What should I do about sexual side-effects of antidepressants?

My psychiatrist suggests that I try antidepressants, but sexual anhedonia is not one of my depression symptoms, and I am reluctant to risk losing my sex drive. Are there any antidepressants with lower rates of sexual side effects, or, alternatively, supplements or additional medications I can take to mitigate the effects?

Selective Serotonin Reuptake Inhibitors (SSRIs) are some of the most effective drugs for treating depression, anxiety disorders, OCD and eating disorders. Unfortunately, they have a high incidence of sexual side effects like decreased sex drive and trouble reaching orgasm.

Fewer than half of people taking SSRIs report sexual side effects, so there is certainly no guarantee that you will have a problem. Side effects of antidepressants are often worst during the first few weeks, and sometimes sexual side effects will clear up entirely after this time. If this doesn’t happen, sexual side effects almost always resolve within days of stopping the medication, so if your psychiatrist believes that an SSRI is the best drug to treat your depression, it is probably worth a try.

If you’ve had a problem with sexual side effects on an SSRI, you should talk to your psychiatrist. There are a few antidepressants which are unlikely to cause sexual side effects, the best known of which is probably bupropion (Wellbutrin).

These drugs do not have sexual side effects because they do not inhibit the reuptake of serotonin. This might also make them less effective, depending on what is causing your depression. They also have different counter-indications (Wellbutrin, for example, lowers seizure threshold, so it is not usually prescribed to patients who may be prone to having seizures).

If SSRIs are the only class of antidepressant you can take or the only class that is effective for you, there are a handful of medications which are sometimes used to try to eliminate sexual side effects. They are all available by prescription only, and all have their own risks and side effects, so a doctor needs to help you evaluate if one of these might be an option for you.

One study found that ginkgo biloba, often sold as a tea or herbal supplement for improving memory (a use which has not held up well in studies), effectively treated sexual side effects caused by SSRIs in a number of patients.

Why this should work is not understood, but ginkgo is available without a prescription, and is unlikely to cause undesirable side effects at low doses, so it may be worth trying. If you’re taking any other medications, it would be a good idea to ask a pharmacist if ginkgo could interact with the other drug.

Recommendations: Two general guides to sex and college sex and relationships.