SSRI Killing Your Sex Drive? Here's What Your Provider Should Be Telling You

You were depressed, your provider started you on an SSRI, and now you’re mostly not depressed but have no interest in connecting with your partner. Sound familiar? This is a common problem in psychiatry and something I wanted to talk about openly with you today. We have made some forward movement in this area, but I find that most of my patients are struggling connecting with themselves or their partners in one way or another. Lack of intimacy is not just something to be swept under the rug. In our last post, we discussed the importance of oxytocin in the treatment of all mental health disorders, and oxytocin is most easily increased through healthy sexual activity. But, annoyingly, one of our most powerful tools in the treatment of mental health disorders, the SSRI, makes it quite hard to connect intimately with yourself and others. 

Let’s first unpack the common problem. 

Sexual dysfunction is rarely a single problem. It can be divided into multiple categories that are physiologic in nature: disorders of sexual drive, disorders of arousal, and disorders of orgasm and ejaculation, as well as other problems including vaginal pain and discomfort, or difficulty maintaining an erection. But sexual dysfunction isn’t always physiologic in nature. 50-70% of people with depression will experience some level of sexual dysfunction and sometimes the sexual dysfunction itself can lead to depression. (Rothmore, 2020) ADHD can make it difficult to sustain focus on sexual activity long enough to achieve orgasm. (Bejilenga et. al 2018) A history of trauma can make it particularly triggering to try to engage in sexual activity even if the trauma was not sexual in nature. (Gerwirtz-Meydan et. al, 2023)

So before we even made it to the treatment, the deck was stacked against us. But anti-depressant induced sexual dysfunction has been identified as a leading cause for people stopping their medications before the treatment was successful. But even worse, people aren’t talking about it with their providers. When surveyed, 50% of patients experiencing sexual dysfunction said they never or infrequently discussed it with their provider. (Rothermore, 2020)

How often does it happen?

Because of the lack of reporting of these side effects, high incidence of sexual dysfunction across all mental illnesses, and lack of screening for sexual health, it is hard to quantify exactly how many patients will struggle with this when they are placed on an SSRI. But in a small survey study, 62.5% of men and 38.5% of women believed that their sexual dysfunction was directly related to their SSRI. I have personally seen it impact my patients, and do notice an improvement with the SSRI is stopped in most cases. 

SSRIs aren’t the only culprit

While all SSRIs have high risk of sexual induced dysfunction, limited studies suggest that paroxetine and escitalopram carry the highest risk. Other drug classes that carry high risk are SNRIs and TCAs. There is some evidence to suggest that some individual SNRIs carry less risk such as desvenlafaxine, but these studies are limited. It’s important to note that other diseases such as diabetes, alcohol use, atherosclerosis, and more can also be associated with sexual dysfunction as well as other commonly used psychiatric medications such as lithium, antipsychotics, mood stabilizers, and beta blockers. 

With the importance of oxytocin and positive sexual activity in overall mental health, this is, in my opinion, a health emergency. We must be screening for, educating, and encouraging sexual health at every visit. Sexual screenings should be thorough and include partnered and non-partnered activity, and along with a comprehensive medical history to help exclude non medication induced causes of sexual dysfunction. 

We’ve decided it’s caused by the SSRI, now what?

Thankfully there are now a lot more treatments to help with sexual dysfunction than there were previously. Let’s get into some of the options. 

Using SSRIs judiciously

Sometimes an SSRI really is the best treatment option. But too often, patients are placed on a high dose and left there for years. This is often not clinically indicated and can cause unnecessary side effects. The STAR*D trial is a major trial that informs care for patients on antidepressants. This trial was recently reexamined and found that in patients with depression, 53.8% will have total remission in 90 days of treatment, 74.5% will have remission at 180 days and 87.5% will have remission at 360 days. (Kennedy et. al, 2025) This means that all patients should have a trial without medication at 6 months to a year following initiation of an SSRI because there is a very good chance that you don’t need it anymore. 

In order to have the best chance of remission, the patient should always pair an SSRI with therapy in order to learn new coping skills. This means that they will have a new set of behaviors by the time they are trialing off of their medication. The time for set it and forget it with psychiatric medications needs to end. Unfortunately, if the medications are removed without having treated the underlying reasons that the symptoms occurred in the first place, relapse is significantly more likely. This leads to restarting medications unncessarily or the patient believing that their brain is just "broken."

I always trial my patients off of an SSRI after 1 year to see if it’s still indicated. But this is always done under careful supervision and coordination with a therapist. As the medication is reduced at a very slow rate, the emotions begin to reappear and the patient and therapist have ample time to implement new skill building techniques. The reemergence of symptoms is not treated as a reason to restart medications, but rather "grease for the therapeutic wheel." This is paired with good lifestyle interventions such as quality sleep, joy seeking activities, healthy diet, and positive social interaction. Taking this approach means that sometimes we sacrifice sexual function for a short amount of time knowing that it’s not permanent and we will work on it at a future date. Pairing SSRIs with quality therapy like this also often means that patients need lower doses than they would without it - meaning even less sexual dysfunction.

We can’t wait it out, so what do we do?

If for any reason, sacrificing sexual function for a short amount of time isn’t an option, there are also some treatment options for increasing sexual activity during SSRI use. Saffron is my favorite supplement to help with this. It has very little side effects, is available over the counter, and is proven in multiple studies to be effective in treating a wide range of sexual dysfunctions. (Kashani et. al, 2022) Testosterone cream can be helpful for both men and women who experience loss of libido, but research is limited about this. (Rothmore, 2020) Sildenafil is helpful in particular for maintaining erections for men even when SSRI induced. (Burghardt et. al, 203) A small study suggests that mirtazapine may be helpful in resolution of SSRI induced sexual dysfunction. (Ozmenler, 2008) Many people use bupropion to augment, but this can increase blood levels of several SSRIs and carries some seizure risk. I find that saffron is a safer and more effective choice in my own patients. 

There are some newer options on the market for women including Addyi. However, I have not yet personally prescribed this because unfortunately it was rushed through approvals with the FDA and is currently under a REMS protocol. This means that each time you get it at the pharmacy you would have to undergo a screening even though it is essentially another SNRI. For a medication where patients struggle to talk to their providers about the condition, I find that this extra screening is likely to be prohibitive. We will be keeping an eye on new treatments as they become available and hopefully this medication will have more applicability in the future. 

As we can see this is a complex issue requiring careful consideration and thought. It’s not something that should be swept under the rug. It’s driving patients off medications, preventing overall health and connection before they’ve even had a chance to heal. That has to change. The good news is that we have more options now than ever before. But none of it matters if we never ask the question in the first place. At Something Human, we make sexual health a routine part of every visit. If I’ve learned anything from my own patients, it’s that when you open the door, they will walk through it. Intimacy isn’t a bonus feature of mental health, it’s central to it. And you deserve a provider who treats it that way. 

Rachel Ward, PMHNP-BC is the founder of Something Human Mental Health. She believes strongly in removing barriers to access to mental health and creating a holistic person centered and welcoming place for people to receive care.

References:

Bijlenga, D., Vroege, J. A., Stammen, A. J. M., Breuk, M., Boonstra, A. M., Van der Rhee, K., & Kooij, J. J. S. (2018). Prevalence of sexual dysfunctions and other sexual disorders in adults with attention-deficit/hyperactivity disorder compared to the general population. ADHD Attention Deficit and Hyperactivity Disorders, 10(1), 87-96.

 Burghardt KJ, Gardner KN. Sildenafil for SSRIinduced sexual dysfunction in women. Current Psychiatry 2013; 12: 29–32.

Gewirtz-Meydan, A., & Godbout, N. (2023). Between pleasure, guilt, and dissociation: How trauma unfolds in the sexuality of childhood sexual abuse survivors. Child Abuse & Neglect, 141, 106195.

Kashani, L., Aslzadeh, S., Shokraee, K., Shamabadi, A., Najafabadi, B. T., Jafarinia, M., ... & Akhondzadeh, S. (2022). Crocus sativus (saffron) in the treatment of female sexual dysfunction: a three-center, double-blind, randomized, and placebo-controlled clinical trial. Avicenna Journal of Phytomedicine, 12(3), 257.

Kennedy, K. P., Heldt, J. P., & Oslin, D. W. (2025). What if STAR* D had been placebo-controlled? A critical reexamination of a foundational study in depression treatment. Journal of Clinical Psychopharmacology, 45(6), 648-661.

Ozmenler NK, Karlidere T, Bozkurt A, et al. Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors. Hum Psychopharmacol 2008; 23: 321–326.

Rothmore, J. (2020). Antidepressant‐induced sexual dysfunction. Medical Journal of Australia, 212(7).