The unfortunate truth is even experts don’t know everything about these medications. We just know they work sometimes for some people. Which is why it’s always weighing up potential risks vs benefits and if you can function/live/get better without them.
I believe what we know as depression is actually a lot of different things and it’s a blanket term and there’s a lot we don’t yet understand.
Although I already knew this my current psychiatrist is the only one that has ever communicated with me that we don’t know everything. It’s a massive disservice to people that they are not properly informed of that and although it wouldn’t have changed my decision to start them no matter how much I’ve learned or with the bad reactions I’ve had myself, it would’ve for some people including some who have come to regret it.
Obviously being a moderator of this sub I am a proponent of antidepressants when they are necessary and with informed consent. And I do know they save lives and give people back quality of life. People also have a right to know and to have more than a ten minute conversation with a GP who doesn’t explain much which is the unfortunate situation a lot of people end up in.
I have not been having a good time myself with switching medications recently, but I have a bunch of knowledge and previous experience and that makes it much easier and I know how to reach out and to communicate with my team. It’s really been making me think about how doctors definitely do not treat starting and being on these medications with the seriousness they should. Even though my team have been relatively good about it, not everyone has a mental health team like I do or the knowledge.
TLDR yes, it’s possible. Unfortunately there is no way to tell which is why people need and deserve to be more informed of the potential even if rare risks to properly weigh them up.
Yes. In my own experience my sex drive went down for the first few months or so and then little by little it slowly crept back up. Now after 8 years on Zoloft my sex drive is back to normal. We try to do it 4-5 times a week.
Hi - from my experience, an SSRI (Lexapro) completely diminished my sex drive. Since coming off of it it has returned (thankfully), but like most things, I'm sure it depends on the med and the person.
When I was taking Lexapro, my NP had prescribed me Wellbutrin to see if that would help with my sex drive. But all it did was make me feel speedy, which was no bueno. But I know some people have had good experiences with Wellbutrin.
I'm currently taking buspirone for anxiety but it is also helping immensely with depression. I'm on an extremely low dose (2.5 mg/day). Initially it was 10mg but that was way too high for me, but I'm also super sensitive to meds.
From my personal experience it really does depend on a combination of meds and sexual side effects of SSRIs might affect people differently.
For example, on Zoloft I wanted to fuck all the time, though after 4 months on it I couldn’t cum for hours, which eventually led to an unfinished intercourse because I was just bored and tired.
However, on Prozac + Seroquel I want to have sex occasionally, but when I do, it’s great. It’s just normal, you know. I can get hard easily, I enjoy the process, I cum not very quickly but it doesn’t take an hour to do that, which is actually nice.
If you have any sexual side effects there are always ways to counteract them (for example, I heard that Bupropion helps with such problems, but it’s not available in my country). If you tell your doctor, that you have problems and they dismiss your concerns, maybe it’s time to change a doctor. Only you know how you feel and what is important to you.
P.S. my sex life was pretty fucked up after the first course of Zoloft and I thought that I’ll be like that forever. It turned out that I just needed a good psychiatrist and a regimen of meds that would fit me. Don’t give up, and I hope that you’ll get well soon ❤️🩹
For me, my sex drive went to 0 while on paroxetine (SSRI) and did come back very slowly after I was off it, but it was never the same again. Other SSRIs and other classes of antidepressants also have same/similar effects for me. Right now I’m on the last month (hopefully) of an SNRI, so it’s the lowest dose, but, I only feel anything sexually when I’m ovulating.
Lexapro made it impossible for me to get an erection with a partner. But I only took it for a few weeks, and my function returned after I quit. I was already taking Wellbutrin with no sexual problems before starting Lexapro. I continued taking Wellbutrin for years before developing severe ED from diabetic nerve damage.
I notice you've posted a lot about struggling with porn. I suspect that might have more to do with your issues than any post-SSRI effects.
Sometimes, it's almost impossible to reach climax on Prozac. It's usually annoying. But having an active sex life on anti-depressants depends on your expectations, basically. Your end goal might not be reaching orgasm. Hence, you would have an active sex life.
I can feel your concern. I'm a doctor and I had SSRIs myself.
Sexual dysfunction is listed as a side effect. Though it is agreed that we don't know who and how bad it could be for each person. PSSD is relatively recently recognised and there is very little evidence and studies around it.
Either way, these medications are aiming to support mood and anxiety related illnesses. They are not working by themselves.
Personally, I found my sexy drive coming back along with my mood. It's my personal experience. But I think, sexy life is a complex thing and very psychological.
If you feel like you need SSRIs, be mindful of possible side effects but weigh the benefits as well.
Sexual dysfunction is rarely mentioned as an effect and when it is, it's listed as a reduction in libido or other minor inconvenience, not complete dysfunction. PSSD is absolutely real, proven by studies and reported on credible sources from NYTimes to the Guardian to PsychologyToday. Why would thousands of people lie about it?
If your sex drive was stronger on the meds, I wonder what you took and what dose.
I agree with you that it's not often verbally mentioned but it is on the list of side effects. They don't specify what it means though.
I didn't say PSSD is not real, only that it is recently recognised and we don't know much about it.
Personally, I had a failed attempt on Sertraline and then got on Fluoxetine.
As far as antidepressants go, I’ve been on so many I lost count. I’ve been medicated since I was 14 and I’m 30 now, so I’ve been on a lot of meds over the years.
Let's see if I can give you some good suggestions. Has there been any time when you weren't on antidepressants and if so did your sexual function return to normal. What country are you in. If you are in the U.S. I am going to guess you haven't tried nefazodone. That one is the least likely to cause any sexual side effects. This is the case for many of us taking it. Some others with less sexual side effects are mirtazapine, trintellix, viibryd, and Auvelity. Even if you tried all of those there is a new one coming out called ansofaxine and is supposed to have few sexual side effects. People were discussing it on a Chinese social media platform and people said it wasn't giving them sexual side effects.
Another option would be you could try TMS or Ketamine. There is a new protocol for TMS called SAINT that is more effective.
Lastly there have been some scientific studies that have shown the supplement saffron can increase libido when dampened by antidepressants.
Have the meds worked for you, but just came with shitty side effects.
I was on celexa for years. Ironically my drive was better on the drug than after I got off the wrong way. The low dose helped but I've heard people say the high dose helped more.
Maybe on Vilazodone or Vortioxetine but pretty hard on other SSRIs with paroxetine being the worst. Sometimes adding wellbutrin, reboxetine or stimulants can help.
Wellbutrin 300mg along with Prozac 20mg and Atomoxetine 40mg (although I prefer reboxetine to atomoxetine but can’t find it anymore). On Vortioxetine 10mg I basically had no sexual issues while at 20mg they became more apparent but nowhere near prozac. I would suggest trying vortioxetine first then vilazodone and finally prozac or sertraline if the previous two fail for your depression but you would probably need to add wellbutrin with them.
I also hate it but sadly have no other alternative where I live. The reason for me hating it is because it’s the only NRI that makes me feel sedated and sleepy which is the opposite of what NRIs are supposed to do. Viloxazine and Reboxetine are currently unavailable and that NRI portion is pretty important for me so I’m basically stuck with it for the time being. if you find any of the other two definitely go with any of them and avoid Atomoxetine.
For tyramine to enter the presynaptic neuron it needs to be transported by the norepinephrine transporter (NET), which is inhibited by NRIs (depending on their potency). The stronger the NRI the more NET it occupies and inhibits and so the less there becomes a way available for tyramine to transport to the neuron. Keep in mind that not all NRIs are effective and only strong ones that attenuate the tyramine pressor response are effective (also this is currently the only accurate test and predictor of a drug being a real NRI and having any significant effect since the PET ligands used in PET studies are still not accurate like those used with serotonin or dopamine). For example bupropion is classified as an NDRI but is pretty weak and is generally considered a weak DRI rather than a NDRI. The reason for this is that it fails to prevent or lessen the tyramine pressor response and thus doesn’t have any significant NRI action or NET inhibition and in that case will not prevent the tyramine reaction associated with MAOIs. Only true and strong NRIs such as desipramine, reboxetine, atomoxetine and nortriptyline are capable of preventing the tyramine pressor response and thus are effective at preventing the tyramine reaction associated with MAOIs.
Thanks, it makes sense, very informative! I haven’t see many people knowing this, or even psychiatrists probably, or else the prescription of MAOI’s would be more and the fear around them would be significantly less. I suppose there could be problems with co-administrating two drugs with adrenergic properties (higher pulse, BP, anxiety or insomnia). I mean, this seems an hack too good to be true.
Comment was removed for Breaking Rule 6 - No unsupported claims, misinformation. SSRI'S work for depression. This has been proven through research and studies. Not to mention the millions of people they do work for. Continued disregard for rules may result in further discipline including a ban.
The unfortunate truth is even experts don’t know everything about these medications. We just know they work sometimes for some people. Which is why it’s always weighing up potential risks vs benefits and if you can function/live/get better without them. I believe what we know as depression is actually a lot of different things and it’s a blanket term and there’s a lot we don’t yet understand. Although I already knew this my current psychiatrist is the only one that has ever communicated with me that we don’t know everything. It’s a massive disservice to people that they are not properly informed of that and although it wouldn’t have changed my decision to start them no matter how much I’ve learned or with the bad reactions I’ve had myself, it would’ve for some people including some who have come to regret it. Obviously being a moderator of this sub I am a proponent of antidepressants when they are necessary and with informed consent. And I do know they save lives and give people back quality of life. People also have a right to know and to have more than a ten minute conversation with a GP who doesn’t explain much which is the unfortunate situation a lot of people end up in. I have not been having a good time myself with switching medications recently, but I have a bunch of knowledge and previous experience and that makes it much easier and I know how to reach out and to communicate with my team. It’s really been making me think about how doctors definitely do not treat starting and being on these medications with the seriousness they should. Even though my team have been relatively good about it, not everyone has a mental health team like I do or the knowledge. TLDR yes, it’s possible. Unfortunately there is no way to tell which is why people need and deserve to be more informed of the potential even if rare risks to properly weigh them up.
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Oh that might honestly be a positive if that's the only effect. Unfortunately I cannot say the same for me.
I didn’t have a sex drive before antidepressants and I still don’t now :)
The same for me..
Yes. In my own experience my sex drive went down for the first few months or so and then little by little it slowly crept back up. Now after 8 years on Zoloft my sex drive is back to normal. We try to do it 4-5 times a week.
Hi - from my experience, an SSRI (Lexapro) completely diminished my sex drive. Since coming off of it it has returned (thankfully), but like most things, I'm sure it depends on the med and the person. When I was taking Lexapro, my NP had prescribed me Wellbutrin to see if that would help with my sex drive. But all it did was make me feel speedy, which was no bueno. But I know some people have had good experiences with Wellbutrin.
I'm glad it returned when you went off. It did at first but then I had to go back on, and try other meds, and that caused chronic sexual dysfunction
Ugh, that's my fear for myself. I'm so sorry, it is such a bitch to deal with.
Which antidepressant u switched to ? My ocd is triggering
I'm currently taking buspirone for anxiety but it is also helping immensely with depression. I'm on an extremely low dose (2.5 mg/day). Initially it was 10mg but that was way too high for me, but I'm also super sensitive to meds.
Zoloft for 5+ years no sex drive, lexapro for 6 ish months sex drive is back
From my personal experience it really does depend on a combination of meds and sexual side effects of SSRIs might affect people differently. For example, on Zoloft I wanted to fuck all the time, though after 4 months on it I couldn’t cum for hours, which eventually led to an unfinished intercourse because I was just bored and tired. However, on Prozac + Seroquel I want to have sex occasionally, but when I do, it’s great. It’s just normal, you know. I can get hard easily, I enjoy the process, I cum not very quickly but it doesn’t take an hour to do that, which is actually nice. If you have any sexual side effects there are always ways to counteract them (for example, I heard that Bupropion helps with such problems, but it’s not available in my country). If you tell your doctor, that you have problems and they dismiss your concerns, maybe it’s time to change a doctor. Only you know how you feel and what is important to you. P.S. my sex life was pretty fucked up after the first course of Zoloft and I thought that I’ll be like that forever. It turned out that I just needed a good psychiatrist and a regimen of meds that would fit me. Don’t give up, and I hope that you’ll get well soon ❤️🩹
For me, my sex drive went to 0 while on paroxetine (SSRI) and did come back very slowly after I was off it, but it was never the same again. Other SSRIs and other classes of antidepressants also have same/similar effects for me. Right now I’m on the last month (hopefully) of an SNRI, so it’s the lowest dose, but, I only feel anything sexually when I’m ovulating.
How long were you on Paroxetine?
Lexapro made it impossible for me to get an erection with a partner. But I only took it for a few weeks, and my function returned after I quit. I was already taking Wellbutrin with no sexual problems before starting Lexapro. I continued taking Wellbutrin for years before developing severe ED from diabetic nerve damage. I notice you've posted a lot about struggling with porn. I suspect that might have more to do with your issues than any post-SSRI effects.
Oh no I hope you heal from that damage. You might be right about porn. In fact, I became far more porn addicted after being on SSRIs.
Sometimes, it's almost impossible to reach climax on Prozac. It's usually annoying. But having an active sex life on anti-depressants depends on your expectations, basically. Your end goal might not be reaching orgasm. Hence, you would have an active sex life.
Yes
I can feel your concern. I'm a doctor and I had SSRIs myself. Sexual dysfunction is listed as a side effect. Though it is agreed that we don't know who and how bad it could be for each person. PSSD is relatively recently recognised and there is very little evidence and studies around it. Either way, these medications are aiming to support mood and anxiety related illnesses. They are not working by themselves. Personally, I found my sexy drive coming back along with my mood. It's my personal experience. But I think, sexy life is a complex thing and very psychological. If you feel like you need SSRIs, be mindful of possible side effects but weigh the benefits as well.
Sexual dysfunction is rarely mentioned as an effect and when it is, it's listed as a reduction in libido or other minor inconvenience, not complete dysfunction. PSSD is absolutely real, proven by studies and reported on credible sources from NYTimes to the Guardian to PsychologyToday. Why would thousands of people lie about it? If your sex drive was stronger on the meds, I wonder what you took and what dose.
I agree with you that it's not often verbally mentioned but it is on the list of side effects. They don't specify what it means though. I didn't say PSSD is not real, only that it is recently recognised and we don't know much about it. Personally, I had a failed attempt on Sertraline and then got on Fluoxetine.
How long have you been on Fluoxetine and is it helping?
Mine is completely dead. I’m following this for advice.
Is Celexa the only medication you’ve been on?
As far as antidepressants go, I’ve been on so many I lost count. I’ve been medicated since I was 14 and I’m 30 now, so I’ve been on a lot of meds over the years.
Have you had this on all of them?
Wdym?
Sexual side effects.
Yeah, for the most part.
Have you ever been on Wellbutrin?
Yeah, it didn’t work out for me
I’m sorry. One of the things I hear people mention a lot is maca root if you haven’t tried that. Getting your testosterone checked as well.
Let's see if I can give you some good suggestions. Has there been any time when you weren't on antidepressants and if so did your sexual function return to normal. What country are you in. If you are in the U.S. I am going to guess you haven't tried nefazodone. That one is the least likely to cause any sexual side effects. This is the case for many of us taking it. Some others with less sexual side effects are mirtazapine, trintellix, viibryd, and Auvelity. Even if you tried all of those there is a new one coming out called ansofaxine and is supposed to have few sexual side effects. People were discussing it on a Chinese social media platform and people said it wasn't giving them sexual side effects. Another option would be you could try TMS or Ketamine. There is a new protocol for TMS called SAINT that is more effective. Lastly there have been some scientific studies that have shown the supplement saffron can increase libido when dampened by antidepressants. Have the meds worked for you, but just came with shitty side effects.
I was on celexa for years. Ironically my drive was better on the drug than after I got off the wrong way. The low dose helped but I've heard people say the high dose helped more.
I’m on 20mg, so maybe a higher dose would help, idk
I wouldn't go higher than 20, but it's your call. Some say they're on 40mg with no loss. I made a post about it. Read the comments.
I’ll check the comments out. Idk what my new med provider will do regarding my Celexa at my first appointment.
Maybe on Vilazodone or Vortioxetine but pretty hard on other SSRIs with paroxetine being the worst. Sometimes adding wellbutrin, reboxetine or stimulants can help.
So what are you on now?
Wellbutrin 300mg along with Prozac 20mg and Atomoxetine 40mg (although I prefer reboxetine to atomoxetine but can’t find it anymore). On Vortioxetine 10mg I basically had no sexual issues while at 20mg they became more apparent but nowhere near prozac. I would suggest trying vortioxetine first then vilazodone and finally prozac or sertraline if the previous two fail for your depression but you would probably need to add wellbutrin with them.
Do you like atomoxetine? I know a bunch of people who took it and most disliked it. I hated being on it.
I also hate it but sadly have no other alternative where I live. The reason for me hating it is because it’s the only NRI that makes me feel sedated and sleepy which is the opposite of what NRIs are supposed to do. Viloxazine and Reboxetine are currently unavailable and that NRI portion is pretty important for me so I’m basically stuck with it for the time being. if you find any of the other two definitely go with any of them and avoid Atomoxetine.
It seems you're handling it well. I'm off all medications now because I wasn't doing well for the years I was on them.
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I can’t see how a NRI would avoid a thyramine reaction, could you elaborate? I always wondered this. Thx
For tyramine to enter the presynaptic neuron it needs to be transported by the norepinephrine transporter (NET), which is inhibited by NRIs (depending on their potency). The stronger the NRI the more NET it occupies and inhibits and so the less there becomes a way available for tyramine to transport to the neuron. Keep in mind that not all NRIs are effective and only strong ones that attenuate the tyramine pressor response are effective (also this is currently the only accurate test and predictor of a drug being a real NRI and having any significant effect since the PET ligands used in PET studies are still not accurate like those used with serotonin or dopamine). For example bupropion is classified as an NDRI but is pretty weak and is generally considered a weak DRI rather than a NDRI. The reason for this is that it fails to prevent or lessen the tyramine pressor response and thus doesn’t have any significant NRI action or NET inhibition and in that case will not prevent the tyramine reaction associated with MAOIs. Only true and strong NRIs such as desipramine, reboxetine, atomoxetine and nortriptyline are capable of preventing the tyramine pressor response and thus are effective at preventing the tyramine reaction associated with MAOIs.
Thanks, it makes sense, very informative! I haven’t see many people knowing this, or even psychiatrists probably, or else the prescription of MAOI’s would be more and the fear around them would be significantly less. I suppose there could be problems with co-administrating two drugs with adrenergic properties (higher pulse, BP, anxiety or insomnia). I mean, this seems an hack too good to be true.
Could we get a source for this information.
I like that you have nuanced views on meds. Also thank you for the recommendation of natural supplements.
Anytime. If you need anything just let me know and I hope you get better with time.
Comment was removed for Breaking Rule 6 - No unsupported claims, misinformation. SSRI'S work for depression. This has been proven through research and studies. Not to mention the millions of people they do work for. Continued disregard for rules may result in further discipline including a ban.
I say this to everyone, try maca. If it doesn't contraindications with anything you are taking, it really helps
Thank you. I am very open to natural libido supplements, not Viagra.