Antidepressants and Erectile Dysfunction: Which Cause ED?

In an ideal world, medications would instantly treat our ailments and illnesses with little to no side effects. Actually, in a perfect world, we’d probably have no ailments and anything our heart desires without consequences — like drinking with no hangover.

Unfortunately, while many of today’s medications are effective, they aren’t without a few trade-offs. Case in point: antidepressants.

As one of the most commonly prescribed medications in the U.S. — almost 9 percent of men took an antidepressant between 2011 and 2014 — antidepressants are a proven treatment for relief from mental health conditions like anxiety and major depressive disorder (MDD). However, some of the more common antidepressant side effects include sexual side effects like erectile dysfunction (ED).

But are certain antidepressants more likely to cause sexual dysfunction than others? Can the generic version of an antidepressant, like venlafaxine, cause erectile dysfunction? Can you take Viagra^® with antidepressants?

We’ll answer these questions below, explaining the connection between antidepressants and erectile dysfunction and what you can do if you get antidepressant-induced ED.

A not-so-fun fact: Sexual dysfunction often occurs as a side effect of antidepressants.

In men, the sexual side effects of antidepressants result in reduced sex drive (low libido) or lowered sexual desire, delayed ejaculation, and difficulties with developing and maintaining an erection.

Of course, antidepressants aren’t the only medications that cause ED. But as the first-line treatment for mental health conditions like depression and anxiety, there’s a good chance many men take this type of medication.

It’s also likely that men experience sexual dysfunction while on antidepressants. After all, almost 42 percent stopped taking psychiatric drugs because of sexual side effects.

And although not everyone develops sexual side effects from antidepressants, many people do. In a review published in Annals of Pharmacotherapy, researchers noted that 30 to 60 percent of those prescribed SSRIs (selective serotonin reuptake inhibitors) experience some adverse sexual effects.

Experts aren’t entirely clear on the link between erectile dysfunction and antidepressants, but there are several theories.

One is that antidepressants cause sexual issues as a byproduct of their effect on serotonin. By inhibiting the reuptake of serotonin, antidepressants — such as SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) — increase levels of serotonin in the body and reduce the severity of depression and anxiety symptoms.

Researchers believe this may affect neurotransmitters (chemicals that communicate throughout the brain and body), including some involved in sexual excitement and function.

For instance, increased levels of serotonin are thought to affect testosterone and dopamine. Testosterone is a male sex hormone responsible for libido and sexual function, and dopamine is a “feel-good” chemical involved in achieving orgasm and ejaculation.

Some antidepressants are also linked to increased levels of prolactin — a hormone that can cause low libido and orgasm dysfunction in men.

It’s important to point out that not all sexual dysfunction occurring with antidepressants can be attributed directly to antidepressants.

Sexual performance issues are known symptoms of depression, with ED and delayed orgasm both being common issues. Many men may also have sexual performance anxiety — feeling nervous or anxious about having sex.

There are several other psychological causes of ED, including relationship problems, low self-esteem, feeling guilty about sex or porn use.

Are there specific antidepressants that cause ED, or is it any medication you take for depression or anxiety? For example, is citalopram erectile dysfunction more likely to happen than Prozac^® sexual dysfunction?

Sexual side effects like ED are known to occur with many antidepressants, including the following common medications:

• Citalopram (generic for Celexa^®)

• Sertraline (Zoloft^®)

• Fluoxetine (Prozac^®)

• Paroxetine (Paxil^®)

• Duloxetine (Cymbalta^®)

• Escitalopram (Lexapro^®)

While many antidepressants can cause erectile dysfunction and other sexual dysfunction, some may be more likely than others.

SSRIs and SNRIs — two of the most commonly prescribed antidepressants — cause sexual dysfunction in 25 to 73 percent and 58 to 70 percent of users, respectively.

Tricyclic antidepressants (TCAs), meanwhile, only cause ED and other sexual dysfunction issues in 30 percent of patients.

Sexual side effects as a result of these medications are often referred to as antidepressant-induced sexual dysfunction or SSRI-induced sexual dysfunction.

If you have bothersome erectile dysfunction or other side effects from an antidepressant, don’t abruptly stop taking it.

Abruptly stopping your medication can result in flu-like symptoms, such as nausea, headache, fatigue and other effects relating to antidepressant discontinuation syndrome.

Instead, talking with your healthcare provider about your side effects is best. They may suggest one or several of the following approaches to deal with side effects and treat erectile dysfunction:

• Switching to a different antidepressant. Some antidepressants have a lower risk of causing sexual issues than others. For example, research suggests that sexual issues are significantly more common with SSRIs than with bupropion. If you take an antidepressant known for causing sexual health problems, your healthcare provider may suggest switching to a different medication.

• Adjusting your dosage. Sometimes, dosage rather than the drug itself results in side effects. Instead of changing your medication, your healthcare provider might adjust your dosage to reduce your risk of experiencing issues that affect your sex life.

• Going on a drug holiday. In some cases, your healthcare provider may recommend going on a “drug holiday.” This might mean not taking your antidepressant for a while or reducing your dosage on days you plan to have sex. Drug holidays are considered a “high-risk” treatment option. As such, your provider may request you keep them informed about any side effects or symptoms of depression occurring on medication-free days.

• Waiting for the issues to disappear. If you’re only prescribed antidepressants for the short term, your healthcare provider might simply suggest waiting until you’re done with treatment to have sex regularly. In some cases, antidepressant side effects improve over time. With the “wait and see” approach, you can see if sexual performance improves on its own as your body gets used to the effects of your medication.

• Using ED medication. Suppose you need to keep using your antidepressant. Your healthcare provider may recommend taking ED medication — like sildenafil (the active ingredient in Viagra^®), tadalafil (generic for Cialis^®) or Stendra^® (avanafil) — at the same time. These medications are available as oral pills or convenient chewable ED hard mints.

But since the cause of erectile dysfunction can also be mental, you may also want to determine if anxiety or depression is contributing to ED. If this is the case, talking to a licensed mental health professional in person or via online therapy can help you determine the root cause of your sexual anxiety.

Another question that might have popped up while reading this: Can you take Viagra with antidepressants? Is it safe? Don’t worry — we’re here to answer all your burning questions.

Simply put, yes. Brand-name Viagra, generic sildenafil and other ED medications can be prescribed to treat erectile dysfunction caused by antidepressants.

Other medications for ED include tadalafil (the active ingredient in Cialis^®), vardenafil (Levitra^®) and avanafil (Stendra^®).

One small study of 14 people found that even a mild 25-milligram (mg) dose of sildenafil taken before sex produced measurable improvements for men prescribed SSRIs.

These medications, called PDE5 inhibitors, make it easier for blood to flow to your penis. They typically start working in 30 to 60 minutes and can be taken shortly before sex to prevent ED during the act.

Erections are partly about healthy blood flow. Explore more ways to increase blood flow to your penis for healthy sexual function.

If you’re taking antidepressants and experiencing erectile dysfunction, it may seem like a catch-22. On the one hand, your mental health might be improving, but on the other hand, your sex life could be declining in quality.

So what can be done? Here’s what to keep in mind about antidepressant-induced ED:

• Often used to treat mental health conditions like major depression and anxiety, antidepressants are a common type of medication.

• Like other prescription drugs, antidepressants can come with side effects — a very common one being erectile dysfunction.

• While sexual problems can happen with any antidepressant drug, certain ones may be more likely to cause ED. This includes citalopram, sertraline, fluoxetine, paroxetine and escitalopram.

• If you’re experiencing ED or other sexual side effects of antidepressants, talk to your healthcare provider. They may recommend taking an ED medication, switching to a different antidepressant, changing your dosage or waiting to see if your side effects go away on their own.

You don’t have to deal with ED alone — or keep it a secret. Many men experience this condition, and fortunately, plenty of erectile dysfunction medications and other treatment options are available.

Explore our sexual health platform today to find a solution.