Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Management

Michael Hirsch, MD
Robert J Birnbaum, MD, PhD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD


Selective serotonin reuptake inhibitors (SSRIs) can reduce libido in women and men, disrupt arousal (lubrication in women and erectile function in men), cause anorgasmia in women, and increase ejaculation latency in men [1,2]. The frequency of sexual side effects may vary among the different SSRIs. Although it is not known how SSRIs impair sexual functioning, the symptoms appear to be dose dependent [3] and genetic polymorphisms may be involved [4].  

Sexual side effects can occur with other antidepressants, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs); however, there are more studies of sexual dysfunction secondary to SSRIs [2]. Unipolar major depression can also impair sexual functioning, and treatment with an SSRI can improve satisfaction [5].

This topic reviews the management of sexual dysfunction caused by SSRIs. The pharmacology, administration, and other side effects of SSRIs are discussed separately. (See "Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects".)


The estimated incidence of SSRI-induced sexual dysfunction ranges from approximately 15 to 80 percent [2,5-7]. As an example:

A 14-week, prospective observational study (Sequenced Treatment Alternatives to Relieve Depression [STAR*D]) of 1473 patients treated with citalopram found that [4]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Ekselius L, von Knorring L. Effect on sexual function of long-term treatment with selective serotonin reuptake inhibitors in depressed patients treated in primary care. J Clin Psychopharmacol 2001; 21:154.
  2. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol 2009; 29:259.
  3. Zajecka J. Strategies for the treatment of antidepressant-related sexual dysfunction. J Clin Psychiatry 2001; 62 Suppl 3:35.
  4. Perlis RH, Laje G, Smoller JW, et al. Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Neuropsychopharmacology 2009; 34:1819.
  5. Baldwin DS, Foong T. Antidepressant drugs and sexual dysfunction. Br J Psychiatry 2013; 202:396.
  6. Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry 2002; 63:357.
  7. Reichenpfader U, Gartlehner G, Morgan LC, et al. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug Saf 2014; 37:19.
  8. Williams VS, Edin HM, Hogue SL, et al. Prevalence and impact of antidepressant-associated sexual dysfunction in three European countries: replication in a cross-sectional patient survey. J Psychopharmacol 2010; 24:489.
  9. Balon R, Segraves RT. Survey of treatment practices for sexual dysfunction(s) associated with anti-depressants. J Sex Marital Ther 2008; 34:353.
  10. Montejo-González AL, Llorca G, Izquierdo JA, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther 1997; 23:176.
  11. Lam RW, Kennedy SH, Grigoriadis S, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord 2009; 117 Suppl 1:S26.
  12. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353:487.
  13. Gartlehner G, Hansen RA, Reichenpfader U, et al. Drug Class Review: Second-Generation Antidepressants: Final Update 5 Report [Internet]. Drug Class Reviews 2011.
  14. Gartlehner G, Hansen RA, Morgan LC, et al. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med 2011; 155:772.
  15. Thase ME, Haight BR, Richard N, et al. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J Clin Psychiatry 2005; 66:974.
  16. Clayton AH, Croft HA, Horrigan JP, et al. Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies. J Clin Psychiatry 2006; 67:736.
  17. Walker PW, Cole JO, Gardner EA, et al. Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion. J Clin Psychiatry 1993; 54:459.
  18. Watanabe N, Omori IM, Nakagawa A, et al. Mirtazapine versus other antidepressive agents for depression. Cochrane Database Syst Rev 2011; :CD006528.
  19. Jacobsen PL, Mahableshwarkar AR, Chen Y, et al. Effect of Vortioxetine vs. Escitalopram on Sexual Functioning in Adults with Well-Treated Major Depressive Disorder Experiencing SSRI-Induced Sexual Dysfunction. J Sex Med 2015; 12:2036.
  20. Ferguson JM, Shrivastava RK, Stahl SM, et al. Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline. J Clin Psychiatry 2001; 62:24.
  21. Taylor MJ, Rudkin L, Bullemor-Day P, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database Syst Rev 2013; :CD003382.
  22. Nurnberg HG, Hensley PL, Heiman JR, et al. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA 2008; 300:395.
  23. Evliyaoğlu Y, Yelsel K, Kobaner M, et al. Efficacy and tolerability of tadalafil for treatment of erectile dysfunction in men taking serotonin reuptake inhibitors. Urology 2011; 77:1137.
  24. Segraves RT, Lee J, Stevenson R, et al. Tadalafil for treatment of erectile dysfunction in men on antidepressants. J Clin Psychopharmacol 2007; 27:62.
  25. Michelson D, Bancroft J, Targum S, et al. Female sexual dysfunction associated with antidepressant administration: a randomized, placebo-controlled study of pharmacologic intervention. Am J Psychiatry 2000; 157:239.
  26. Landén M, Eriksson E, Agren H, Fahlén T. Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. J Clin Psychopharmacol 1999; 19:268.
  27. Lorenz TA, Meston CM. Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial. Depress Anxiety 2014; 31:188.
  28. Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry 1995; 152:1514.
  29. Zajecka JM. Clinical issues in long-term treatment with antidepressants. J Clin Psychiatry 2000; 61 Suppl 2:20.