What the evidence shows
Sexual side effects can include reduced libido, difficulty with arousal, delayed or absent orgasm, and erectile difficulties. Prevalence varies meaningfully by medication and dose. Patient surveys, summarised in Royal College of Psychiatrists resources, suggest that sexual effects are underreported to prescribers — patients often do not raise the issue, and prescribers often do not ask. The first step in managing this is naming it, in the same way you'd name any other common side effect worth tracking.
Why it happens
The mechanism is primarily serotonergic. Increased serotonin availability quiets activity in pathways that regulate sexual response. Maudsley Prescribing Guidelines describe this as a class-wide effect of SSRIs, with profile varying by specific medication. Some antidepressants are notably less likely to cause sexual side effects than others.
Conversations worth having with your prescriber
Options exist, and prescribers expect this conversation. Possibilities documented in clinical guidelines include:
Dose reduction. Often the simplest intervention, and worth raising first with your prescriber.
Switching medication. A switch to a medication with a lower sexual-effects profile is a recognised option.
Augmentation. Adding a specific medication alongside your current one can offset the effect for some patients.
Temporary dose holidays. Only under prescriber direction — not all medications support this safely.
The right path varies by your specific medication and situation, and it's exactly the kind of thing worth raising at your next follow-up appointment.
What to flag to your prescriber
Raise these with your prescriber or seek care
- Sexual side effects affecting your relationship or wellbeing.
- Sexual side effects that have not improved over months.
- Painful intercourse — this is not the same as a typical sexual side effect and warrants medical assessment.
- Inability to perform at work or in daily activities related to fatigue.
Frequently asked questions
Are sexual side effects from antidepressants permanent?
For most patients sexual side effects resolve when the medication is changed or stopped. A small minority report persistent symptoms after discontinuation, which is an area of ongoing research.
Can I do anything about it without stopping my medication?
Yes. Options include dose adjustment, switching medications, augmentation strategies, and behavioural approaches. Speak to your prescriber — sexual side effects are a recognised reason for adjustment.
Why didn't my prescriber mention these side effects?
Sexual side effects are commonly under-discussed in primary care. You are entitled to raise them and to ask for options. Patient resources from the Royal College of Psychiatrists explicitly recommend doing so.
Evidence and sources referenced
- NICE Guideline NG222 — Depression in adults: treatment and management (United Kingdom).
- Royal Australian and New Zealand College of Psychiatrists (RANZCP) — Clinical Practice Guidelines for Mood Disorders.
- NPS MedicineWise — prescriber and patient resources on antidepressant treatment (Australia).
- Royal College of Psychiatrists — patient information on antidepressants.
- TGA and FDA — product information for SSRI and SNRI medication classes.
- Maudsley Prescribing Guidelines in Psychiatry — prescribing patterns and side-effect timelines.
Related reading
Keep a calmer record of the first 90 days
If you want a calmer way to keep a short daily record across the first 90 days, Causiq is being built for exactly that.
Join the waitlist