For this article, Dr. Jessica Nouhavandi sat down with two sexual health experts, Dr. Kristen Mark and Isharna Walsh, from Coral, a sexual self-improvement app on a mission to normalize sexual wellness and help users experience boosted confidence, deeper intimate connections, and new frontiers of enjoyment.
Mental health and sexual desire have a very, well, intimate relationship. And like any relationship, it goes both ways. Sexual satisfaction can boost mental health while being in a good place mentally can boost sexual satisfaction. However, the opposite is also true: decreased sexual satisfaction can affect mental health, and poor mental health can decrease sexual satisfaction.
Now, add in a global pandemic. Depression and anxiety levels are on the rise nationally, while the frequency of sex by individuals and couples alike has fallen. This merry-go-round of sexual health and mental health is further complicated by the fact that a common side effect of popular mental health prescription treatments is decreased libido.
If you take medication to treat your mental health condition and have noticed a decrease in libido, you’re not alone. Whether you’ve been taking meds for years or have just started during the pandemic, the sexual side effects can be distressing. However, they don’t have to be permanent! Read on below to learn a variety of tips for reclaiming your sex life.
How antidepressants affect your sex life
Antidepressants can be a life-changing treatment option for those suffering from depression and/or anxiety. According to the National Center for Health Statistics, approximately 1 in every 10 Americans takes an antidepressant.
SSRIs, which stand for selective-serotonin reuptake inhibitors, are one of the most popular options available. Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), and Lexapro (escitalopram) are all SSRIs. Unfortunately, these medications can cause sexual side effects in anywhere from 30% to 70% of men and women. One study of patients taking citalopram found that the effects can range from decreased libido (54%) to difficulty orgasming (36%) to erectile dysfunction (37%).
These antidepressants work by increasing levels of serotonin in the brain. While this decreases feelings of anxiety and depression, it can also decrease sexual desire. You may also experience other sexual side effects. Some female patients report difficulty with lubrication and orgasm, while male patients report difficulty getting or maintaining an erection. These side effects are one of the most common reasons our patients report being unhappy with their medications.
Even without the side effects of specific medications, mental health conditions themselves can affect your sex drive. As Dr. Kristen Mark, sex and relationship researcher and therapist who contributes to Coral, explains: “The brain is the most important sexual organ, regardless of gender. So when our mental health suffers, our sex life is bound to suffer.”
Here’s what you can do about it
It’s possible to have a fulfilling sex life while taking antidepressants, we promise. You might just need to make some adjustments in order to offset the sexual side effects of your medications. Luckily, there are a lot of expert-backed tips from both pharmacists and sexperts that you can try.
Tip #1: Acknowledge the issue
The very first step is to acknowledge that your sex life isn’t where you want it to be. This can be hard, as there is a lot of stigma surrounding issues in the bedroom. Sexual dissatisfaction is a lot more common than many people realize though, even without adding antidepressants into the mix. Approximately 34% of American couples reported feeling sexually unsatisfied in their relationships, according to a study done in 2017. Now, with COVID-19, a drop in having sex has been reported. More than 50% of couples in an NBC poll reported that the pandemic had “negatively impacted their love life.”
The point is: You’re not alone. And once you identify that there is an issue, feelings of frustration will lessen.
“Many people get frustrated because they don’t know why something is happening to their sex life right when they feel like their mental health issues are starting to improve due to antidepressants,” Dr. Mark explains. “If you can name it, that is hugely helpful for moving toward fixing it.”
It can be especially frustrating because of the negative feedback loop between mental health, mental health medications, and lowered libido. That means that even though anti-depressants are likely a big culprit, your mental health might also be contributing too. Don’t worry too much about trying to figure out which came first though, and instead focus on taking a solution-based approach.
This first step is especially important if it’s your partner who is dealing with antidepressant side effects. That can be a really difficult situation, as they’re struggling with their mental health condition, antidepressant sexual side effects, and the effect those side effects have on you, their partner.
As Dr. Mark says, “Talking about [the elephant in the room] is critical [because] it allows you to express empathy and let them know that you’re there for them through this difficult time and can be supportive both in and out of the bedroom.”
Tip #2: Change your medication routine
With the guidance of your pharmacist or doctor, try changing what time of day you take your antidepressant. This is because side effects are more likely to resolve a few hours before your next dose. For example, if you are currently taking your antidepressant when you wake up around 8 am, then the sexual side effects are more likely to improve early the next morning, around 5 to 6 a.m. For many people, that might be considered an inconvenient time to experience a surge in libido.
However, if you switch to taking your antidepressant around bedtime, say around 11 p.m., then the sexual side effects might be wearing off around 8 to 9 p.m. the next day, a potentially much more convenient time to have sex or engage in sexual activities.
On the note of timing, if you just started an antidepressant, side effects might disappear completely after a few weeks or months as your body adjusts. As always, never make any changes to your medication routine without consulting a pharmacist and/or doctor.
Tip #3: Schedule sex
One desire-specific strategy Dr. Mark recommends is to schedule sex. It might not sound sexy, but finding a dedicated time to have sex can actually fuel desire. Most people have a linear conception of sex in their head, where sexual desire leads to having sex. However, according to something called the Basson Model of Sexual response, the real process is much more circular.
“Sexual desire isn’t always spontaneous but can be responsive in nature instead. So scheduling sex or engaging in sex, even if you don’t feel like it (as long as this is within the context of a healthy relationship), can be helpful for battling the frustrating side effects of medications.”
Coral has a great exercise for exactly how to go about the awkward-sounding business of scheduling sex, which you can find here. They even provide some possible scripts you can use for bringing it up with your partner, such as:
- “I know we’re both really busy, but I wonder if scheduling time for intimacy could make us feel more connected. Would you be willing to try an exercise around scheduling sex?”
- “Ready for some romance? I want to try scheduling sex! I know it doesn’t sound sexy, but I think it can be. What do you think?”
Once you’ve gotten the logistics out of the way, the app then suggests some experiences that can help the partner feeling sexual side effects from medication get into the mood. These can range from low-stakes activities for increasing intimacy to guided vulva and penis massages.
This tip can work great alongside Tip #2 because you can make sure to schedule sex for the time period when the side effects of your antidepressant are most likely to wear off.
Tip #4: Nurture intimacy in all its forms
It’s natural to focus on having an orgasm during sex, so it can be especially frustrating that difficulty orgasming is a common side effect of antidepressants. However, Dr. Mark explains that you might be making it even harder by emphasizing orgasming.
“By focusing on orgasm (or lack thereof), you’re less likely to have an orgasm,” Dr. Mark says. “The more we focus on it and make sex goal-oriented, the less likely we are to achieve that goal. So, remove the pressure, just enjoy sex for sex and you’ll have much better luck pushing through orgasm issues and reaching release.”
Instead, it’s important to go beyond just focusing on the orgasm in order to nurture intimacy in all its forms. Try getting creative by focusing on pleasure in parts of your body you don’t normally associate with sex; for example, caressing the navel, hip bones, neck, ears, palms of your hands, and so on. It can also help take some pressure off if you indulge in nonsexual touch such as cuddling, massage, or eye-gazing exercises.
By releasing the pressure of trying to orgasm and introducing more ways to feel pleasure and intimacy, you can actually make an orgasm—and libido in general—more likely to happen! It sounds a bit counterintuitive, but it can work.
Tip #5: Find expert help
If you are still unsatisfied (pun intended) with your sex life, then there’s no shame in seeking out expert help. While your doctor and/or pharmacist can help adjust your medication if necessary, a therapist or sex therapist can be a great option for focusing on specific mental health or sex concerns.
Another great option is to draw on the wealth of knowledge from experts like Dr. Mark through an app like Coral. Coral is a leading sexual self-improvement app founded by Isharna Walsh that has helped over 300,000 people create their best intimate lives.
For example, Coral takes scheduling sex a step further by providing an extensive library of guided audio exercises to spice things up. According to Walsh, this can help you start a positive cycle instead.
“The next time your scheduled-sex date comes up, you might try a new technique or couples exercise, which can be deeply rewarding and create a positive feedback loop, making you more likely to schedule sex again. It’s a virtuous cycle.”
Coral helps make tackling sexual side effects less intimidating. Especially if you’ve been experiencing them for some time, you might feel like you have to make the hard choice between a fulfilling sex life or improved mental health through medication. But as we’ve explained in this article, you can’t separate the two. Coral can help you make sexual wellness just as much of a priority as mental wellness.
“Whether it’s by popping in to learn a quick fact from the Daily Coral or receiving a reminder to hug your partner from our Couple Connect private partner chat, it can function as a kind of behavioral activation therapy that helps you stay in touch with your sexuality,” Walsh says. “Those small, positive interactions and experiences add up to something truly transformative over time.”
Tip #6: Take additional medication to offset side effects
Additionally, there are other medications you can take that might help offset the sexual side effects of your antidepressant. If the side effect reported is erectile dysfunction, then Sildenafil (Viagra) may be prescribed. The medication works by relaxing arteries and muscles in the penis, thus encouraging the necessary blood flow to produce an erection.
While Viagra is commonly thought of as a drug for men, it can also help women who are finding it difficult to orgasm due to their antidepressants. A 2008 random controlled trial investigated the use of Viagra in female patients taking anti-depressants who reported decreased sexual functioning. The study found that 72% of the participants who took Viagra reported feeling much improved when rating their sexual functioning. Whereas Viagra encourages blood flow to the penis in male patients, it encourages blood flow to the clitoris in female patients. This increased blood flow Viagra helps make orgasm easier.
Lastly, for women experiencing lower libido levels, bupropion extended-release (Wellbutrin Xl) can help. Bupropion is a norepinephrine dopamine reuptake inhibitor (NDRI), which is different from an SSRI. Rather than decreasing libido, the medication instead encourages a more active one, especially in high doses.
Tip #7: Lower your dose or change medications
Lastly, you can discuss with your doctor potentially lowering the dose of your medication, as lower doses are less likely to cause side effects. If the side effects persist, your doctor may recommend trying a different medication. Even within the same family of medications such as SSRIs, you might respond differently. One clinical study found that patients experienced the most sexual side effects with paroxetine (Paxil), followed by fluvoxamine (Luvox), sertraline (Zoloft), and fluoxetine (Prozac). Beyond a specific medication, the family of drugs it belongs to might also matter. For example, instead of switching between two different SSRIs, your doctor might also suggest switching to a completely different type of antidepressant, such as tricyclic antidepressants. Amitriptyline (Elavil) is a popular example. Tricyclic antidepressants appear to cause fewer sexual side effects.
We all deserve to have stable mental health and satisfying sex lives. If you find that your antidepressant is interfering with your time between the sheets, then don’t be afraid to give some (or all) of these tips a try. And as always, remember you aren’t alone! This is a legitimate medical concern; your pharmacist and doctor—alongside expert resources like Coral—are here to help.
Kristen Mark, Ph.D., MPH is a sex and relationships researcher, educator, and therapist. She is the Joycelyn Elders Endowed Chair and Professor in Sexual Health Education at the University of Minnesota Medical School. Dr. Mark is an AASECT-certified sexuality educator and affiliate research faculty at the Kinsey Institute. Her work centers around the intersection of sexual health and relationships.
Isharna Walsh is the founder and CEO of Coral, a sexual wellness app that offers evidence-based guides for better sex for all. Born in Sri Lanka and raised in Australia, Isharna has always been fascinated by the invisible rules that govern culture and society. A sex-positive activist, she left her VC position to create a mission-based company intent on eradicating sexual shame, combating misinformation, and disseminating pleasure-centric sex education in a brand new way.