Is Erectile Dysfunction Caused by Antidepressants Permanent?

Sexual side effects—including anorgasmia (failure to have an orgasm), genital anesthesia, low libido (low desire to have sex), and erectile dysfunction (ED)—are very common among patients who take selective serotonin reuptake inhibitors (SSRIs). Commonly prescribed SSRI antidepressants include Zoloft (sertraline) and Prozac (fluoxetine).

Until recently, experts have assumed that sexual dysfunction always resolves after someone stops taking SSRIs. But recent research indicates that sexual side effects, including ED, can persist even after SSRI treatment stops. 

This article discusses post-SSRI sexual dysfunction (PSSD), including causes, treatment, prevention, and more.

SSRI Side Effects and Erectile Dysfunction

SSRIs are often the first-choice treatment for major depressive disorder (MDD). They work to treat depression by increasing the brain’s level of serotonin—a neurotransmitter (chemical substance that carries messages between nerves) involved in emotional regulation, mood, and sleep. 

Some examples of SSRIs include: 

• Zoloft (sertraline)
• Prozac (fluoxetine)
• Celexa (citalopram)
• Paxil (paroxetine)
• Lexapro (escitalopram)

In general, SSRIs are safe and effective in treating depression. However, 25% to 73% of people who take SSRIs experience sexual side effects. In fact, most people who take an SSRI experience genital sensory changes within 30 minutes of taking the drug.

Sexual side effects of SSRIs may include:

• Erectile dysfunction (ED), and inability to achieve or maintain an erection sufficient for penetrative sex
• Anorgasmia
• Delayed orgasm
• Diminished orgasm
• Low libido
• Genital arousal (irritability)
• More rarely, genital anesthesia (numbness or lack of pleasure in the genital area)
  

What Is Post-SSRI Sexual Dysfunction?

SSRIs have been prescribed to treat depression and other mental health disorders since 1987. In 2006, researchers began to formally investigate a condition known as post-SSRI sexual dysfunction (PSSD) syndrome. 

Patients with PSSD continue to experience sexual side effects like genital numbing, erectile dysfunction, and low libido even after they stop taking SSRIs. In rare cases, sexual dysfunction may persist for decades and even get worse over time.

Antidepressants Most Likely to Cause ED

Many of the most popular SSRIs—such as Zoloft, Prozac, Lexapro, and Paxil—have sexual side effects. Some SSRIs are more likely than others to cause ED.

Zoloft Side Effects in Men

Zoloft is a commonly prescribed SSRI. Zoloft side effects in men may include delayed ejaculation, penile anesthesia, reduced sexual desire, and difficulty sustaining an erection.

However, research indicates that Zoloft is somewhat less likely to cause erectile dysfunction or post-SSRI sexual dysfunction than some other SSRIs.

Lexapro Side Effects in Men

Lexapro is usually prescribed to treat depression or generalized anxiety disorder (GAD). Lexapro sexual side effects include ED, delayed and diminished orgasm, and reduced sexual desire. Lexapro is somewhat more likely to cause sexual side effects than Zoloft.

Learn more about Lexapro vs. Zoloft.

Paxil Side Effects in Men

Paxil is prescribed to treat MDD and various other mental health conditions, including post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). 

Paxil sexual side effects in men include ED, low libido, anorgasmia, and genital anesthesia. In women, Paxil may also cause inadequate lubrication.

Research suggests that Paxil is the SSRI most likely to cause ED and other kinds of sexual dysfunction. It’s a last-choice treatment for many healthcare providers if sexual dysfunction is a concern.

Prozac Side Effects in Men

Prozac is commonly prescribed to treat MDD, OCD, and panic disorder. Prozac's sexual side effects may include ED, low libido, penile anesthesia, and anorgasmia. However, sexual dysfunction is slightly less common with Prozac than with other SSRIs.

SSRIs Best for Avoiding Sexual Dysfunction

Because SSRIs are so effective in treating depression, many people want to continue taking them despite sexual side effects. 

Some evidence from older studies suggests that Luvox (fluvoxamine) may cause fewer sexual side effects than Zoloft and other SSRIs. However, it still causes a significant number of sexual side effects. Luvox is usually prescribed for OCD, but healthcare providers prescribe it “off-label” to treat symptoms of depression as well.

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another class of antidepressants. In addition to MDD, SNRIs are prescribed to treat anxiety disorders and chronic nerve pain. 

Examples of common SNRIs include: 

• Pristiq (desvenlafaxine)
• Effexor XR (venlafaxine)
• Cymbalta (duloxetine)

Studies indicate that SSRIs and SNRIs lead to similar sexual problems, including abnormal ejaculation, painful ejaculation, and post-SSRI sexual dysfunction.

Cymbalta Side Effects in Men

Cymbalta (duloxetine) is prescribed to treat symptoms of depression, anxiety, and chronic pain. Cymbalta sexual side effects include ED, delayed orgasm, and loss of interest in sex. These side effects are especially pronounced among people who respond well to the drug overall.

Tricyclic and Tetracyclic Antidepressants (TCAs and TeCAs)

Tricyclic and tetracyclic antidepressants (TCAs and TeCAs) such as Pamelor (nortriptyline), Anafranil (clomipramine), and Elavil (amitriptyline) were part of the “first generation” of antidepressants. For many years, they were considered the first-line treatment for depression.

In recent years, they have been largely abandoned in favor of SSRIs due to a higher frequency of severe side effects.

Because they work similarly to SSRIs, TCAs and TeCAs can also cause delayed ejaculation, low libido, and erectile dysfunction.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase inhibitors (MAOIs), first developed in the 1950s, are a strong class of antidepressants. Examples of MAOIs include:

• Nardil (phenelzine)
• Marplan (isocarboxazid)
• Parnate (tranylcypromine)

About 40% of people who take MAOIs experience sexual side effects, including delayed orgasm and low libido.

Antidepressants Least Likely to Cause ED

While many antidepressants cause erectile dysfunction, some prescription medications can help to ease the symptoms of depression while avoiding sexual side effects.

Norepinephrine and Dopamine Reuptake Inhibitors (NDRIs)

Norepinephrine and dopamine reuptake inhibitors (NDRIs), such as Wellbutrin XL and Wellbutrin SR (bupropion), are a class of “second-generation” antidepressants. They relieve symptoms of depression and anxiety by increasing the level of dopamine and norepinephrine in the brain. 

In comparison to SSRIs, SNRIs, and other antidepressants, NDRIs are significantly less likely to cause sexual dysfunction. In fact, some research suggests that Wellbutrin can even improve sexual function and increase libido. While you can take Wellbutrin on its own, some healthcare providers prescribe it as an adjunct therapy to counteract the sexual side effects of SSRIs.

Other Antidepressants

There are several other antidepressants that are less likely to cause erectile dysfunction and long-term sexual side effects. These include:

• Viibryd (vilazodone): Viibryd is an SSRI and partial serotonin receptor agonist that is prescribed to treat MDD. Its mechanism of action is more targeted than other SSRIs, making it less likely to cause unwanted side effects like sexual dysfunction. In four clinical trials, only around 5% of study participants reported any sexual side effects.
• Trintellix (vortioxetine): Trintellix is a newer SSRI for MDD. Because it’s pharmacologically different from other SSRIs, it’s less likely to cause ED. Clinical trials on Trintellix side effects suggested that around 16% to 34% of participants experienced symptoms like anorgasmia, low libido, ED, and delayed ejaculation. Some people who switched to Trintellix from another SSRI experienced improvements in sexual functioning. 
• Remeron (mirtazapine): Remeron works similarly to a tetracyclic antidepressant. It's less associated with sexual dysfunction.
• Emsam (selegiline): Emsam is an MAOI that is delivered through a stick-on skin patch. Research suggests that Emsam doesn’t cause sexual side effects in low doses.
  

Summary

SSRIs are prescription medications that are used to treat depression and other mental health conditions. 

While SSRIs are generally safe and effective antidepressants, they often cause sexual side effects. Sexual side effects from SSRIs may include erectile dysfunction, low libido, and anorgasmia, as well as genital anesthesia and abnormal ejaculation.

In some cases, the sexual side effects of SSRIs can persist even after you stop taking the medications. This is a condition known as PSSD. 

Common SSRIs include Zoloft, Lexapro, Prozac, and Paxil. Of these, Paxil is the most likely to cause sexual dysfunction. Other common antidepressants, such as SNRIs, TCAs, and MAOIs, also frequently lead to sexual dysfunction. 

Research suggests that NDRIs such as Wellbutrin do not have the same sexual side effects as other antidepressants. Viibryd, Trintellix, Remeron, and Emsam are also less likely to cause erectile dysfunction.

A Word From Verywell

Sexual dysfunction can be stressful and challenging to navigate, especially if you're already managing depression symptoms. If you are experiencing sexual side effects from SSRIs, talk to your healthcare provider about changing your dose or trying a different antidepressant.