Which antidepressants gave you the least sexual side effects?
January 15, 2014 2:56 PM   Subscribe

I've had issues with an SSRI and SNRI having orgasms - would like your advice about potential other drugs. Wellbutrin not possible (gave me high blood pressure)

Hello, 30F here. Yes, I'm already in therapy.

I have been on the border of dysthymic for several years now. At times it borders on pretty depressed. Several of those times, I went ahead and tried antidepressants, BUT:

1. within one day, celexa and cymbalta (SSRI and SNRI) both immediately killed my ability to become aroused or have an orgasm). I'm not cool with this - sex is one of the things in life that brings me joy.

2. Wellbutrin gave me high blood pressure, which I normally do not have, so please don't suggest that one.

3. St John's wort worked great for about 6 months then crapped out.

So questions is:
Especially females, but males welcome: which antidepressants gave you the least sexual side effects? If you want to break it down to arousal, desire, and orgasm, that would also be interesting to me.

Throwaway: antidepthrowa@gmail.com

Much appreciated!
posted by anonymous to Health & Fitness (23 answers total) 11 users marked this as a favorite

Prozac (fluoxetine) seemed to have no effect on either my libido or my orgasms, but the line from A to B got a lot longer. After about 8 years on Prozac, I was switched to Zoloft, and discovered that in fact the Prozac HAD had an effect, just not a more profound effect than being depressed! I was much more responsive in every way on Zoloft. After discontinuing the Zoloft, I had yet ANOTHER leveling up in sexual response, so I know it still did have some effect on me, but overall, it was the milder of the two in terms of side effects.
posted by KathrynT at 3:02 PM on January 15, 2014

Ask your doc about tricyclics.
posted by Blazecock Pileon at 3:05 PM on January 15, 2014

A low dose of Lexapro (10-20mg/day) has had the least, but still some.
posted by pantarei70 at 3:11 PM on January 15, 2014

I don't take one anymore, but I still consider tricyclics to be kind of a wonder-drug as far as depression goes, because the only side effect I ever noticed was that I slept like a log, which for me was an extra bonus. But a lot of doctors don't seem to even consider them anymore if you don't ask to try them specifically.
posted by Sequence at 3:13 PM on January 15, 2014

Zoloft wasn't great for me in the pants department. I *could* orgasm, but it was quite the process to get there.

I've been on Effexor for years and haven't experienced any sexual side effects.
posted by sonika at 3:21 PM on January 15, 2014

You mentioned St. John's Wort and how it worked great then began to lose its desired effects - it is something you need to cycle off of periodically to maintain the efficacy.

Another natural supplement you may consider (provided you are not bipolar) is SAM-e (S-adenosyl methionine). It's widely used in Europe for depression and arthritis and should have no sexual side effects. Research has been conducted on its efficacy and many sources are listed in the following articles:


Lamictal and Seroquel, the latter of which I'm still on, has had the least impact on my sex drive or ability to orgasm (compared to Citolopram, Lithium, Effexor and Fluoxetine). The worst offender for me was Citolopram, which killed sexual desire for me and the ability to orgasm. It quickly returned upon stopping that particular med.
posted by stubbehtail at 3:22 PM on January 15, 2014 [1 favorite]

I am not clear if experiencing sexual side effects on one SSRI indicates that you will have sexual side effects on another SSRI. I know that Prozac made me really sleepy, but Zoloft and Celexa did not. None of them gave me sexual side effects that I noticed.

Certainly it seems that being non-responsive to one SSRI doesn't mean you won't respond to another SSRI (see number six in this overview of the STAR*D study). In other words, if one SSRI doesn't work for you, there's a pretty good chance another will. So, we know that different SSRIs have different effects, and it may be worth trying another SSRI to see if the sexual side effects go away.

This is pretty tenuous reasoning, but since you experienced the side effects within a day, it seems like it might be pretty easy to try a bunch of drugs (in sequence of course).

Like most of my Internet brethren, I am not a doctor and am wildly speculating. Good luck.
posted by Renegade Duck at 3:23 PM on January 15, 2014

This is a very common side-effect. Sometimes it goes away after a while.

In my experience it is also a bit of a trial and error game because everyone responds very different to the same antidepressant. For example, stubbehtail writes citalopram killed his/her sexual desire. In my case it had the least side-effects.
posted by jfricke at 3:30 PM on January 15, 2014

I found Mirtazapine great for this stuff. It can make you sleep all the time and gain weight, which leads some doctors to avoid it, but it's been the thing I've taken that was most helpful for both mood and libido stuff.

It might be worth noting that it was something I took when I was profoundly depressed, and really needed the drug I was switching to to a) kick me hard in the brain and b) let me get enough sleep to be able to do something about getting myself back together. YMMV depending on circumstances, and the other potential side effects may not be worth it even if it does help your libido/ability to orgasm.

I'm a lady.
posted by terretu at 3:42 PM on January 15, 2014 [2 favorites]

1. within one day, celexa and cymbalta (SSRI and SNRI) both immediately killed my ability to become aroused or have an orgasm). I'm not cool with this - sex is one of the things in life that brings me joy.

How long did you stay on them though? Celexa and Cymbalta can definitely affect your ability to orgasm, but the first 8 weeks or so are definitely the worst (in my experience, from being on both Cymbalta and Lexapro, a close relative of Celexa). The side effects, including the orgasm stuff, tend to level off after a couple months. You gotta give it time. These are long-term drugs.

Lexapro for me has had the fewest side effects, sexual or otherwise, but there are still some. Might be worth a shot. It doesn't bother me too much, as basically now I can just have sex for a long time, but it can be frustrating. I had to basically just decide to make the trade-off, which, sadly, is what most people on SSRIs or SNRIs especially, seem to come to terms with.
posted by Lutoslawski at 3:45 PM on January 15, 2014 [3 favorites]

I'm currently on Wellbutrin and blood pressure medication. That's an option if it otherwise works for you.

I was on Cymbalta before that, and it gave me all sorts of weird side effects at first: zero sex drive, zero appetite, crazy dreams every night. The first two disappeared after a few weeks, and the dreams went away after about three months. Not being depressed was absolutely worth the trouble. It's common for SSRI/SNRI side effects to fade; I wouldn't assume that any day one effects are permanent.

(I'm a woman, currently in my 30s, with dysthymia that sometimes turns into major depression if untreated.)
posted by Metroid Baby at 3:49 PM on January 15, 2014

I agree that the side effects are usually the worst at the beginning, for both Cymbalta and Lexapro.

Another option is to consider the mood stabilizers. Lamictal is notable for being effective with bipolar depression, and no one I know on it has complained about sexual side effects (I can tell you some fun stories about astonishingly vivid dreams, OTOH.) There's a list of some other similar ideas in this article about antidepressants which aren't antidepressants.

It's also worth contemplating the not-entirely-small body of evidence that treatment resistant depression and antidepressant poop-out are indications that you're more likely to be find success with the same stuff that helps bipolar type II; Lamictal is basically the first in line for those of us with BPII. It's also the first thing that's really stuck for me, though I also depend on several other meds, including Trileptal and Cymbalta, at the moment. That's in part because we're in "let's not mess with things right now because it might cause Fee to lose her job" mode.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 3:55 PM on January 15, 2014 [1 favorite]

I was on celexa for 12 years. No sexual side effects for me until year 10. Currently on Luvox CR... no libido.
Switching to the new Viibryd this week which is supposed to have low sexual side effects. I guess we'll see.
Ive heard people say good things about Luvox not decreasing libido but I havent tried it.

YMMV of course.
posted by KogeLiz at 3:57 PM on January 15, 2014

Zoloft was fine for me - for about a week it seemed to be more difficult than usual to reach orgasm, but I figured that was probably either me overthinking the possibility, or continuing to react to the upsetting circumstances that were the reason I was taking the Zoloft. I'm pretty sure it was fine after that. (For the record: female, then late 20s.)
posted by escapepod at 4:01 PM on January 15, 2014

Ladyperson here. I've been on Viibryd for about 2 years, and while I had some side effects for the first couple months (both sexual and otherwise), everything evened out after that and is currently hunky-dory. So that's at least one data point in favor of Viibryd's marketing as having fewer sexual side effects.
posted by pemberkins at 4:25 PM on January 15, 2014

Tricyclics: cheap, effective for some, no sexual side effects. Down side: dry mouth/eyes/vagina and takes up to two months to gauge effectiveness.

Also helpful to remember that depression is effective at suppressing libido, arousal and orgasm.

Says this BPII female, on psych meds thirty years.
posted by Jesse the K at 5:25 PM on January 15, 2014

29F who finds libido and orgasm . . . challenging on Zoloft. Libido moreso than orgasm; if it's sexy time, I get in the mood right quick, but feel completely indifferent to sex the rest of the time.

But this is sooooo individual. My SO was on Zoloft for a bit in college. And found that not only did it put him to sleep almost 24/7, it also INCREASED his libido to the point of distraction. He switched to Prozac and has had no problems.
posted by chainsofreedom at 6:33 PM on January 15, 2014

Female. Both Lexapro and Cymbalta lowered my sex drive, and when I first went on them (especially Lexapro, which I tried first), I was anorgasmic for a few weeks. Then that side effect went away and I was fine. It's not the same as being unmedicated, but it's only half a tick worse, I think.

Sexual side effects are very much a thing with antidepressants, but you really need to give them more than a day to judge whether they're affecting you in that way. I'd say at least a month.
posted by jaguar at 7:17 PM on January 15, 2014

Celexa knocked me out for 24/7 for the first two weeks (all I did was go to work and sleep), so I can't speak to the first two weeks of libido, but after that I was fine. I'm currently on Pristiq, which is working wonders for the depression, but does seem to give me a bit of the sexual side effects. I've only been on it a couple of months, though. Lexapro, unsurprisingly, didn't give me any side effects either. (Female, BPII)
posted by Meep! Eek! at 7:26 PM on January 15, 2014

as terretu noted, mirtazapine is famous for minimal sexual side effects, though I'm not a lady, I didn't notice any sexual side effects the year I was on it
posted by colin_l at 7:37 PM on January 15, 2014

I'm female and can report no problems in the fun department with agomelatine / Valdoxan. In fact, I have no side effects, once the initial headache and crankiness went away. It's unfortunately not available in all countries. Lexapro didn't help me.
posted by ceiba at 8:10 PM on January 15, 2014

I'm taking Pristiq with barely any side effects at all. I highly recommend it.
posted by mollywas at 9:41 PM on January 15, 2014

The claims for TCAs above don't hold for clomipramine.
posted by professor plum with a rope at 12:49 AM on January 16, 2014

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