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  • mednickmd

Prozac got your sex life down?

Updated: Mar 30, 2022

You do not have to choose between your mental health and your sex life.

SSRIs can be incredibly effective treatments for anxiety and depression. Unfortunately sexual side effects are very common. However that does not mean that you have to simply grin and bear it.

Many people hesitate to bring up sexual side effects with their doctors. Many of my patients who do bring this up will apologize first or call it "TMI." There is no such thing as TMI when it comes to psychiatric care - everything can be relevant! If you don't feel comfortable telling your doctor about any of your side effects, you may need to consider a new doctor. Addressing side effects is a major part of psychiatric care.

There are some ways to get around sexual side effects. If your doctor deems it safe, you can skip a dose of medicine on a day you've planned intercourse. It's not exactly romantic, but it often works - the sexual side effects have been known to wear off before the symptoms have time to kick back in. Even if it's not a sustainable plan, it can still help you figure out if the meds are the problem or not.

Side effects also vary by SSRI. One may affect you strongly while others do not. Some of the newer generation SSRIs (Trintellix, Viibryd), have been touted to be side-effect free (I've seen mixed but promising results). By one large review study, Paxil was the worst offender as far as orgasm dysfunction, affecting almost 60% of patients, while Luvox was the best down at 9%. On arousal and desire dysfunction, Celexa weighed in at a hefty 75% compared to Lexapro affecting less than 5% of patients. And on total sexual dysfunction, Zoloft was tops with 80% and Luvox lowest at 25%. The other SSRIs in each group fared somewhere in between (data from Inder & Castle 2011, Serretti & Chiesa 2009). All of this means that switching medications may alleviate the problem, while still maintaining the benefit of the treatment.

In addition, there are medications that may be added on to alleviate some of the problem. Don't settle for mood relief OR a sex life - it is entirely possible to have both.

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