Major Depressive Disorder (MDD), commonly referred to as Depression, is a common psychiatric diagnosis that involves persistent and intolerable negative affect. While the exact cause is unknown, some prominent theories suggest an imbalance of chemicals in the brain, a genetic predisposition, and environmental factors may increase one’s likelihood of a diagnosis. Symptoms of depression can include, but are not limited to: feelings of persistent sadness, irritability, emptiness, hopelessness, helplessness, guilt, worthlessness, or restlessness. A combination of medications and therapy have been used to treat depression. Some antidepressant medications can result in sexual dysfunction or difficulties, including a loss of libido or increased difficulty having an orgasm. Individuals who are experiencing these difficulties should visit a medical professional to discuss treatment options before discontinuing a medication.
What Is Depression?
Major Depressive Disorder (MDD) is a mood disorder affecting approximately 6.7% of adults.1 Depression symptoms vary from person to person, but commonly include:
- feelings of sadness or tearfulness
- loss of interest in activities that were previously pleasurable
- change in weight and appetite, change in sleep patterns
- difficulty concentrating
- feelings of excessive guilt or shame
- thoughts or plans of death/suicide.
While many people may experience some or all of these symptoms after a significant loss (such as the death of a loved one, divorce, or a job termination), it is important to distinguish between grief and depression. Grief, which may be self-limiting and tolerable, does not necessarily require formal treatment, while depression is a disorder characterized by persistent and intolerable symptoms that can be life-threatening without format treatment.9 Grief-related major depression may also arise after a traumatic loss. It is important to seek medical attention if you believe you may have depression. Depression is commonly treated via psychotherapy, medication, or a combination of both.1
A direct cause of depression has not yet been identified by scientists. The monoamine hypothesis regards a depletion of serotonin, dopamine, and norepinephrine, which are reward-related neurotransmitters, as the primary cause of depression. A probable hypothesis known as the Diathesis Stress Model states that certain individuals may be genetically predisposed, and depression emerges due to an interaction between this predisposition and environmental factors. It is widely accepted that several different factors may account for the development of depression, including one’s biochemistry, genetics, personality, and environment.1 Scientists have pinpointed specific genes that can be inherited from one’s parents and cause fluctuations in brain chemistry. Some evidence supports the transfer of depression genes from parent to child which makes MDD an inheritable disorder.2 Lastly, one’s experiences and environment (their potential exposure to loss, violence, neglect, or abuse) may increase their odds of being diagnosed with depression.1
Symptoms of depression can include feelings of persistent sadness, irritability, emptiness, hopelessness, helplessness, guilt, worthlessness, and/or restlessness. People may also experience a loss of interest in hobbies or activities that they once found joyful, which may include sex. They may also experience somatic symptoms such as body pains, headaches, and cramps along with fatigue and decreased energy associated with insomnia or oversleeping.3 Major Depressive Disorder can be life threatening, as some individuals present with symptoms leading to thoughts of suicide or suicide attempts.1 Sexual dysfunction is also a common symptom of depression and can even be affected by antidepressant drugs.4
Antidepressants and Sex
Between 30 to 70% of people who take antidepressant drugs experience some sexual problems. Sexual side effects most commonly occur in the class of antidepressants called the selective serotonin reuptake inhibitors (SSRIs).5 These drugs include Cymbalta, Lexapro, Zoloft, Prozac, Celexa, Paxil, and others SSRIs.6 The sex-related side effects are proposed to occur due to alterations in other hormones implicated in sexual arousal or pleasure, such as dopamine or testosterone, which may occur as a result of altered levels of serotonin.10 Overall, these antidepressants may cause people of any gender to experience a lowered sex drive or a difficulty achieving orgasm. Additionally, people with vulvas may experience unique side effects, including vaginal dryness and lowered sensitivity, whereas people with penises may experience erectile dysfunction. Keep in mind that not all people taking these specific antidepressants experience sexual side effects. Some antidepressants which focus on dopamine or norepinephrine primarily (including Remeron and Wellbutrin), are known to cause fewer sexual side effects.11 A person should consult their doctor about other options if they are experiencing negative side effects from other antidepressants.6
Treating Antidepressant-Related Sexual Dysfunction
If you or someone you know is experiencing sexual dysfunction or loss of libido which causes distress, it is advisable to seek treatment from a clinician or mental health professional. Sexual dysfunction is a sensitive topic for most people and should be addressed with care. Treatment for sexual dysfunction caused by antidepressants should never be started without first consulting a clinician, as there are risks associated with self-treatment.
If the side effects experienced after beginning an antidepressant cause discomfort or distress, one should consult their doctor and ask about the possibility of changing medications.
When taking an antidepressant that leads to unwanted side effects, it is vital to consult a medical professional about which option is best. Stopping a psychiatric medication without first tapering off can be detrimental to one’s mental health and may cause worsening depression. With the help of a medical professional, a person may change their medication dosage, try a new one, or stop the medication completely, in order to regain the sexual function they desire.6
1. Parekh, Ranna. “What Is Depression?” What Is Depression? American Psychiatric Association, Jan. 2017. Web. 21 Jan. 2017.
2. Fabbri, C., A. Marsano, and A. Serreti. “Genetics of Serotonin Receptors and Depression: State of the Art.” National Center for Biotechnology Information. U.S. National Library of Medicine, 1 May 2013. Web.
3. “Depression.” National Institute of Mental Health. National Institute of Health. Web.
4. Borchard, Therese. “Sex on Antidepressants.” This Emotional Life. PBS, 1 Jan. 2011. Web. 22 Apr. 2015.
5. Rosen, RC. “Effects of SSRIs on Sexual Function: A Critical Review.” Journal of Clinical Psychopharmacology. U.S. National Library of Medicine, n.d. Web. 23 Jan. 2017.
6. Cherney, Kristeen. “Managing Antidepressant Sexual Side Effects.” Healthline. 14 Mar. 2014. Web. 22 Apr. 2015. 7. Baldwin, David, and Andrew Mayers. “Sexual Side-effects of Antidepressant and Antipsychotic Drugs.” BJPsych Advances. The Royal College of Psychiatrists, 1 May 2003.
8. Stulberg, Debra, and Bernard Ewigman. “Antidepressants Causing Sexual Problems? Give Her Viagra.” The Journal of Family Practice. Quadrant HealthCom Inc., Dec. 2008. Web.
9. Zisook, S., & Shear, K. (2009). Grief and bereavement: what psychiatrists need to know. World psychiatry : official journal of the World Psychiatric Association (WPA), 8(2), 67–74. https://doi.org/10.1002/j.2051-5545.2009.tb00217.x
10. Lorenz, T., Rullo, J., & Faubion, S. (2016). Antidepressant-Induced Female Sexual Dysfunction. Mayo Clinic proceedings, 91(9), 1280–1286. https://doi.org/10.1016/j.mayocp.2016.04.033
11. Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The mental health clinician, 6(4), 191–196. https://doi.org/10.9740/mhc.2016.07.191
Last Updated: 9 May 2022.