Depression Medications: Side Effects and Libido, a Follow-Up

The bottom end of a bed is shown with clothes laying on it.Since my last blog, Depression Medications: How Can You Get Your Libido Back? a number of you have asked for more information about possible sexual side effects caused by antidepressants. Before I say more—a cautionary word—I’m a psychotherapist/counselor, not a medical doctor/psychiatrist. So what I write in this blog is drawn from my (extensive) experience working with people who have challenges and/or difficulties with sex—I’m a sexologist, not a psychopharmacologist!

Some of the worst culprits, or libido smashers, are the selective serotonin reuptake inhibitors (SSRIs) such as Effexor, Paxil, Prozac, and Zoloft. Unfortunately, these are all heavily prescribed. I mentioned last month that many folks can benefit from a so-called “drug holiday,” when they forgo their medication for a few days. Be aware that this intervention does not work for Prozac. This is due to the much longer period of time that Prozac remains in the bloodstream, compared to the other shorter-acting SSRIs, like Zoloft.

Several types of antidepressants have virtually no side effects. The most common ones that I hear about are Wellbutrin, Xanax, and Klonopin. I’ll often suggest, to the new people I see, substituting (with the agreement of their medical doctor, of course) Xanax or Klonopin for Wellbutrin because the latter can exacerbate anxiety or “agitated depression,” as it’s called by psychiatrists.

Wellbutrin is also infamous for causing insomnia and headaches, which tend to make most of us anxious, and it certainly doesn’t contribute to an enjoyable sexual connection! Wellbutrin is pharmacologically distinct from the SSRIs, as it enhances the neurotransmitter dopamine, which has the opposite effect on libido and orgasm of serotonin. Xanax and Klonopin are usually prescribed to combat anxiety, not serotonin, so they tend to have very few sexual side effects.

I will often recommend that people who are leery about psychotropics try St. John’s Wort, which is most effective, I’ve found, for Type A blood types (remember, I’m not prescribing, just using anecdotal experience to make these suggestions!). Because it’s not regulated as a pharmaceutical substance, I’m told that efficacy can vary widely.

The individuals I see in my office have reported that Viagra is effective for SSRI-induced absence of orgasm, and I’ve known people of both genders who swear by the botanical preparation ginkgo biloba to reverse libido, arousal, and/or orgasm problems. One sex therapist colleague tells me that Viagra can be helpful for women as well, but no one I work with has directly reported this to me.

If switching to an alternative psychotropic is not clinically appropriate or effective, some doctors might recommend adding another medication on a daily or as-needed basis. Many people are hesitant about taking one drug, let alone two! But for those who are comfortable with it, a second medication can often offer an antidote to the side effects of an otherwise helpful medication.

Most commonly, a sexual-savvy psychiatrist will prescribe a single low dose of Wellbutrin for people complaining of sexual side effects from other antidepressants—employing lower does of Wellbutrin than would be necessary to treat depression alone. These small doses can restore the serotonin-dopamine balance that I mentioned earlier, alleviating sexual side effects.

People starting out with me often ask if I suspect that their sexual problems are relationship issues or caused by medication. I always ask them how long the sexual challenges have been occurring. SSRI-induced sexual dysfunction follows a fairly typical pattern: it begins within days or weeks of starting the new psychotropic medication. For example, a woman may report that she can no longer reach orgasm with her husband within weeks of beginning Prozac for obsessive compulsive disorder.

Women rarely volunteer this immediately, but I ask LOTS of questions, which makes it easier to discuss sexual concerns. Men usually have less hesitation talking about such problems, and as one man said to me recently, “that’s why we came to a sex therapist and not the marriage therapist down the street!” The fact that I coach by phone also seems to help, especially for men, who might have difficulty opening up “when the plumbing doesn’t work!”

Don’t forget—if you have questions about your medications, make sure to discuss them with your medical doctor or psychiatrist.

© Copyright 2011 by Jill Denton, LMFT, CSAT, CCS. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Steve

    February 23rd, 2011 at 4:36 PM

    I was on zoloft for a while for depression and anxiety but I never noticed any decrease in sex drive. As a matter of fact when I was on the medication it made me feel so much better than I had before starting the drugs that I found me and my wife to be closer than before. I guess they can affect people in all kinds of different ways.

  • Beth

    February 23rd, 2011 at 7:04 PM

    Most,if not all, of these drugs have been around for decades now. Ans we still have to take them with their side-effects. Are there no alternatives at all? What about traditional medications from the East? If a person is prescribed one of these drugs for medication, with the side effects being a loss of libido, it is only going to alleviate the depression due to the relationship problems that are bound to occur. So a drug taken for depression is causing depression!!!


    February 24th, 2011 at 4:27 AM

    Side effectsof one drug forcing you to take even more drugs?! No thanks! I would rather go with alternative medicine for depression.

  • Dianna

    February 24th, 2011 at 5:39 AM

    Ok so if it is a decision of feeling so much better than I had been or having sex, I think that while I am healing I will take the feeling better no matter what effect the drugs may have on my libido.

  • Rob

    February 25th, 2011 at 4:11 PM

    How can you tell if it’s the meds or the anxiety itself that’s affecting your libido? My wife’s got new meds for anxiety and her sex drive has plummeted. I don’t know if it’s both or one of them that’s to blame.

  • Jane

    February 26th, 2011 at 6:24 AM

    Are there any moves from the pharmaceutical companies who develop these drugs to push for research into one that does not cause these hormonal fluctuations that could be the cause of lower sex drive in some users?

  • Shaun

    February 26th, 2011 at 9:52 AM

    All the side-effects of medicine make me wonder if it’s even worth it. Look at any bottle of pills and you’ll see a laundry list of things that can go horribly wrong, including heart disease, stroke, death, sweating, and for some bizarre reason, “unpleasant taste”. I’m starting to think that the pharmaceutical companies are having a right laugh at the choices they present.

  • ronan

    February 26th, 2011 at 1:38 PM

    I feel antidepressants cause more problems than they solve. If we made more of an effort to not get so depressed with everything we wouldn’t have this problem in the first place. I find I do better when I consciously focus on seeing the positives than when I’m on meds alone.

  • bruce

    June 21st, 2012 at 1:16 PM

    I have been taking Xanax for a while now .I had Prostate Cancer and thing were looking up in till i starred taking Xanax also i had many financial issues in the past year . I am not doing well sexually and especially in the last month .
    I am using injection therapy but came reach an orgasums unless i am with out my partner

  • Lynne

    August 16th, 2012 at 12:36 PM

    Effexor is not an SSRI. It is SNRI – not only does it affect seratonin but also norepinephrine. Don’t try to take a vacation per say from Effexor. Withdrawl hits quickly with the stuff – mood swings and headaches among other things.

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  • Carolyn Mac Donald

    January 11th, 2017 at 9:37 PM

    I am a physician, although not a psychiatrist. I would caution you about recommending Klonopin or Xanax as an alternative to Wellbutrin or any antidepressant. These medications are benzodiazepines and have a high potential for abuse/misuse/addiction. With close supervision, they can be helpful as an adjunct on an occasional basis for anxiety but as a sole treatment they are as effective as alcohol, i.e., a short-term easy fix with long-term consequences. Anxiety management, relaxation and mindfulness techniques are more effective. A large part of my practice is pain management, where benzodiazepam addiction frequently compounds the problems and dangers of chronic opioid use.


    February 19th, 2019 at 9:41 PM

    I have been taking clonazepam for two or three years.and I am also on propnalol 10 mg.i musterbate every week .ok in years 2014 when I started a relationship the sex was awesome even gud with few drinks also.but beacuse off my drink problem my doctor prescribed me 0.5 mg clonazepam which is bezodizepam any after I taking that my sex life is very it coj off my masterbation or clonazepam.and iget very quickly ejculation which is do in my head in.i had to ejaculation treatment or prevention of masterbation or how do I get me out off this trouble.i got New partner alouth I am more younger than her.but still I had to drink alot for performing gud sex in bed plz let know wat to do

  • Annie Gillies

    December 20th, 2019 at 12:08 PM

    My son has sexual dysfunctions a very long time. He is 40 years old and gave up on woman. He has a great sense of humor if in company,he loves people. He hated Bob Jones University. If my second husband would live he never would allow my son attend that university. They destroyed many student’s life.. Once I went to visit him, it was hard for him to stay w me at a hotel,they let him if separate rooms but we moved in 1 room saving a hundred dollar, 2 beds and I was his mother. We could drive away but he was afraid. In the morning the school’s security came, grabbed him and took him. I was devastated. He has social anxiety, panic attacks and depression, top of it at Bob Jones University made him to stay for a long time because my husband died and they told him, I am a single woman, not his mother. He is 40 yrs.old now and not dating. He had very bad experiences with woman, most likely sexual dysfunction’s and the few woman he had tried to have sex with actually were yelling at him and he was so scarred he stopped dating. I feel so sad and would do anything,if there would be a nice lady who would be kind to him. He has many friends online but not so many in person, but he still has more than I have. I like to be alone. I read and watch TCM.I am an Audiologist (At Hungary) and Hackensack Medical Center) Reg. Pharmacy’s Assist.. I was very nervous all my life as I grown up. Those times in Hungary it was ashamed to go to a psychiatrist. My family was persecuted at 1956 when I was 6 years old. 4 policeman of the communist Russia ( They run down Hungary in one day with their tanks) , they arrest my father who was one of the organizer of the revolution against the communist party at one of the county of Hungary. He was in the “Terror House” in Budapest. They suffered 40 years. I married a psychiatrist at 1975 and came to USA legally. My marriage ended 2 years later because I was always nerves and nobody helped me. They just blamed me for everything. I never told them what a great family I had,my husband met my father in Hungary and told everyone how smart he is. He was a lawyer/author. I am on Clonazepam for years for seizures. I had everyday seizures after they put me on Nardil. A Psychic-analyst misdiagnosing me. I almost died when accidentally ate blue cheese with Nardil, 250/150Bp, emergency room, almost died for Nardil.

    and panic attacks and this is the only medication helping me and I also take doxepine and I never had any problem what my son has. He is taking 0.5mg clonazepam 3 times a day and escitalopram 20mg. Once a day. I read the latest causing sexual dysfunction’s. Now what medication for depression has no side effect with clonazepam? I believe clonazepam is not dangerous since it is only 0.5mg and my son and I never drink alcohol or taking any other drugs. My son need advise. I can not believe in cruelty it doesn’t matter what. He is intelligent just panic/depression which will not go away. I need advise not selling me drugs. Thank you! Happy Holidays! Annie

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