The People's Perspective on Medicine

What Can Woman Do About Lower Sex Drive from Fluoxetine?

SSRI antidepressants like fluoxetine can lower sex drive. A different antidepressant might solve the problem, but adjusting could be a challenge.

Balancing the benefits and harms of medications can be quite a challenge. Doctors have known for decades that SSRI-type antidepressant drugs such as fluoxetine (Prozac) or paroxetine (Paxil) can affect sexual interest and performance (Journal of Sex & Marital Therapy, Fall 1997). Unfortunately, patients are still left in a quandary when they experience lower sex drive from taking an antidepressant they need to function. What can they do?

Lower Sex Drive While Taking Fluoxetine:

Q. I’ve been on fluoxetine for two years to treat depression. Now my sex drive has completely gone. I tried lowering my dose, but due to mental fuzziness and confusion I had to return to the higher dose again.

This whole situation is killing me. I feel sexless. I’m in a beautiful relationship with a wonderful man I love very much. He is very understanding and patient, but I fear that I will lose him over the lack of sex.

I’ve even contemplated ending the relationship, but I don’t want to lose the love of my life just because I need an antidepressant. Do you have a solution to suggest?

Antidepressants and Sex:

A. Many antidepressants lower sex drive and interfere with sexual pleasure. There is even a medical name for this condition: treatment emergent sexual dysfunction (TESD).

The official prescribing information for drugs like fluoxetine minimizes this problem. For example, the DailyMed data on fluoxetine (Prozac) suggests an incidence of 3 to 11 percent. Studies in healthy volunteers, on the other hand, indicate that between 50 and 80 percent of people taking this medication report sexual dysfunction (Journal of Clinical Medicine, Oct. 7, 2019). One real-world study found that approximately 80 percent of patients on antidepressants reported sexual problems (Archives of Sexual Behavior, April 2019). 

Other Therapeutic Options:

A few antidepressants may be less likely to lower sex drive. Ask your doctor whether bupropion or mirtazapine would be options for you. They act on different neurochemicals than the selective serotonin re-uptake inhibitors such as fluoxetine. Some experts suggest that vilazodone (Viibryd) might also be less likely to interfere with sexual enjoyment (Therapeutic Advances in Psychopharmacology, Jan. 2018). Others recommend a trial of desvenlafaxine (Pristiq) (Journal of Clinical Medicine, May 21, 2019). Switching from one antidepressant to another could be disruptive, though, so you and your doctor will need to work closely to get the right balance of benefit without undue harm.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Montejo-González AL et al, "SSRI-induced sexual dysfunction: Fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients." Journal of Sex & Marital Therapy, Fall 1997. DOI: 10.1080/00926239708403923
  • Montejo AL et al, "Management strategies for antidepressant-related sexual dysfunction: A clinical approach." Journal of Clinical Medicine, Oct. 7, 2019. DOI: 10.3390/jcm8101640
  • Montejo AL et al, "A real-world study on antidepressant-associated sexual dysfunction in 2144 outpatients: The SALSEX I Study." Archives of Sexual Behavior, April 2019. DOI: 10.1007/s10508-018-1365-6
  • Chokka PR & Hankey JR, "Assessment and management of sexual dysfunction in the context of depression." Therapeutic Advances in Psychopharmacology, Jan. 2018. DOI: 10.1177/2045125317720642
  • Montejo AL et al, "Frequency of sexual dysfunction in patients treated with desvenlafaxine: A prospective naturalistic study." Journal of Clinical Medicine, May 21, 2019. DOI: 10.3390/jcm8050719
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The conditions described as Treatment Emergent Sexual Dysfunction (TESD) are also known as Post-SSRI Sexual Dysfunction and Persistent Genital Arousal Disorder (PGAD). Both men and women have suffered permanent changes.

The most disturbing aspect is that care providers do not warn patients of possible effects beforehand. This “We know what’s best for you” attitude is condescending. Patients should be able to make informed decisions.

An international group of respected physicians submitted a petition to the FDA in 2018 requesting that the FDA insist on boxed warnings on the medications and that counseling leading to informed decisions be provided. The petition, published in International Journal of Risk & Safety in Medicine 29 (2018) 135–147, is here: https://rxisk.org/wp-content/uploads/2018/06/JRS745-1.pdf . The European Medicines Agency was also petitioned.

There are a number of NIH papers on PSSD, easily found and mostly quite readable by the layman.

See your physician, or a functional medical professional such as some Nurse Practitioners/midwives, about getting on bioidentical hormone replacement therapy. Seek out reliable referrals. You may be able to have a sex drive and an antidepressed brain, TOO!

I had the same problem with SSRI uptake antidepressants, no sex drive and the inability to reach a climax. I was switched to Bupropion and had no problems at all.

Great article!

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