Sexual Side Effects of Psychiatric Medicines: What Can Help

Changes in your sex life can happen after starting some psychiatric medicines. You may notice less interest in sex, trouble getting aroused, erection problems or changes in orgasm. These problems can feel awkward to talk about. You may also worry that your doctor will ask you to stop a medicine that is helping your mental health.

But you do not have to deal with the problem silently. Your doctor can help work out whether the medicine is causing it and what can be changed safely.

Which Psychiatric Medicines Can Affect Your Sex Life?

Several types of psychiatric medicines can cause sexual side effects. The risk depends on the medicine, the dose and the person taking it.

Antidepressants

Antidepressants are one of the medicine groups most often linked with sexual side effects. SSRIs and SNRIs, such as sertraline, escitalopram and venlafaxine, may cause problems such as:

• less interest in sex
• difficulty getting or keeping an erection
• difficulty becoming aroused
• delayed ejaculation
• difficulty reaching orgasm

In a study of 1,022 people whose sexual function was normal before treatment, 59% developed a sexual problem while taking an antidepressant [1].

If your main concern is erection problems while taking an antidepressant, read our guide to antidepressants and erectile dysfunction.

Antipsychotics

Some antipsychotics can also affect your sex life. They may lower sexual desire or cause problems with erections, arousal or orgasm. Some antipsychotics raise a hormone called prolactin, which can affect sexual function.

The risk is not the same with every antipsychotic [2]. You can learn more about this group in our guide to antipsychotics.

Mood Stabilisers and Anti-Anxiety Medicines

Sexual side effects have also been reported with some mood stabilisers and anti-anxiety medicines, including benzodiazepines [5]. There is less research on these medicines than on antidepressants and antipsychotics.

Not everyone taking psychiatric medicine will have sexual side effects. Two people taking the same medicine may have very different experiences.

What Sexual Side Effects Can Psychiatric Medicines Cause?

The changes are not always about erections. Psychiatric medicines can affect different parts of your sex life. You may notice:

• less interest in sex
• difficulty getting or keeping an erection
• less sexual arousal
• vaginal dryness
• delayed ejaculation
• difficulty reaching orgasm
• orgasms that feel weaker than before

You may have one of these problems or several. Women can experience sexual side effects too. In a study from Lucknow, researchers looked at 50 women taking escitalopram whose depression had improved. Half had sexual difficulties. Low sexual desire was the most common problem [3].

Rarely, some medicines can cause a painful erection that lasts for hours and does not go away. This needs urgent medical care.

Is It the Medicine or the Mental Health Condition?

Sometimes it can be difficult to tell.  Depression itself can lower your interest in sex and affect sexual function. Anxiety, stress and relationship problems can also affect your sex life. Physical health problems can play a part too. These include: diabetes, high BP, thyroid problems, hormone problems, alcohol use and other medicines

One useful clue is when the problem started. For example, if your sex life was fine before starting a new medicine and the problem appeared soon after, the medicine may be playing a role. But this does not prove that the medicine is the only cause. Your doctor can look at the full picture before deciding what may be happening.

A sexual side effect can be frustrating, especially when the medicine is otherwise helping. But suddenly stopping treatment may cause withdrawal symptoms or allow the mental health condition to return. Speak to your doctor before changing the dose or stopping the medicine.

Should You Stop the Psychiatric Medicines If You Notice Any Sexual Problem?

No. Do not stop it on your own. Stopping some psychiatric medicines suddenly can cause withdrawal symptoms. The condition being treated may also return or become worse. The same applies to skipping tablets before sex. Do not change how you take your medicine unless your doctor tells you to.

If sexual side effects are bothering you, tell your doctor instead. There may be ways to manage them without giving up a treatment that is helping you.

If you have already stopped your medicine and your mental health is getting worse, contact your doctor. If you feel you may harm yourself or cannot stay safe, seek urgent help or use our crisis support and helplines.

What Can Your Doctor Do About Sexual Side Effects?

There is no single solution that works for everyone. What your doctor suggests will depend on the medicine you take, how well it is working and what sexual problem you are having. They may consider:

Waiting and Reviewing

Sometimes sexual side effects improve after your body gets used to a medicine. If the problem is mild and the medicine is working well, your doctor may suggest waiting for a while and checking again.

Changing the Dose

For some medicines, a lower dose may reduce sexual side effects. But do not lower the dose yourself. Your doctor needs to make sure that the medicine still works and that the change is made safely.

Changing the Medicine

If the problem continues, your doctor may consider another medicine. Some psychiatric medicines are less likely to cause sexual side effects than others. The right choice depends on the condition being treated and your overall health.

Treating the Sexual Problem

Sometimes the psychiatric medicine can stay the same and the sexual problem can be treated separately. For example, sildenafil may help some men who develop erection problems while taking antidepressants [7].

The treatment will depend on the type of sexual problem you have. Any new medicine should be checked by a doctor to make sure it is safe to take with your current medicines.

Can Sexual Side Effects Continue After Stopping Psychiatric Medications?

For many people, sexual function improves after the medicine is stopped or changed [5].

However, sexual problems have sometimes been reported after certain antidepressants have been stopped. In 2019, the European Medicines Agency asked for warnings that sexual problems may continue after stopping SSRIs and SNRIs in some cases [8].

It is not clear how often this happens. If a sexual problem continues after you stop a psychiatric medicine, tell your doctor. Do not assume you simply have to live with it.

How Do You Talk to Your Doctor About It?

You do not need to use medical words or explain everything perfectly. You can simply say that “Since starting this medicine, I've noticed a change in my sex life.” It can also help to tell your doctor:

• what changed
• when you first noticed it
• whether it started after a new medicine or dose change
• whether your mental health has improved
• any other medicines you take

If you would rather discuss this without a partner or family member in the room, you can ask to speak to your doctor privately.

Getting Your Mental Health and Sex Life Back on Track

Sexual side effects from psychiatric medicines can be frustrating, but you do not have to ignore them. The first step is to tell your doctor what has changed. They can check whether the medicine, your mental health condition, another health problem or a combination of these may be responsible.

Depending on the cause, they may wait and review, change the dose, switch medicines or treat the sexual problem separately. Most importantly, do not stop or change your psychiatric medicine on your own. The aim is to find a treatment plan that supports both your mental health and your sex life.