Are you on Antidepressants? Having Sexual Dysfunction? You are in good company!

I feel like more and more people lately have been pulling me aside to ask me questions about either a low sex drive, no sex drive, or men are having erectile dysfunction (at young ages)…and each time I ask, “Is there any chance you are on an antidepressant or SSRI”? Without a doubt, the answer is always “yes, is this related?” and the lightbulb goes off.  This makes me think that HCPs don’t necessarily do a great job preparing patients for the side effects of these medications that can be used to treat anxiety, depression, post traumatic stress disorder (PTSD), along with other issues.  It is neither abnormal to have these side effects nor be on one of these medications….just to get that out there! And there are certain Selective Serotonin Reuptake Inhibitors (SSRIs)/antidepressants that cause more sexual side effects than others.

What is considered sexual dysfunction?

Well, a lack of interest in sexual intimacy for someone who once had a higher sexual drive is considered sexual dysfunction, along with erectile dysfunction (for men) and vaginal dryness and decreased sensitivity (for women).  Also, for both sexes, antidepressants can lead to a decrease in the ability to achieve orgasm….or make it much more difficult to reach orgasm.  This happens in one form or another to almost everyone at some point in their lives (whether they want to admit it or not) and many antidepressants just increase these issues, but they are so helpful in treating depression and anxiety.

What Antidepressants have a lower risk of sexual side effects?

-Buproprion (Wellbutrin- in all forms including XL and SR)

-Mirtazapine (Remeron and Remeron SolTab)*

*One study showed a very high rate of sexual dysfunction, while a couple of other studies showed much lower rates. Due to that, I am suggesting it as a lower rate drug, but you should talk it out with your HCP.

Which ones have higher rates of sexual dysfunction?



-Paxil (almost half of all users experience sexual dysfunction)





Is there anything I can do to combat the sexual side effects?

YES!  If your antidepressant is working well and you feel good on it, there is no need to change medications (it is an option if you are just starting a medication or are switching meds, you can ask your HCP for one that may have lower sexual side effects), but there are also other options to help and improve your sexual desire while improving your mental state, because a huge component of the sexual dysfunction is mind over matter.  Really. People stress themselves out because they do not have a strong sexual desire, so they anxious about performing, etc. and then they have difficulty performing.  Some tips to try to work through it:

-Talk to your partner about your concerns…sometimes talking about it alleviates some of the fears related to sexual performance.

-If you take your antidepressants at night, schedule to take it a little later that night if you plan on having a special night with your significant other.

-Talk to your HCP about lowering your dose, do you ned to be on the dose you are?  Also, there are studies that show some people do very well on drug “holidays”; maybe taking their antidepressants Sunday through Thursday so they have a good level of the drug in their system but they can have more of a sexual desire on weekends.

-Add another medication: 50-100mg of Viagra or 5-20mg of Cialis taken before sexual activity has been shown in studies to improve arousal, erectile function, and lead to meaningful orgasm (men).  Low doses of Viagra have also been found to help women with their sexual arousal and ability to reach orgasm.

I am not advising to stop medications or decrease doses without talking to your HCP, they know you and your needs better than I do, but it is important to talk about these things with them.  Really, they should be asking you how your sex life is after you start these medications…but if they don’t screen you, tell them! We are so used to getting questions like this, it is great to have it out in the open, so please do not suffer in silence, your HCP will work with you no matter what route you want to take in treating your side effects from your antidepressants.

So get chatting with your HCP and get humping with your partner (safely)  😉

Yours in Good Health



This is a little hard to talk about: Erectile Dysfunction

Many people are unclear as to what Erectile Dysfunction (ED) actually is, despite those really ridiculous Cialis and Viagra commercials on TV (which can be horribly awkward to watch in mixed company at times!!) ED affects between 15 and 30 million men in the US and approximately 22.3% of all office visits to HCP’s are for ED.  It is something that many men are embarrassed about and feel unable to speak to their partner about, and it can cause huge rifts in relationships. It is important to know that signs and talk to your partner about it, it is a physical issue that is normal, and totally fixable, so go to the doctor together and make it a couple problem, and don’t let your partner suffer and feel badly alone!

What exactly is the definition of ED?

It’s the inability to maintain an erection that is firm enough to have sex, on an ongoing basis, along with trouble getting an erection, difficulty maintaining an erection, and/or a reduced sexual desire.  If you have any of these symptoms, especially if you have diabetes or heart disease, you should go see your HCP and talk to them about it, your options, and to find out what might be going on with your body. Don’t let it get too far that your partner might get upset or think that they are the one causing the problem…be open about it and go to see your HCP.

erectile-dysfunctionWhat are the causes?

There are SO MANY possible causes of ED, in which some are physical, mental, and a combination of the two.  Some physical causes are: heart disease, atherosclerosis, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson’s disease, Multiple sclerosis, low testosterone, Peyronies disease (a build up of scar tissue in the penis), tobacco use, alcohol (alcoholism), substance abuse, pelvic/spinal cord surgery, enlarged prostate, and prostate cancer.  So, obviously it goes from being something that is easily fixed, to things that are more serious. As far as psychological issues: stress, depression, anxiety, fatigue, and relationship issues can all cause ED. Another psychological reason that many men have a form of ED, in this current society, is due to the inability to get their partner pregnant; we have a society wrought with infertility and it can case serious relationship problems on many levels. As well, many medications that your HCP might put you on for various health issues, can also cause ED.

Before you go to your HCP appt:

Write down symptoms that you have had even including things that you might think unrelated to ED.  Also, write down any life changes going on, including anything that might be causing relationship stress.  An update list of current prescribed and over the counter medications are always important to bring to every appointment, but especially to an appointment regarding ED.  Try to bring your partner to your appt and both of you talk before you go and both write down list of questions both separately and together.

What might happen at/after your appt?

A physical exam, which is standard at all appointments, but your HCP will inspect your penis, testicles, and check for nerve feelings.  Most likely you will have blood drawn to assess your risk of heart disease, diabetes, cholesterol, and testosterone levels.  A urinalysis may be performed to also look at your risk of diabetes, etc.  An ultrasound may be done to look at blood flow to your penis, it uses a plastic probe on the outside of your penis to project a video of the current blood flow (a non invasive exam). They also might have you go home and perform an overnight erection tests; many men have erections at night during sleep, and have no idea that they had an erection, if the test is positive, then the reason you have ED is psychological.  What they will ask you to do is to put a piece of tape that they will give you (it is easily split) around your penis, and if you wake up in the morning and the tape it split open, you’ve had an erection.

How do we treat it?

You can take oral pills like Viagra, Cialis, and levitra which are medications that enhance your bodies natural nitric oxide levels which helps muscles relax and allows more blood flow to your penis, allowing for a stronger erection.  You may need to change doses and change times that you take before getting an erection.   You need to talk to your HCP to take these drugs if you also take any nitrate drugs like nitroglycerin, Imdur, or Isosorbide because you can have too much of a build up of nitrates in your blood.  Also be careful with blood thinners and alpha blockers (for enlarged prostate).  Your HCP will have to discuss using medications if you have had a stroke, have either low blood pressure or uncontrolled high blood pressure, heart disease or heart failure, and/or uncontrolled diabetes.
Other medication options:
Alprostadil injections: a small needle is inserted in the base or side of the penis and you inject the medication, due to the small size of the needle there is usually little to no pain, and you can get an erection within 5-20 minutes and the erection usually lasts around an hour.
Alprostadil penis suppository: Using a special applicator, you insert a small suppository 2 inches up the inside of the urethra. The side effects can be pain, bleeding from the urethra, dizziness, and can cause a fibrous build up inside your penis.
Testosterone replacement: if you have low testosterone levels, oral supplements can help to increase your levels and ability to maintain/obtain an erection.
Other options:
Penis pumps: a hallow tube with a hand or battery-powered pump, you put your penis inside, pump out the extra air, which causes blood to flow to the penis and cause an erection, you need to put a tension ring on the base of your penis, then remove the pump.  The erection usually lasts long enough to have sex, then remove the tension ring.
Penile implants: implants are surgically places on both sides of the penis, either inflatable or semi rigid rods.  The inflatable implants, are inflated before sexual intercourse to help obtain an erection and the semi rigid rods allow for a firm but flexible penis at all times. Due to it being surgical in nature, there is a risk of infection, and usually a later option for ED.
Blood vessel surgery: at times a leaking vessel can cause a decrease in blood flow to the penis, a simple surgical procedure may be able to fix that problem.
Psychological counseling: if the problems are psychological in nature, counseling can help to talk about the problems and may help to decrease ED issues.

How can you fix it with lifestyle changes?

If you use tobacco, quit. Lose weight to get to a healthy level, exercise regularly, get treatment for alcohol and drug abuse, and work through relationship issues with your partner and with the help of a professional.

Alternative medicine:
Acupuncture is said to help with ED and relieve stress and anxiety, so it can help with some psychological problems.

Due to all of the possible causes, it is not only the first sign that something serious might be going on, but it also is something that might be fixed simply and easily, so I really encourage seeing an HCP early to talk about it.  Be open and honest with yourself, your partner, and your HCP.  ED is not something to be embarrassed about or something that you should allow to ruin a relationship.  If you notice any of these problems with yourself or your partner, please talk about it and go see you HCP ASAP!!

Yours in Good Health