Antidepressants: Which cause the fewest sexual side effects?

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Antidepressants: Which cause the fewest sexual side effects?

My psychiatrist is recommending that I take an antidepressant for my depression. But I'm worried about the sexual side effects. What can be done to prevent or minimize such side effects?

- Jane / Kentucky

Mayo Clinic psychiatrist Hall-Flavin, M.D., and colleagues answer select questions from readers.

Answer

Sexual dysfunction is a frequent side effect of antidepressants. So your concern is understandable. The risk and severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. Common sexual side effects include reduced sexual desire, erectile dysfunction, and difficulty achieving orgasm or ejaculation.

According to a 2007 overview of research, the antidepressants with the lowest rate of sexual side effects include:

Bupropion (Wellbutrin), a norepinephrine and dopamine reuptake inhibitor (NDRI) Nefazodone, a combined reuptake inhibitor and receptor blocker Mirtazapine (Remeron), a tetracyclic antidepressant Duloxetine (Cymbalta), a serotonin and norepinephrine reuptake inhibitor (SNRI)

Selective serotonin reuptake inhibitors (SSRIs) — such as fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) — all have a high rate of sexual side effects. But some research suggests that Paxil is more likely to cause sexual dysfunction than are other SSRIs.

Tricyclic antidepressants — such as amitriptyline, clomipramine (Anafranil), amoxapine and desipramine (Norpramin) — have a lower rate of sexual dysfunction than do SSRIs. However, some research suggests that clomipramine and amoxapine have a higher rate of sexual side effects than do other tricyclic antidepressants.

Exactly how antidepressants interfere with sexual desire and function remains the subject of ongoing debate and investigation. Unproven theories abound. For example, some blame the sedating effect of certain antidepressants for dampening sexual desire. Others speculate that antidepressants cause chemical changes in the parts of the brain that regulate sexual desire and function. Complicating all of this is the effect of depression itself in decreasing sexual desire and function.

It's impossible to predict which individuals are most likely to develop sexual side effects while taking an antidepressant. In some cases, sexual side effects may improve once your body adjusts to the medication. But in others, sexual side effects may last for the duration of treatment. If you experience sexual side effects while taking an antidepressant, consider these strategies:

Talk to your doctor about the possibility of changing your dose. Consider taking a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose. Talk to your doctor about adding or switching to an antidepressant that may counteract sexual side effects, such as bupropion (Wellbutrin) or mirtazapine (Remeron). The anti-anxiety drug buspirone (BuSpar) also may reverse antidepressant-induced sexual dysfunction. Talk to your doctor about taking a medication intended to directly treat sexual dysfunction.

How well these strategies might work depends on the specific drug and your individual circumstances. If sexual side effects are troublesome, talk to your doctor before discontinuing your medication or trying unproven remedies.

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