What is the Connection Between SSRIs and Sexual Dysfunction?

The rate of sexual dysfunction, such as erectile issues, disinterest in sex, or inability to achieve orgasm is exceptionally high when people use selective serotonin reuptake inhibitors (SSRIs). The principal connection between SSRIs and sexual dysfunction is the frequency at which sexual dysfunction occurs with SSRI use: in approximately 30-70% of users. Some of the antidepressants that create more free serotonin are less likely to cause side effects than others, but even at the low end, a 30% risk means one in three individuals taking these drugs will experience some sort of sexual difficulties. Studies point out that it’s challenging to completely determine the precise relationship between serotonin reuptake and sexual problems because all of the SSRIs have at least a weak action on other neurotransmitters.

Drugs that seem to most demonstrate a relationship between SSRIs and sexual dysfunction include Prozac®, Paxil® and Zoloft®. All of these medications at least minimally affect other neurotransmitters like dopamine, norepinephrine and acetylcholine. It’s posited that the multiple action of these drugs on neurotransmitters other than serotonin may be part of the problem. Medicines that least affect these additional brain chemicals may be associated with a lower, but still clinically significant risk, of sexual problems.

On the other hand, this theory may be refuted to a degree by drugs that act on other neurotransmitters but do not affect serotonin. Bupropion (Wellbutrin®) is an example. It is an atypical antidepressant that affects dopamine and norepinephrine and it is one of the few antidepressants that does not cause sexual dysfunction. Its presence in the array of medicines used to treat depression suggests that serotonin reuptake inhibition is one of the key reasons that SSRIs and sexual dysfunction are related. There may be other explanations, too, such as that multiple action on a combination of neurotransmitters is most likely to create sexual problems.

There are ways to break the connection between SSRIs and sexual dysfunction. Doctors can prescribe medications like Viagra® that treat symptoms like erectile dysfunction on an as needed basis. Sometimes amphetamines like methylphenidate can help. Another option is to add bupropion as an adjunct therapy to the main antidepressant or to switch patients to bupropion alone or another antidepressant with a lower profile of sexual side effects.

It should be noted that occasionally the connection between SSRIs and sexual dysfunction is beneficial. Men who suffer from premature ejaculation may have success in resolving the condition when they use an SSRI. Since serotonin reuptake inhibition tends to slow sexual response, this may improve the ability to maintain an erection throughout a sexual encounter.