Do SSRIs Cause Sexual Side-Effects?

When treating many mental health disorders, including depression, post-traumatic stress disorder, anxiety, and panic disorder, selective serotonin reuptake inhibitors (SSRIs) are often the first-line medical treatment. SSRIs have proven effective at improving mood, decreasing panic attacks, and decreasing anxiety symptoms, providing people with much-needed symptom relief for mental illness.

Unfortunately, sexual dysfunction is one of the most common side effects of this class of medications that may increase the risk for discontinuation and nonadherence to pharmacotherapy. SSRIs take several weeks to months before optimally relieving the symptoms of mental health conditions, making medication adherence crucial for patients to achieve maximum benefit. When users experience unwanted sexual side effects before they reach the maximal benefits of the medication, they may miss out on an excellent therapy that can effectively reduce their symptoms.

This article will explore the mechanism behind these sexual side effects, the different sexual dysfunctions people might experience, and which specific SSRIs are most likely to cause these issues. Most importantly, we will also guide you on what to do if you experience side effects and how to adjust your treatment regimen accordingly.

Why Does This Happen? Understanding the Mechanism

 To better understand why SSRIs lead to sexual dysfunction, it is essential to have a basic understanding of how this medication works. SSRIs alleviate symptoms by increasing serotonin levels, an important neurotransmitter, in the central nervous system. This medication blocks serotonin reuptake, leaving more free serotonin available at serotonin receptors. The increase in serotonin in the central nervous system leads to an improvement in mood.

Excess serotonin in other areas of the body may cause some unwanted effects. Research has found that elevated serotonin can affect other hormones and neurotransmitters involved in sexual function, such as testosterone, estrogens, and dopamine. Testosterone affects sexual arousal, and dopamine plays a role in achieving orgasm, two functions that are often impaired by SSRI use.

Although this is the proposed mechanism behind SSRI-induced sexual dysfunction, the precise reasons are still not fully understood. Researchers believe the delicate interplay between neurotransmitters impacted by serotonin levels can affect individuals differently based on genetics, environmental factors, and predisposed susceptibility to sexual dysfunction.

What Type of Sexual Dysfunction Do Individuals Experience?

SSRIs can impact different aspects of normal sexual functioning, which may lead to various sexual issues. Some of the most common types of sexual dysfunction that people may experience while taking an SSRI include:

• Delayed ejaculation: This is the most common side effect of SSRIs in men. This is when a man has difficulty with ejaculation or the inability to ejaculate at all, even when sufficient sexual stimulation is provided. Men are often left feeling frustrated and embarrassed.
• Inability or difficulty with orgasm: Similar to delayed ejaculation, up to 42% of women on SSRIs may experience challenges achieving an orgasm. They may experience a delay in orgasm or be unable to achieve one.
• Reduced sexual desire: Many people on SSRIs report decreased libido or sexual desire. People may have less of an interest in engaging in sexual activities and have a reduction in sexual urges or thoughts.
• Difficulty becoming aroused: Taking an SSRI can make it difficult to become sexually aroused, such as achieving an erection or producing lubrication. This may be due to reduced sensitivity or decreased blood flow to the sexual organs.
• Difficulty sustaining arousal: Individuals who can become aroused may face challenges maintaining arousal throughout sexual activity. Often, this leads to reduced pleasure and satisfaction during sex.
• Erectile dysfunction: When men cannot achieve and maintain an erection firm enough for sex, this is known as erectile dysfunction. This is a common side effect for men taking SSRIs that can lead to reduced sexual satisfaction, worsen depression, and cause marital or relationship issues with sexual partners.

Not every person experiencing sexual dysfunction will experience all of these symptoms. The specific way sexual dysfunction manifests will vary from person to person.

What SSRIs Cause Sexual Dysfunction?

All SSRIs can result in unwanted sexual side effects, but certain medications are more known for contributing to sexual dysfunction than others. The most prescribed SSRIs that lead to sexual dysfunction include:

• Paroxetine (Paxil)
• Citalopram (Celexa)
• Fluvoxamine (Luvox)
• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Escitalopram (Lexapro)

Paroxetine is associated with the highest risk of developing sexual side effects. Studies have demonstrated that delayed ejaculation, reduced sexual desires, and erectile dysfunction are most common in paroxetine. Citalopram has been found to have a similar sexual side effect profile to paroxetine, although this finding has not been replicated in all studies.

Remember that individual responses to different SSRIs can vary. One person may experience significant sexual dysfunction with a particular medication, while another may have no issues. If you are experiencing unwanted sexual dysfunction due to your SSRI, discussing other options with your doctor or mental health professional is essential.

What To Do If You Experience Sexual Side Effects 

If you are experiencing sexual dysfunction while taking an SSRI, it is crucial to communicate with your healthcare provider openly. They can help you decide if the sexual problems are related to the SSRI or caused by another factor, such as untreated depression or medications you are taking. Potential alternatives to SSRI treatment include bupropion, mirtazapine, vilazodone, vortioxetine, and serotonin-norepinephrine reuptake inhibitors.

Potential solutions to sexual side effects that your doctor may suggest include:

• Lowering your SSRI dose: Higher doses of all SSRIs are associated with a higher risk of sexual dysfunction, so discuss the lowest possible effective amount to treat your symptoms with your doctor. Sometimes, lowering the dosage can alleviate unwanted sexual side effects yet maintain therapeutic benefits for depression.
• Switch to a different medication: If your symptoms are severe, there are other medications you can try that have a lower risk for sexual dysfunction. Commonly prescribed medications with a lower risk for sexual dysfunction include bupropion, mirtazapine, serotonin-norepinephrine reuptake inhibitors (SNRIs), vilazodone, and vortioxetine.
• Add a new medication: Doctors sometimes recommend adding another drug to counteract the sexual side effects of SSRIs. Bupropion is a medication found to improve sexual response and reduce SSRI sexual dysfunction. There is also evidence that saffron may counteract some aspects of sexual dysfunction, particularly the ability to reach orgasm. For men with erectile dysfunction, research has found adding sildenafil or tadalafil can reduce erectile dysfunction in men with sexual dysfunction as a result of antidepressant treatment.
• Scheduling sexual activity: Although this might seem unnatural, scheduling and preparing for sexual activity at a specific time when symptoms are at their lowest is an effective strategy to combat unwanted SSRI-induced sexual dysfunction. For many patients, certain times of day are worse than others, so scheduling sexual activity around symptom-reducing time frames can be a great way to remain on your medication while still engaging in sexual activity.

The best way to figure out an effective strategy to reduce sexual dysfunction is to discuss your particular situation with your doctor. Finding the right solution might take trial and error with your doctor, but identifying a method that works for you is within reach.

Does Health Insurance Cover Treatment for Sexual Side Effects?

Health insurance coverage for treatments related to sexual side effects can vary significantly, depending on the specifics of each individual insurance plan. The general rule is that if sexual side effects are symptoms of a recognized medical condition or are caused by another treatment covered by insurance, these side effects’ treatment might be covered. For instance, conditions like depression, anxiety, or hormonal imbalances, which can lead to sexual side effects, are typically covered by insurance plans.

Insurance providers such as Aetna, BHO, Blue Cross Blue Shield, Carelon, Cigna, Halcyon Behavioral, Medica, Meritain Health, UMR, and UHC may offer varying degrees of coverage for treatments of sexual side effects. Some insurers may cover treatments if sexual dysfunction is a symptom of an otherwise covered medical condition or if it’s a side effect of a necessary medication. However, treatments specifically for erectile or sexual dysfunction are often not covered. It’s essential to review your policy or consult with your insurance provider to understand what exactly is covered.

It’s important to remember that each insurance plan is different, and the specific condition, recommended treatment, and individual’s policy details can affect coverage. Therefore, always consult with your insurance provider to understand the nuances of your coverage.

Final Thoughts

SSRIs have been proven highly effective treatments for depression, PTSD, and panic disorder. They can potentially improve a person’s quality of life significantly but, unfortunately, come with the risk of unwanted sexual side effects such as erectile dysfunction, decreased sexual desire, and decreased sexual arousal. Awareness of the specific SSRIs more likely to cause these side effects can help individuals make more informed decisions about their treatment options.

If you experience sexual side effects while taking SSRIs, don’t hesitate to contact your healthcare provider and have an honest and open conversation about what you are experiencing. They can help you explore potential solutions, such as lowering medication dosage, switching medications, or adding additional medications to counteract the unwanted side effects. Although everyone is unique, your clinical professional will help you find a solution to restore sexual function while properly treating your mental illness.