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Antidepressants with the lowest sexual side effects

Antidepressants with the lowest sexual side effects

Sexual dysfunction is a frequent side effect of antidepressants. The risk and severity of sexual side effects depends on the individual and the specific type and dose of antidepressant.

Common sexual side effects include reduced sexual desire, erectile dysfunction, and difficulty achieving orgasm or ejaculation.
According to a 2007 overview of research, the antidepressants with the lowest rate of sexual side effects include: 

  • Bupropion ,a norepinephrine and dopamine reuptake inhibitor (NDRI) 
  • Nefazodone, a combined reuptake inhibitor and receptor blocker 
  • Mirtazapine , a tetracyclic antidepressant 
  • Duloxetine , a serotonin and norepinephrine reuptake inhibitor (SNRI)

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine ,paroxetine and sertraline , all have a high rate of sexual side effects. But some research suggests that Paxil is more likely to cause sexual dysfunction than are other SSRIs.

Tricyclic antidepressants  such as amitriptyline, clomipramine , amoxapine and desipramine  , have a lower rate of sexual dysfunction than do SSRIs. However, some research suggests that clomipramine and amoxapine have a higher rate of sexual side effects than do other tricyclic antidepressants.

The matter of  how antidepressants can interfere with sexual desire and function remains the subject of ongoing debate and investigation. There are a lot of unproven theories. For example, some blame the sedating effect of certain antidepressants for dampening sexual desire. Others speculate that antidepressants cause chemical changes in the parts of the brain that regulate sexual desire and function.

Complicating all of this is the effect of depression itself in decreasing sexual desire and function.

It's impossible to predict which individuals are most likely to develop sexual side effects while taking an antidepressant. In some cases, sexual side effects may improve once the body adjusts to the medication. But in others, sexual side effects may last for the duration of treatment. If the patient experiences sexual side effects while taking an antidepressant, these strategies should be considered:

  • The patient should talk to the  doctor about the possibility of changing your dose. 
  • He should consider taking a medication that requires only a once-a-day dose, and schedule sexual activity before taking that dose.
  • The patient should talk to the  doctor about adding or switching to an antidepressant that may counteract sexual side effects, such as bupropion or mirtazapine .
  • The anti-anxiety drug buspirone also may reverse antidepressant-induced sexual dysfunction.
  • The patient should talk to the  doctor about taking a medication intended to directly treat sexual dysfunction.


How well these strategies might work depends on the specific drug and individual circumstances. If sexual side effects are troublesome. The patient should talk to the  doctor before discontinuing your medication or trying unproven remedies.



Prepared and edited by: Dr. Ahmad Saleh


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