI Lexapro, while the entire class of SSRI’s tend to cause more sexual side effects than the class of SNRI antidepressants. 

Wellbutrin is a non-SSRI that has perhaps the least sexual side effects of all antidepressants.  However, this antidepressant may not be appropriate for the specific characteristics of your depression.  The norepinephrine and dopamine reuptake inhibiting actions of Wellbutrin can be more activating, causing agitation and insomnia, than the SSRI and Tricyclic antidepressant classes.

-Add Wellbutrin (Bupropion) to your current antidepressant:

Having just discussed the great sexual side effect profile of Wellbutrin above, it is worth mentioning that many people do very well by simply adding Wellbutrin to their antidepressant regimen. 

This method for avoiding the sexual side effects of antidepressants increases the cost and effort associated with treating your depression.  However, Wellbutrin plus an SSRI can be quite effective.

-Get the timing right:

The level of antidepressant in your system will be highest closer to the time you take your medication.  The exception to this rule is the extended release formulations.  If you are on an extended release antidepressant try switching to a non-extended release formulation.  Otherwise, experiment to find the time periods when you are most likely to be experiencing minimal sexual suppression from your antidepressant.  When possible, plan your attempts to orgasm for these time periods. 

Fortunately, it is entirely possible to avoid the sexual side effects of antidepressant medications.  With a bit of thoughtfulness and willingness to try different methods, you and your physician will find a way to treat your depression without negatively affecting your sex life.

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