Can your antidepressant be causing ED?

If you’ve been diagnosed with depression, there’s a good chance your doctor prescribed an antidepressant medication. Antidepressants can be effective tools in treating this mood disorder, according to the Cleveland Clinic. Along with therapy, they can help ease depression and boost your energy.

But in men, these medications can also come with an unwanted side effect: erectile dysfunction (ED). If you have a chronic problem getting and keeping an erection (meaning it happens over and over), you may have ED.

Depression itself can cause erectile issues, too. Men with untreated depression often have decreased sexual desire and problems getting an erection. Research published in the Journal of Sexual Medicine showed that men frequently have depression and ED at the same time.

The good news: If you’re experiencing ED and depression, you can get help — and get your sex life back. Here’s what you need to know about symptoms and treatment.

Getting checked for depression and ED

Your doctor will try to assess from the start how much of the problem is mental and how much is physical, says Marc Cohen, MD. He is a urologist and medical adviser at Bastion Health in Florida. “You can have just physical erectile dysfunction without it impacting your mental well-being,” he says. Or you can have underlying depression that might be making ED worse.

Experts recommend that anyone experiencing depression and ED get screened for both. Even if depression is contributing to your erectile issues, ED can be caused by other serious medical conditions such as heart disease, hypertension and diabetes. These conditions require treatment as well.

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How antidepressants can affect ED

There are many types of antidepressants, and most elevate the level of brain chemicals called neurotransmitters. Those chemicals — such as serotonin, norepinephrine and dopamine — help with communication between brain cells.

The most commonly prescribed medications are called selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:

• Escitalopram (Lexapro^®)
• Fluoxetine (Prozac^®)
• Paroxetine (Paxil)
• Sertraline (Zoloft^®)

This class of medication can ease mild to moderate depression. But SSRIs can also reduce sexual desire. In men, this side effect can make it difficult to get or maintain an erection.

[h2] Managing ED while on an antidepressant

If you experience ED symptoms while taking an SSRI, talk to your doctor or urologist. (Caution: Never stop taking SSRIs abruptly. Doing so can cause nausea, dizziness, lethargy, a general sense of unease and flu-like symptoms, according to the Mayo Clinic.) A combination of strategies can help solve ED issues.

Strategy 1: Switch to a different depression medication. Your doctor might want you to try a medication known as an atypical antidepressant. This class of antidepressants has a low rate of sexual side effects. Examples include:

• Bupropion (Wellbutrin XL^®, Wellbutrin SR)
• Mirtazapine (Remeron^®, Remeron Soltab^®)
• Vortioxetine (Trintellix^®)

(To learn more about antidepressants, read our guide.)

Strategy 2: Manage your schedule of medication and intercourse. “Dosing and timing are critical with all of these drugs,” says Dr. Cohen. The time of day you take an antidepressant affects the interplay of your hormones, blood flow and emotions. For example, if you take your SSRI a few hours before you want to have sex, you may not be able to get an erection when you hit the bedroom.

Instead, “hold the dose until after intercourse if you’re going to have intercourse today,” says Dr. Cohen. You can also talk to your doctor about lowering your dosage or delaying it, he says. What you drink, what you eat, even how much you sleep can determine how SSRIs affect you day to day.

Strategy 3: Take a “medication holiday” if your doctor advises it. Antidepressants can stay in the body even if you miss doses. With your doctor’s permission, you could try stopping your antidepressant before a weekend, for example. This way you can have sex over the weekend and enjoy better erections without changing your medication regimen altogether.

“Some people on antidepressants can skip a dose without it impacting their depression,” says Dr. Cohen. “I personally don’t like to fool around with a patient’s antidepressant if it’s working for them.” That’s why it’s important to get your doctor’s sign-off.

Strategy 4: Consider adding an ED medication to your regimen. Your doctor might suggest a medication to counter the sexual side effects of your antidepressant. Erectile dysfunction medications help improve blood flow to the penis. They can be taken alongside your antidepressant, according to the Mayo Clinic. Examples of ED medications include:

• Sildenafil (Viagra^®)
• Tadalifil (Cialis^®)

Bottom line: Antidepressants don’t have to dampen your sex life. What’s most important is to speak to your doctor about depression, anxiety and ED. The conditions are intertwined. That means being anxious or stressed out about your erections could prevent an ED medication from working effectively, points out Dr. Cohen. “Patients have to be able to relax and be in the mood and not worry about things.”

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Additional sources
Antidepressant basics: Cleveland Clinic (2020). “Depression and Sex”
ED and depression study: The Journal of Sexual Medicine (2018). “Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis”
SSRIs and withdrawal: Mayo Clinic (n.d.). “Selective Serotonin Reuptake Inhibitors”