Antidepressants & Sex - Bad Bedfellows?

Deciding on an antidepressant

Antidepressants and sex: When choosing which one of the myriad antidepressants to prescribe our patients, many factors play a role in the decision making process. These include potency, cost, dose range and side effects. In some situations side effects are desirable, such as the sedating effects of Mirtazapine for sleep. In many other cases, the undesirable effects are a significant impediment for a patient to start a medication that may significantly improve their quality of life.

Side effects

One of these common side effects is sexual dysfunction. Loss of libido, erectile dysfunction and

anorgasmia are potential side effects of many antidepressants. Many patients are hesitant to start a

medication that could interfere with their sex life - particularly (younger) males. When considering the risk

of sexual dysfunction, the Australian Therapeutic Guidelines stratifies antidepressants as follows:

• >30% risk with with SSRIs, SNRIs and Clomipramine

• 10-30% risk with Mirtazapine, Mianserin, Vortioxetine and all other tricyclics

• <10% risk with Agomelatine, Reboxetine. Data also supports Moclobemide and Bupropion here

Here are some considerations when comparing antidepressants with low risk of sexual dysfunction:

In summary, while there is never a perfect antidepressant for any patient, careful consideration of the

patient’s needs and priorities will still give options to present to them for pharmacological treatment -

including medications with low risk for sexual dysfunction.

Authored by Dr Ryan Williams. Ryan is a GP Psychotherapist at True North Psychology with immediate availability for psychotherapy and medication reviews. References for above available on request.