By Emma McGowan

Nothing kills your libido like a bout of depression. Your brain and body feel slow. You’re tired all the time. It’s hard to motivate yourself to make breakfast, much less make out. And so you go to the doctor for help and they prescribe you medication, usually a selective serotonin reuptake inhibitor (SSRI), which is the most common type of antidepressant.

And it works! You quickly find that you’re spending less time in bed, your interest in your hobbies is coming back, and your brain clears out. But when it comes to sex… Not so much. 

What’s the deal? If depression tanked your libido, wouldn’t it follow that the medication used to treat it would bring your desire roaring back? You’d think so but — as it turns out — for a lot of people, the only thing more likely to kill your libido than depression is the medication used to treat it. 

How do SSRIs affect your sex life?

While there are a range of medications used to treat mental health issues like depression, anxiety, PMDD, and bipolar disorder, among others, SSRIs are the most commonly prescribed today. Brand names of SSRIs include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). SSRIs increase the amount of serotonin in your brain and, in some cases, dampen the effects of dopamine. 

Here’s the problem with that model when it comes to libido: dopamine is your brain’s orgasm “accelerator” and serotonin is your brain’s orgasm “brake,” according to the experts at the British Psychological Society. Because dopamine is the number one neurotransmitter involved in human orgasm, lowering its effect on the brain can lead to anorgasmia (the inability to orgasm). It can also lead to a longer delay leading up to orgasm or a feeling of detachment when you do cum. 

On the flip side, SSRIs lead to an increased amount of serotonin in the synapses (the space between neurons), which studies have shown to be associated with anorgasmia. Scientists aren’t totally sure what the reason for this is, although it likely has to do with serotonin’s interaction with the serotonin-2 receptor subtype. Intervention with other medications have shown to counteract the anorgasmic effects of SSRIs—like cyproheptadine, which, funnily enough, is an allergy medication.

All of those chemical changes in your brain can lead to not only difficulty orgasming but also potentially decreased sexual desire, decreased sexual excitement, and erection or delayed ejaculation problems. 

But here’s the deal: Not everyone who takes SSRIs will have sexual side effects. There are still so many unknowns when it comes to SSRIs. In fact, researchers aren’t even totally sure why they work when it comes to treating mental health issues. So while some people might experience anorgasmia with an antidepressant, others might not have any sexual side effects at all. 

Side effects can vary based on the drug and on your dosage. And there’s also the possibility of sexual side effects when you start taking a new med, only to have those side effects diminish or go away entirely as your body adjusts. In other words: It’s going to be different for everyone.

What to do if you think your meds are killing your libido

Sexual side effects from SSRIs are real — and a real bummer. But one thing you absolutely shouldn’t do, however, is just stop taking your meds on your own. Any changes to a medication regime need to be monitored by your doctor in order to avoid more serious — and potentially life threatening — side effects.

If you’ve started a new medication and you think it’s messing up your sex life, there are a couple of different things you can do about it. Here are some suggestions from a 2010 lit review from researchers at Trinity College Dublin.

Wait it out

Many people find that the negative impacts on their sex life diminish over time, along with other common side effects. So your first course of action if you think your meds are tanking your libido would be just to wait and see if it gets better. Frustrating? Yes. But also potentially your best move.

Lower your dose

Oftentimes an increased dosage of an SSRI leads to an increase in side effects — including sexual ones. So if your sex life is suffering since you upped your meds, talk to your doctor about trying out a lower dose.

Try a new medication 

Not all antidepressants have sexual side effects — and even the ones that do have them don’t all have the same effects. Your doctor might suggest trying out a different medication to help ease any issues you’re having.

Get into therapy

Depression and other mental health issues are almost never just about brain chemicals. There’s often other things going on in your life that are affecting both your mental state and your sex life. Therapy — and particularly cognitive behavioral therapy — have been shown to help with both sexual dysfunction and any underlying issues that might be contributing to it.

It might not be your meds

Finally, consider the fact that the problems in your sex life might not be due to your medications. Have there been other changes in your lifestyle, like in exercise or diet or alcohol consumption? Are you especially stressed lately? Did you suffer a loss or a major life disruption? Any and all of those things can put a zap on your libido, so it’s worth doing some exploring — either on your own or with a therapist — into what the root cause might really be.