Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review
Open accessAbstract
Sexual dysfunction is an underdiscussed adverse effect to selective serotonin reuptake inhibitors (SSRIs) and may increase the risk for discontinuation and nonadherence to antidepressant pharmacotherapy. Given the prevalence of depression, health care providers should educate patients about SSRI-associated sexual dysfunction in order to promote patient awareness and medication adherence. This study evaluated primary literature from 1997 to 2015 to identify SSRI-related sexual side effects, therapeutic alternatives, and treatment strategies. The results indicate that paroxetine is associated with the greatest rate of sexual dysfunction among the SSRIs. Potential alternatives to SSRI treatment include bupropion, mirtazapine, vilazodone, vortioxetine, and serotonin-norepinephrine reuptake inhibitors. In the event that a subject responds solely to SSRIs but experiences unwanted sexual side effects, bupropion may be added as an adjunctive medication. Some limited evidence also suggests that saffron may reduce some aspects of sexual dysfunction, excluding ability to reach orgasm.
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Development of sexual dysfunction following selective serotonin reuptake inhibitor medications was confirmed in women.
“The development of sexual dysfunction following selective serotonin reuptake inhibitor medications was confirmed in women before [18, 19].”
From Effect of l-arginine compared to placebo on sexual function in women with major depressive disorder: a randomized controlled trial (2024) · cites this paper as [18]
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“Insomnia disrupts the hypothalamic–pituitary–gonadal axis, leading to reduced testosterone levels and endothelial dysfunction mediated by oxidative stress, impairing vascular penile relaxation necessary for erection [40].”
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“Using evidence from the literature, in subsequent questions we displayed the top 4 most common side effects for escitalopram, an SSRI-class drug (Medicine “A”) [11, 17, 18], bupropion (Medicine “B”) [19–21], and mirtazapine (Medicine “C”) [22, 23].”
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“11 12-15 This pattern of findings suggests that SSRIs may cause additional, unique sexual side effects above and beyond those associated with depression.”
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British Society for Sexual Medicine (BSSM) Position Statement on Premature Ejaculation
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“There is an acknowledgement that low sexual desire, orgasmic difficulty, and ED are frequent side effects of SSRIs, and withdrawal can be problematic [48].”
Post-orgasmic illness syndrome accompanied with testosterone deficiency: a case report
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Antidepressant and Anxiolytic Potentials of the Chewing Stick, Salvadora persica
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“Although selective serotonin reuptake inhibitors remain the drug of choice, signifcant adverse efects such as sexual dysfunction and nervousness would afect the compliance state of the patients, resulting in a poor outcome [37].”
BackgroundReduction of Prostate Cancer Risk: Role of Frequent Ejaculation-Associated Mechanisms
Hassan, M., Flanagan, T. W., Eshaq, A. M., Altamimi, O. K., Altalag, H., Alsharif, M., Alshammari, N., Alkhalidi, T., Boulifa, A., Jamal, S. M. E., et al. (2025) · Cancers · doi:10.3390/cancers17050843 · Cited by 3 · see citing works
“Selective serotonin (5-HT) reuptake inhibitors are widely prescribed as antidepressants and have long been associated with sexual side effects like premature ejaculation [226,227].”
Large-scale analysis demonstrates the influence of CYP2C19 genotype on specific SSRI side effects
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“This mechanistic insight has practical implications for treatment selection, particularly given that sexual dysfunction affects 40-65% of SSRI users and represents a leading cause of treatment discontinuation [26,48].”
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“Fluoxetine frequently causes sexual dysfunction and can affect all phases of sexual function (arousal, desire, and orgasm) (Jing & Straw-Wilson, 2016).”
BackgroundDepression roundtable: Is there a role for BoNT?
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Sexual Dysfunction with Antidepressants: A Clinical Review
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“8 It has been observed that there is less sexual dysfunction associated with the use of agomelatine, amineptine, bupropion, moclobemide, mirtazapine, or nefazodone.”
BackgroundInfluentialGesselman, A. N., Kaufman, E. M., Weeks, L. Y. S., Moscovici, Z., Bennett‐Brown, M., Adams, O. R., Campbell, J. T., Piazza, M., Bhuyan, L., Dubé, S., et al. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1292603 · Cited by 2 · see citing works
“In the U.S., mental health treatment primarily consists of psychotherapy and/or prescribed psychiatric medications (27, 28).”
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“The development of sexual dysfunction following selective serotonin reuptake inhibitor medications was confirmed in women before [18, 19].”
BackgroundSexual functioning in depression
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Pharmacological Management of Dhat Syndrome
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Escitalopram, an antidepressant, stimulates steroidogenesis in mouse Leydig cells
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Role of Medicinal Plants in Combating Anti-depressant Induced Male Infertility
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Factors affecting sexuality of elderly people and sexual dysfunctions
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“Men aged more than 50 with depression have worse sexual satisfaction, decreased erection and more symptoms of depression, but there appear also iatrogenically induced sexual dysfunctions by selective serotonin reuptake inhibitors[13,46,47].”
BackgroundChronic Pain and Erectile Dysfunction: Mechanism, Treatment, and Future Perspective
Widyadharma, I. P. E., Tedyanto, E. H., Adnyana, M. O., & Wijayanti, I. A. S. (2024) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.20.1.38 · Cited by 1 · see citing works
“Disturbances in both can cause sexual and erectile dysfunction (15).”
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Psychopharmacotherapy of Depressive Disorders
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A Psychopharmacology Guide by Psychiatrists for Non-psychiatrists
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Part II: Statistics in practice: Statistics overview
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“delayed ejaculation, reduced libido) is a major disadvantage of SSRI medication, which might be distressful for the MDD patient, and they may start to discontinue the medication [10].”
InfluentialSelective serotonin reuptake inhibitors and spermatogenesis
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KAJIAN EFEK SAMPING ANTIDEPRESAN TERHADAP FUNGSI SEKSUAL
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Obsessive‐compulsive disorder and men's health. Part 2: Treatment and related sexual dysfunction
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Effects on Sexuality of Medication Used in Pregnancy and Childbirth
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- Authors
- Jing, E., & Straw-Wilson, K.
- Affiliations
- University of Arizona (US)
- Southern Arizona VA Health Care System (US)
- Corresponding author
- Jing, Elizabeth
- Venue
- Mental Health Clinician
- Published
- 2016-07
- Volume
- 6
- Issue
- 4
- Pages
- 191-196
- ISSN
- 2168-9709 (ISSN-L)
- PMC
- PMC6007725
- OpenAlex
- W2464530165
- Cited by
- 121
- References
- 34
- Citations by year
- 2026: 9 · 2025: 24 · 2024: 23 · 2023: 24 · 2022: 15 · 2021: 15 · 2020: 7 · 2019: 3 · 2018: 1
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Mental Health Clinician (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- sexual dysfunction, selective serotonin reuptake inhibitors, antidepressant side effects, paroxetine, medication adherence, depression treatment, bupropion, mirtazapine, vilazodone, vortioxetine, serotonin-norepinephrine reuptake inhibitors, adjunctive therapy, saffron, orgasm
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