Antidepressants and Erectile Dysfunction

If you’ve been diagnosed with major depression or an anxiety disorder, your healthcare provider may prescribe an antidepressant to improve your mood and provide relief from your symptoms.

Antidepressants are some of the most commonly used prescription medications. In fact, almost 13 percent of all people aged 12 and up in the United States took antidepressants on a monthly basis at some point between 2011 and 2014.

Unfortunately, antidepressants were part of the list. (Even more unfortunate? Depression erectile dysfunction is also very possible.) As it happens, antidepressants and erectile dysfunction actually have a very close link that most men might not even think about prior to or during treatment. 

In fact, antidepressants are one of the types of medication most closely associated with sexual dysfunction in men. 

Below, we’ve explained what antidepressants are, as well as how certain antidepressants can lead to sexual performance issues such as erectile dysfunction. 

We’ve also shared the treatment options that are available if you’ve recently started to take an antidepressant and need help dealing with ED. 

What Are Antidepressants?

Antidepressants are medications used to treat depression and anxiety. They work by changing the levels of certain natural chemicals, called neurotransmitters, in your brain and body.

Neurotransmitters are involved in regulating many aspects of your thoughts, feelings and bodily functions. For example, the neurotransmitter serotonin -- a common target of antidepressants -- is involved in regulating mood, happiness and anxiety.

By increasing your levels of certain neurotransmitters, antidepressant medication can stabilize your moods and reduce the severity of depression and certain forms of anxiety.

Several different types of antidepressants are used today. Your healthcare provider may suggest using one of the following classes of antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs). These are the most widely used and common antidepressants. They work by increasing serotonin levels. SSRIs are typically used as first-line treatments for major depression and other depressive disorders.

• Serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants work by increasing serotonin and norepinephrine levels. They’re often used when SSRIs are ineffective at controlling depression symptoms.

• Tricyclic antidepressants (TCAs). These older antidepressants work by targeting five different neurotransmitter pathways. They’re equally as effective as SSRIs, but have a higher risk of causing adverse effects and generally aren’t prescribed as often.

• Monoamine oxidase inhibitors (MAOIs). These antidepressants were first launched in the 1950s. Because of their high risk of side effects and drug interactions, they’re rarely used except when other medications aren’t effective.

• Other antidepressants. Not all antidepressants fit into a distinct category. Some drugs used to treat depression, such as bupropion (Wellbutrin®), are commonly referred to as atypical antidepressants due to their different mechanisms of action and effects. 

Our full list of antidepressants goes into more detail about these medications, how they work as treatments for depression and their potential risks and side effects. 

Can Antidepressants Cause Erectile Dysfunction (ED)?

Not-so-fun-fact: Many antidepressants cause sexual dysfunction as a side effect. In men, this is most commonly manifested as a reduction in sex drive (decreased libido) and difficulties with developing and maintaining an erection.

In addition to reducing sexual desire and affecting your erectile health, certain antidepressants can also cause orgasmic dysfunction (difficulty reaching orgasm and ejaculating). For example, Lexapro may cause delayed ejaculation.

Sexual side effects such as erectile dysfunction are known to occur with many antidepressants, including the following common medications:

• Citalopram (Celexa®)

• Sertraline (Zoloft®)

• Fluoxetine (Prozac®)

• Paroxetine (Paxil®)

• Duloxetine (Cymbalta®)

• Escitalopram (Lexapro®)

These sexual side effects are often referred to as antidepressant-induced sexual dysfunction or SSRI-induced sexual dysfunction.

Although not everyone develops sexual side effects from antidepressants, many people do. In a review published in the Annals of Pharmacotherapy, researchers noted that between 30 and 60 percent of people prescribed SSRIs experience some negative sexual effects.

So in short, yes, antidepressants can and often do cause ED. If you’re prescribed one of these medications and notice weaker erections or a dulled sexual response, there’s a good chance it could be a side effect of your antidepressant treatment.

Another not fun fact: nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen can also cause sexual dysfunction.

How & Why Antidepressants Cause Erectile Dysfunction

Although experts aren’t aware of exactly why some antidepressants cause erectile dysfunction, there are several theories about the sexual side effects of antidepressants. 

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 SNRIs increase levels of serotonin in the body and reduce the severity of depression and anxiety symptoms.

Researchers believe that this may affect other hormones and neurotransmitters, including some that are involved in sexual excitement and function.

For example, increased levels of serotonin are believed to affect testosterone, an important sex hormone responsible for libido and sexual function, and dopamine, a “feel good” chemical that’s involved in achieving orgasm and ejaculation.

Some antidepressants, including escitalopram and sertraline, 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 that occurs with antidepressants can be attributed directly to antidepressants.

Sexual performance issues are known depressive symptoms, meaning they develop in people with depression. In women, a common symptom of depression is vaginal dryness. In men, ED and delayed orgasm are both common issues.

If You Get ED, Should You Stop Taking Your Antidepressant?

If you’ve recently started to take an antidepressant and notice that you’re beginning to develop erectile dysfunction or another sexual side effect, you may have considered stopping treatment to prevent the issue from getting worse. 

This isn’t a good idea for several reasons. The first is that stopping treatment might cause your depression to either come back or worsen. The second is that abruptly giving up treatment with antidepressants can cause withdrawal symptoms.

Referred to as antidepressant discontinuation syndrome, these symptoms can include nausea, flu-like issues, insomnia, dizziness, sensory disturbances and mood changes, such as agitation and irritability. 

These symptoms often develop within a few days of stopping your medication and can continue for several weeks at a time.

What to Do if You Get Antidepressant-Induced ED

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

Instead, it’s best to talk with your healthcare provider about your symptoms. They may suggest one or several of the following approaches to deal with your side effects and treat your 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 drugs such as bupropion.If you’re prescribed an antidepressant that’s known for causing sexual health problems, your healthcare provider may suggest switching to a different medication.

• Adjusting your dosage. Sometimes, it’s the dosage rather than the drug that 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 suggest going on a “drug holiday” by not taking your antidepressant or reducing your dosage on days when you plan to have sex.Drug holidays are considered a “high-risk” treatment option. Your healthcare provider may ask you to keep them informed about any side effects or symptoms of depression that occur 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 regularly have sex.In some cases, antidepressant side effects improve over time. Your healthcare provider may suggest a “wait and see” approach to see if your sexual performance improves on its own as your body gets used to the effects of your medication.

• Using ED medication. If you need to keep using your antidepressant, your healthcare provider may recommend taking ED medication such as sildenafil (the active ingredient in Viagra®) at the same time. Research has found that oral sildenafil helps to improve erections and other aspects of sexual function for many men who use antidepressants.

Can You Take Viagra With Antidepressants?

Put simply, yes. Both brand name Viagra, generic sildenafil and other ED medications are often used to treat erectile dysfunction that’s caused by antidepressants.

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

These medications, which are called PDE5 inhibitors, work by making 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 improve your erectile function and prevent ED. 

Several studies have found that PDE5 inhibitors work well at treating antidepressant-associated sexual dysfunction such as ED. In one small study of 14 people, even a mild 25mg dose of sildenafil taken prior to sex produced measurable improvements for men prescribed SSRIs.

Our guide to the most common erectile dysfunction treatments explains how these medications work, their potential side effects, how to use them and more. 

Take Action to Treat Antidepressant-Induced ED

Antidepressants are highly effective for the treatment of depression and other mental illnesses, but they often cause side effects. 

Unfortunately, for many men, these can include sexual health and performance issues such as erectile dysfunction. 

If you take antidepressants and develop ED, it’s always best to talk to your healthcare provider about your options. They may recommend adjusting your dosage, switching antidepressants or making other changes to reduce the severity of your side effects. 

Another option is to use ED medication. We offer several FDA-approved ED medications online, which are available after a consultation with a licensed healthcare provider who will determine if a prescription is appropriate. 

Interested in learning more about successfully treating ED? Our guide to the causes of erectile dysfunction goes into more detail about how erectile dysfunction develops, as well as the steps that you can take to get rid of it for good.