New relationship and starting Lexapro
October 16, 2014 8:07 PM   Subscribe

Effects on libido, dosage, other factors

I was prescribed Lexapro for social anxiety and GAD which is fairly mild (I am functional and enjoy my life but have some hang ups), but which is very long-standing and I'd be curious to see what effects medication have. I am in CBT already. The psychiatrist I saw prescribed 5mg per day, which I understand is a low dosage. I haven't started it yet.

I am also in a new relationship, which is going very well and in which I'm really enjoying the intimacy and the sexual aspects of the relationship. I think in general I have a pretty high libido, but I was going back and forth on whether or not to start the Lexapro because I've read about the sexual side effects, which seem to be decreased libido and inability to orgasm. I'd be really bummed if those became applicable in any significant way. I can probably deal with a slight decrease in libido because I probably have some to spare but in general I very much want to continue to be aroused by and enjoy intimacy with the person I'm seeing. I think my questions are: 1. In a new relationship, there's sort of a surfeit of lust and sexual chemistry. If I started an SSRI would all the lusty brain chemicals be likely to override the libido-related side effects of the drug or vice versa? 2. What is the likelihood/extent of sexual side effects on SSRIs at low dosages in particular? 3. If you took Lexapro for anxiety, especially mild-moderate anxiety, was it worth it?
posted by mermily to Health & Fitness (12 answers total) 4 users marked this as a favorite

I've been through something similar, and I saw it through rosier glasses. (Somewhat) reduced libido could be a valuable bulwark against sexual burnout with this partner. It could create space for other aspects of the relationship (which might otherwise be smothered under all the heat) to develop, mature, and enrich. Thereby setting a much more robust foundation for things to grow forward from.

At an even deeper level, if you really care for this person, it might not be a bad thing to winnow your physical need for sex (i.e. your "horniness", which isn't terribly specific re: who's along for the ride) from the deeper impulse to express deep affection to a cherished someone with your body in a less goal-oriented way. In other words, the drug may (or may not) reduce one's frenetic need to pleasure oneself, but the deeper feelings, more of the heart and the spirit, aren't physical and thus can't be touched by some drug effect.
posted by Quisp Lover at 8:24 PM on October 16, 2014

I took Lexapro for anxiety and it definitely helped (I was taking either 10mg or 20mg per day) and yes, it also reduced libido. But not entirely. Once I got adjusted to the dosage, things were not that different from an unmedicated state.

And honestly (in my case) having my anxiety all running wild and free wasn't exactly ideal for relationships and sexual intimacy either. It's a balance.

I think a 5 mg dose of Lexapro is worth a try if your doctor advises it. You can always stop and adjust as needed.
posted by pantarei70 at 8:33 PM on October 16, 2014 [1 favorite]

I started on the same dose as you and I had decreased libido for a few months, and then things normalized. But even when it was decreased, it wasn't a complete inability to orgasm- it just took more patience and a different type of stimulation.

And in the long run, the decreased anxiety about life made it way easier to enjoy my libido, even at a decreased state.
posted by joan_holloway at 8:41 PM on October 16, 2014

I started on 5mg and didn't notice any effect on my libido at all. (Thinks back.) Mind you, at the time there was a lot of other stuff happening so I wasn't really paying attention. However, in general, I'd say it's one of the kinder, gentler SSRIs to take - apparently it usually has fewer side effects than many of the others. I haven't really noticed any except a bit of nausea when I was coming off it. However, also taking it for depression, not anxiety. Worth it.
posted by Athanassiel at 8:56 PM on October 16, 2014

This is a question for your psychiatrist. Your psychiatrist is a medical doctor more familiar with the side effects of the drug than anybody on the internet. Ask them about sexual side effects first, and then compare to the real-life stories the folks here have to get a handle on it. But your doctor should be asked this.

If there is a potential decrease in libido, and you value your libido generally and the current situation is one where you want to enjoy a new partner, consider not taking the drug and trying a non-drug therapy, such as CBT to deal with GAD and social anxiety. In my experience, CBT is pretty good for depression, GAD and social anxiety.
posted by Ironmouth at 9:13 PM on October 16, 2014 [1 favorite]

Sexual side effects are among the common side effects of SSRIs, but not everyone experiences them. Different studies yield different figures, and no doubt the incidence of sexual side effects suffers from underreporting effects in the literature, but regardless, for Lexapro the numbers for decreased libido or anorgasmia are 10% or less depending on what study(ies) you're looking at. My libido has been low for a long time, but Lexapro (10 mg in my case) hasn't made it any worse, and it's had no impact on my ability to orgasm. I trialed a bunch of other antidepressants first before trying an SSRI out of fear of the dreaded sexual side effects, but it hasn't been a problem (now, these extra 30 lbs since March? That is an issue...)
posted by drlith at 9:17 PM on October 16, 2014

It's quite uncommon not to have anorgasmia (I don't believe the 10% number, and neither does any clinician I've asked about it). But, worse comes to worse, you come off off the medication. So I'd say it's worth a shot. Try tapering up slowly (start maybe at 2mg and work to 5mg over a week).
posted by persona au gratin at 12:09 AM on October 17, 2014

Best answer: Different SSRI (Lexapro didn't work for me, so take this with all the salt in the world), but I had decreased libido and a difficult orgasm from Day 1 and it never went away. 2 years into taking it I met someone awesome, and the new relationship energy was such that we had an active sex life. So, that's good news!

Bad news is that once that wore off, I was back to the status quo, and I find my lack of libido REALLY hard to accept in the context of a long-term relationship. However, Wellbutrin has done a bunch at mitigating that.
posted by chainsofreedom at 3:17 AM on October 17, 2014 [1 favorite]

Personally, Lexapro had no effect on my libido or ability to orgasm. If anything, it actually made things better with a partner, because I wasn't stuck in my head in terms of asking/giving direction, and helped me feel better about communicating needs.

I had a super severe reaction (headaches, felt like I had cramps) when starting it (started at 2.5mg, and slowly slowly increased), so am definitely in the camp of taking it slow when starting. Once things normalized though, all the negative reactions went away.
posted by troytroy at 6:02 AM on October 17, 2014 [1 favorite]

Tangentially realted to sexiness i guess, I took very low dose lexapro for about 2 weeks and it gave me awful gas and my then partner said I would toss and fart all night as well. I couldn't tak ethe gas and blaoting so i gave up on it before noticing any other real effects. Don't know if the gas thing is common, but it was pretty severe / embarassing.
posted by WeekendJen at 7:29 AM on October 17, 2014

Best answer: Anecdata: I've been on a fairly large number of typical and atypical antidepressants attempting to find something that worked for the depressive portion of my bipolar disorder; this included Lexapro. The only one that has ever affected my libido was Effexor, and it was bad enough to make me want to get off of it as fast as possible. (Without giving too many details, I have a high libido even for a male, to the point where numerous partners have commented on it -- but Effexor made any sort of physical intimacy very.. difficult.)

The interaction of these drugs with our own individual brain chemistries is very unpredictable, and can't really be known for any specific person without trying. Any antidepressant has a reasonable possibility of affecting your libido, but you can't know for yourself until it happens.

Are you at a point in your relationship where you'd be comfortable discussing this with your partner? If so, an honest dialog about what you feel you need to do and your concerns could be very useful, both to allay your own worries and to help reduce damage if the drug does have a negative effect on you.

If not, I definitely second the idea of talking to your psychiatrist about this. They are, indeed, MDs, and more than most have a lot of experience with these medications -- and the side effects they can have. Use that as a resource for yourself and express your concerns to your doctor. They may have some positive feedback, or be able to suggest alternative treatments or medication regimes. One possibility would be to ask about anxiolytics that are not antidepressants; Buspar (buspirone) is often prescribed for GAD, and effects on libido are listed as "uncommon", with an incidence of less than 1%. Your doctor may be able to go down this line with you, perhaps?
posted by jammer at 7:34 AM on October 17, 2014 [1 favorite]

Response by poster: Hi all,

I did ask my psychiatrist these questions and had this conversation with her when I got the prescription. She basically said the answer to whether or not there would be sexual side effects was maybe or maybe not, which is why I wanted to pursue finding more information about people's particular experiences with this dosage and whether they were satisfied with the end result. I'm in CBT already. I'll have a conversation with my boyfriend. Thank you for the feedback.
posted by mermily at 1:19 PM on October 17, 2014

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