How to reverse sexual dysfunction caused by antidepressants

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Nelson Vergel

In an open-label study of 1,022 patients with a mean 40 years of age, 59.1% reported antidepressant-associated sexual dysfunction.10 The study analyzed the following antidepressants: citalopram, paroxetine, venlafaxine, sertraline, fluvoxamine, fluoxetine, mirtazapine, nefazodone, amineptine, moclobemide, clomipramine, imipramine, maprotiline, phenelzine, and trazodone. Of those with sexual dysfunction attributed to antidepressants, 38.3% rated themselves as being concerned enough about sexual dysfunction to discontinue antidepressant therapy . Another 34.5% indicated that, although they did not intend to discontinue antidepressant therapy because of it, they and/or their partner were concerned or distressed about sexual dysfunction. That nearly 4 of 10 patients in this study were concerned enough about their sexual dysfunction to discontinue their antidepressant is worrisome in view of the fact that noncompliance with the therapeutic regimen may result in relapse or recurrence of depression.

Antidepressant-Associated Sexual Dysfunction: A Potentially Avoidable Therapeutic Challenge


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Nelson Vergel

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From Medscape:

A variety of antidotes have been reported to treat SSRI-induced sexual dysfunction effectively; however, virtually all the data on these agents are derived from open case reports and case series. Insofar as sexual function improvement may be responsive to placebo effects, it is impossible to estimate the true efficacy of these antidotes.[SUP][27]
Most of these antidotes either have serotonin-blocking properties (especially 5HT-2 antagonistic effects) or augment catecholamine activity, especially that of dopamine. The antiserotonergic antidotes are cyproheptadine, buspirone, nefazodone, and mianserin. Medications enhancing dopaminergic tone include amantadine, bupropion, and stimulants, with yohimbine showing noradrenergic effects. Among the reported antidotes, the only 2 without antiserotonergic effects or catecholaminergic activity are gingko biloba and urecholine.
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mi muchos casos, producen retardo en la eyaculacion, que beneficia a las personas ansiosas. Es mi experiencia. Tengo 34 años y es tan fuerte la ansiedad que quizá la TRT ayude a darme seguridad y disminuir la ansiedad. Un psiquiatra jamás lo recomendaría, solo automedicacion
I´m on Escitalopram for years by now for cronic stress and anxiety problems. When I stared I told my psychiatrist about my concern reg libido etc,, and he said I could add Bupropion to counteract some side effects. That´s been my combo for years and years. I can´t tell really by now how it would be if I only took Escitalopram.


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Antidepressants with the lowest rate of sexual side effects include:

Bupropion (Wellbutrin XL, Wellbutrin SR)
Mirtazapine (Remeron)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)

I have been taking Vilazodone (Viibryd) for about 5 months. Before I went to my max dose of 40mg, getting, maintaining an erection and achieving orgasm was possible within 5-10 minutes of sexual activity. At 40mg, however, anorgasmia is back but at least I still maintain my erection (for the most part). The anorgasmia is what bothers me now, and I'll tend to lose the mood even before my partner orgasms. They're also upset because I can't reach it. I saw apomorphine and perhaps pramipexole would help that, though.
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