SSRIs: death knell for an already-crippled libido?

September 13, 2011 5:43 PM

Anecdotal experiences wanted: I am considering trying SSRIs for my anxiety, but I am worried that my already-low libido will disappear altogether. Psychiatrist suggests that the low libido may be caused by anxiety, and so taking SSRIs could actually help. Has either of these things happened to you?

(I know there have been lots of questions about SSRIs and sexual side effects, but I'm specifically interested in people who were having sexual problems before they started SSRIs.)

I am a woman in my late twenties. I have come to accept the levels of anxiety I experience in my everyday life are abnormal. There's never really been a time when I haven't been anxious, so I don't have a basis of comparison for determining how bad it is, but in my baseline state my mind is pretty much continuously running through a roster of everything there is to worry about, and in my worse moments I feel like I'm going to jump out of my skin. I have a lot of trouble concentrating and waste a lot of time browsing the internet, which keeps me from getting anything done. I've only recently come to realize that my internet addiction is a form of self-medication for treating my anxiety.

I have seen a psychiatrist and she prescribed me some Klonopin; I've tried taking quarter and half pills and I don't know if it really does anything. (I admit I'm afraid to take it as regularly as she suggested because I know benzodiazepines can be addictive and I'm afraid of becoming dependent.) She's urging me to try SSRIs, as is my boyfriend. There are two main concerns holding me back. The dumb one is a fear of gaining weight -- yes, I know this is a stupid reason, and so I'm trying not to give it much thought. The less-dumb concern is a fear that the SSRIs will exacerbate extant sexual problems.

I've had persistent problems with low libido. It's possible that this is entirely caused by anxiety, both directly (obviously it's hard to relax and feel sexy when I'm so ramped up all the time) and indirectly (my boyfriend engages in certain behaviors that trigger my anxiety, which in turn makes me angry and resentful and on edge around him). At the very least, I'm sure the anxiety doesn't help matters. But I'm afraid that the sexual side effects of the SSRIs would steamroll whatever small gains the relief of my anxiety would generate.

It doesn't help that, in some ways, I feel like the only thing I've got going for me sexually is that I have always found it very easy to orgasm. I'm afraid that even if the SSRIs didn't directly decimate my sex drive, they'd make it really difficult for me to orgasm, taking away the post-coital bliss and the oxytocin flurries and the positive reinforcement that ultimately keeps sex on the table. And, of course, I'm terrified that whatever side effects do occur won't stop even if I discontinue the drugs, even though post-SSRI sexual dysfunction seems to be pretty rare. (But is even the minor risk of permanently fucking up my sexuality worth the possible gains?)

So I guess I'm looking for personal experiences from people with libido problems who have taken SSRIs. Are they always a libido-killer or can they actually help alleviate sexual problems?

(In case it's relevant, I think my psychiatrist would start me on Lexapro, since that's what my mother takes for her depression and so she presumably finds it effective.)

Throwaway e-mail: [e-mail]

posted by anonymous to Human Relations (24 answers total)

Wellbutrin, a common antidepressant, often increases libido. Might be worth investigating.
posted by bprater at 5:48 PM on September 13, 2011 [3 favorites]

My interest in sex varies wildly based on my larger mood. The only time a drug has done anything for it either way was Wellbutrin, which made me a sex fiend.

However, I have bipolar disorder along with the anxiety. Mania = free and happy and that is one hot dude over there. Depression = sleep and are you kidding me? Anxiety = too jittery to think about anything but how jittery I am.

I'm currently on Lexapro, and it had no negative impact on me at all. In fact I think if they upped the dose my libido would recover somewhat; I'm in the middle of the "are you kidding me" thing right now. My mom was on Lexapro and she thought everything was glorious (we don't exactly talk about sex, but I have a feeling that wasn't impacted negatively based on how much she loved the stuff.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:51 PM on September 13, 2011

Also, CBT has helped me with my anxiety, it turns out. The last two weeks (check out my question and answer history) have been a revelation in terms of how much CBT and therapy generally can improve the racing thoughts/can't stop worrying thing.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:55 PM on September 13, 2011 [1 favorite]

I'm on Celexa for GAD with a Klonopin scrip for acute episodes, and my libido has definitely increased. I found when I was depressed, the antidepressant killed my sex drive, but for anxiety I'm not experiencing that. It has worked wonders for me, FWIW.
posted by mckenney at 6:03 PM on September 13, 2011

Well, maybe Lexapro would not be the best choice for you:

-----------------------ADVERSE REACTIONS-----------------
Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are: insomnia, ejaculation disorder (primarily ejaculatory delay), nausea, sweating increased, fatigue and somnolence, decreased libido, and anorgasmia (6.1).

If you want to check out the side effects of other drug candidates, just google "[Drugname] package insert". FWIW, I am taking Lexapro, and the only side affects I've seen are insomnia and nausea -- only a little, and only at first.

But really your doctor will prescribe for you based on all the relevant info you tell him (so yeah, you have to tell him). There are many, many antidepressants to choose from, and that is what doctors are for.
posted by pH Indicating Socks at 6:05 PM on September 13, 2011

Ditto what others have said above (and likely below). Wellbutrin helped awaken my low libido, and I also lost significant extra weight without even trying. Of course YMMV, but if you want anecdotal examples that show that your assumptions may be proven as much as 100% wrong, do add mine to the pile. My quality of life is basically unrecognizable pre- versus post-SSRIs (and CBT), and I can only wish the same for you.

Please remember that you and your doctor can always adjust your medication (dosage or type) if you find that the side effects are outweighing the benefits for you. Always. My best advice would be to share your concerns with your doctor before, and while, you follow her plan for you -- following that plan to the letter, by the way (please discuss with her that you have been so afraid of dependency that you haven't been taking the Klonopin as directed, for example) -- and just keep moving forward.

Hope you'll post again with an update on how you're doing.
posted by argonauta at 6:10 PM on September 13, 2011 [3 favorites]

CBT, therapy and meds all help my anxiety. The meds usually lower my libido, though.
posted by Lovecraft In Brooklyn at 6:12 PM on September 13, 2011

Listen, try an SSRI for at least 4 weeks (the first two weeks are side effects; after 2-4 weeks, your anxiety will improve). It will probably help with your anxiety, and a coin flip will determine if it helps or hinders your libido. You can get as many anecdotes as you want, but realize not everyone responds the same.

The downsides of not trying include: low libido stays low, anxiety stays high.
Upsides of trying SSRIs are: libido potentially increases, anxiety drops.

I think that's clearly in the 'give it a shot, but remain non-committal until you've given it enough time that you can accurately assess what's going on."

So long as you tell your doc everything else you may be on, the risks are very low. And if, after a month, you wind up with a low libido and want to stop, you can either stop SSRIs entirely, or you can switch to another SSRI to see if that helps.

I say this as someone who just started SSRIs for anxiety/depression after about a year of resisting. I really should have done it ages ago.
posted by flibbertigibbet at 6:16 PM on September 13, 2011 [3 favorites]

If the klonopin helps, why not just go ahead and take it as directed for awhile to see if that helps? Being "dependent" on a drug is only a problem if you can't have it any more. As long as your doctor keeps writing the scrips, being dependent isn't a bother. My husband has been on daily doses of klonopin for 15 years with no ill effects that either one of us has noticed.

It's possible that with klonopin, some CBT therapy and maybe an exercise program you could manage your anxiety without an SSRI and not even have to deal with all the potential not-fun side effects.
posted by Serene Empress Dork at 6:39 PM on September 13, 2011

Priorities, love. Do you want to have great sex, or do you want to not suffer from a debilitating illness that knocks you on your ass again & again & again? Especially given that there's X percent chance you can be better AND still have great sex.

People's reactions to mental health medications is such an individualized thing: Yes there is a % probability that side effect X will happen to you. But you'll never know until you go on the specific drug.

I was on 750 mg Wellbutrin for almost 5 years. I have rotten libido, which has only gotten worse over the years. But the Wellbutrin didn't affect me one way or another in that area. I remember --it was one of the set monitoring questions they asked me for years.

I understand the fear. I was furious with my therapist for even bringing up the idea of meds, which I had specifically stated were not a treatment option I cared to explore from the outset of our working relationship. I was terrified that meds, while fixing the problems, would make me fundamentally not "me" anymore. I remember expressing to my therapist, months later, how amazed I was that I still felt exactly like me. --But suddenly this me could actually USE all the knowledge and skills we'd been working on for so long. Because the part of me that had made it impossible to keep it together had finally been put to sleep. Or something. I could still get upset, or mad, or anxious, or happy, or giddy or, or everything I always could, but I was no longer getting completely stuck in those gears; if I got mired, I could use the tools to get out. While still feeling completely & totally me. It was amazing.

I'm off meds now, btw. I know they talk about on meds for life for some of us. The prescribing doctor she brought in certainly said that as well. But even if you're told that, it's not always a certainty. Who knows what tomorrow will bring? But if you're looking for a reason NOT not to try SSRIs, don't use the libido thing as an excuse. It's like saying you don't want to drive in a car today because you might burn yourself on an overheated dashboard. OK, it's a possibility...but not really that big a one, and even if it does happen, it can be dealt with. New meds, other meds, adjusted dosages...it's not a dealbreaker & you can always go off the meds if you don't like how they make you feel (CORRECTLY, please! I went cold turkey from my Wellbutrin & I can tell you, you'd BETTER be in a mental place where you can handle yourself if you're going to do something that stupid).*

*If you really want to know why I went off, feel free to memail me. (It isn't really relevant to the question. I just wanted you to know that meds aren't always a life-sentence even if they say it is.)
posted by Ys at 6:42 PM on September 13, 2011 [2 favorites]

Wellbutrin, btw, is not an SSRI. It's a norepinephrine-dopamine reuptake inhibitor according to Wiki.

I will add to the chorus though that I have been on it for a while and my sex drive remains high.

I tried a couple SSRIs but they all gave me either more anxiety or, in one case, severe visual hallucinations (all of these effects went away after stopping, of course).
posted by wildcrdj at 6:45 PM on September 13, 2011

You asked for anecdotes from both sides, so I guess I'll chime in to say that yeah, starting an SNRI (for OCD, in my case) dealt the killing blow to my already faltering libido and also made me anorgasmic.

That said, however, I am so much happier and more functional that I consider it totally worth the trade. Definitely give it a try and see how it goes. Plenty of other people have commented to show that it doesn't have to be like that, and even if it is, you may find you feel the same way I did about it. There are just no words to express how different things are without the constant anxiousness of OCD.
posted by dorque at 6:47 PM on September 13, 2011 [1 favorite]

Prozac really inhibited my orgasms. I did research, and discovered Citalopram was noted for reduced levels of this side effect. Asked my doc to switch me, and the problem was much reduced.

Me: "Why did you have me on Prozac, anyway, if you knew Citalopram had lower side effects?"
Him: "That's a good question. I don't remember."

Made a note to myself to keep doing the research HE SHOULD HAVE DONE - AFTER ALL HE'S THE EXPERT I HIRED FOR PROFESSIONAL ADVICE, and discovered Escitalopram (aka Lexapro) - one-half of the chiral mix that is Citalopram - essentially ditched all the major side effects for most people.

And for me as well.

So, don't let all the Lexapro warnings scare you away completely. It may work just fine for you.
posted by IAmBroom at 6:48 PM on September 13, 2011

If you come easily, low dose SSRI will probably just make it take a little longer, anecdotal evidence suggests. also, you can add wellbutrin to SSRI to reduce sexual side effects if needed and it has the plus of being energizing while SSRI's can sometimes be sedating.

and yes, dependence /= addiction re: the klonopin. addiction is compulsive use of substance despite negative consequences, dependence is needing substance to function. diabetics are dependent on insulin, not addicted to it. if it makes your life better, it's not addiction.

with all of this YMMV, but why not try? you can always stop if it doesn't help.
posted by Maias at 7:09 PM on September 13, 2011

I've had anorgasmia issues with SSRIs. But here's the thing: you can't know until you try it. So give your boyfriend hte heads up that there may be less sexytime in your immediate future while you get your dosages sorted out, and try it. If he's a decent fellow, he'll be supportive (it helps to be willing to put on your game face and give a blowjob or handjob every now and then).
posted by thinkingwoman at 7:38 PM on September 13, 2011

Like Wellbutrin, Effexor is not an SSRI and so causes much less of this problem for most people.

Not that I would know personally, of course, but if I did, I might say that anorgasmia can be outgrown after a few, say 6, months, or with, er, scorched earth tactics, but the low libido is pretty much there to stay.

It's not PC at all to say, so please take it with a grain of salt, but if sex is the meat and potatoes of this relationship, and you want to keep the relationship, and you're already worried that an SSRI might cause a problem, it might be worth trying Wellbutrin or Effexor first.
posted by skbw at 8:34 PM on September 13, 2011 [1 favorite]

Wellbutrin is often given with a secondary anti-anxiety drug (such as Xanax) if the anxiety is idiopathic and not coming from the depression, just FYI.

It is NOT an SSRI, and it is often not as effective on anxiety as SSRIs.

Your mileage will vary; reaction to the antidepressants varies widely. But you might try taking your anti-anxiety drug as prescribed first, at least -- does your doctor know you aren't taking the prescribed dose with the prescribed regularity?
posted by Eyebrows McGee at 8:36 PM on September 13, 2011 [1 favorite]

Clarification: I don't mean that I get from your post that sex is the meat and potatoes; I mean that if that is in fact the case, then, etc.
posted by skbw at 8:40 PM on September 13, 2011

The only "sexual side effect" I've noticed on Zoloft (been on it for almost 2 years) is that instead of my clitoris being really sensitive, my g-spot is now. Same thing happened a decade ago when I was on Prozac.
I gained weight when I started on SSRI's, but that was welcome because I was battling anorexia. I pretty much just gained what I needed to be at a normal weight again.
posted by luckynerd at 9:32 PM on September 13, 2011 [1 favorite]

My anecdote is that, although I had the libido-suppression side effect, it didn't happen gradually as I ramped up the dose— it happened pretty suddenly as I crossed some threshold. Below that dose, I still have most of the positive effects without the "sex? what's that?" effects.

Also, I just want to repeat what everyone else says about these meds always being adjustable or, for that matter, quittable. Telling your doctor, after you've taken it for a few weeks, that the benefits aren't worth the side effects is perfectly acceptable, and you should expect your doctor to help you taper off the meds (quitting cold turkey can be unpleasant) or suggest other meds.
posted by hattifattener at 9:53 PM on September 13, 2011

Citalopram was overall - good for my sex life.

I was basically uninterested in sex right before I took it, and I've always had trouble climaxing - well, I'm not sure if it's climaxing, or not experiencing a refractory period. It feels good, and then great, and then even betterer, but not anything like a 'release' or, I can stop now - I just want to keep going.

Therefore, Citalopram may or may not have made it more difficult to climax. It was already a problem, so I'm not sure.

Even if it did, I do know that my libido definitely went way up*.

It also made me mentally healthy enough to, for example, leave the house, and even go out and have a wonderful day in the sunshine, randomly meet and befriend a whole group of strangers, one of whom was a ridiculously hot Swedish sexy viking boy tourist, and have wild sex for 3 months.

YMMV.

I have male friends who were on Citalopram, and had some side-effects, and then started raving about switching Escitalopram, so, booyah for them.

Finally, it was such a struggle to actually *let* myself take medication. I kept coming up with different reasons (excuses) why I shouldn't do it. Even without a sex drive, leaving the house was better. Depression and anxiety kill my libido AND my life. I finally got to the point where I decided I didn't care if I had side-effects, I didn't care if it I was trying something woo-woo and wouldn't work, I was doing so well about not caring about everything else, I decided to not-care in a useful way, and just try anything.

I went through about 3 meds before going on Citalopram, they sucked in various ways (or I got a rash, and was pulled off them), and I practiced not caring about that and just trying the next one, and then one helped. Win.

* This was fine, because of later mentioned Swedish boyfriend.
posted by Elysum at 10:57 PM on September 13, 2011 [3 favorites]

I'm a 32 year old male and was on Pristiq (an SNRI) for about 18 months.. no problems with libido. I've been off it for about 3 months and have just started taking Zoloft (took the first tablet this morning), it's an SSRI, so, like yourself I'm a bit curious as to what kind of effect it will have on libido and/or orgasm.
posted by theswedishchef at 6:52 AM on September 14, 2011

I also have a friend whose low libido and anorgasmic side effects gradually faded after some months on Effexor. Said friend also found that she gained weight on a lower dose, but lost weight on a higher dose.
posted by kamikazegopher at 10:50 AM on September 14, 2011

Oh, I didn't quite explain that I suspect the great-sex-with-no-climax was actually the *factor* in having a higher sex drive. Embers never quite died down, so to speak.
Kinda frustrating, mostly awesome. Still worth the tradeoff.
posted by Elysum at 6:17 PM on September 14, 2011