Antidepressants: Which cause the fewest sexual side effects?

Sexual side effects are common with antidepressants in both men and women. So your concern is understandable. The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem.

Antidepressants with the lowest rate of sexual side effects include:

• Bupropion (Wellbutrin)
• Mirtazapine (Remeron)

Antidepressants most likely to cause sexual side effects include:

• Selective serotonin reuptake inhibitors (SSRIs). These commonly prescribed antidepressants cause sexual side effects in most people. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly), fluvoxamine (Luvox), paroxetine (Paxil, Paxil CR) and sertraline (Zoloft). Fluvoxamine may cause less bothersome sexual side effects than other SSRIs.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), which include venlafaxine (Effexor) and duloxetine (Cymbalta). The recently approved SNRI desvenlafaxine (Pristiq) may cause fewer sexual side effects than some other antidepressants, but more research is needed to confirm this.
• Tricyclic and tetracyclic antidepressants, such as amitriptyline, clomipramine (Anafranil), amoxapine  and desipramine (Norpramin).
• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate).

If you're taking an antidepressant that causes sexual side effects, one of these strategies may help:

• Waiting several weeks to see whether sexual side effects get better.
• Scheduling sexual activity before taking an antidepressant if your antidepressant requires a once-a-day dose.
• Switching to another antidepressant that may be less likely to cause sexual side effects.
• Adding a second antidepressant or another type of medication to counter sexual side effects. For example, the addition of the antidepressant bupropion (Wellbutrin) or the anti-anxiety medication buspirone (Buspar) may ease sexual side effects caused by an antidepressant.
• Adding a medication to directly improve sexual function, such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra). Although these medications are used to treat sexual problems in men, initial research suggests sildenafil may also improve sexual problems caused by antidepressants in some women.

Stopping medication because of sexual side effects is a common problem, and for most people this means depression returns. Work with your doctor to find an effective antidepressant or combination of medications that will reduce your sexual side effects and keep your depression under control. Be patient. Because everyone reacts differently to antidepressants, it may take some trial and error to identify what works best for you.

Don't underestimate the importance of finding a medication with tolerable sexual side effects. Poor sexual function can cause depression; likewise, depression can worsen sexual function. For most people, sexual function is important for maintaining confidence and a satisfying relationship with their romantic partner.