Cymbalta (Duloxetine) and Libido
Cymbalta (duloxetine) does not increase libido and is more likely to cause decreased sexual desire and function as a common side effect.
Sexual Side Effects of Duloxetine
Duloxetine, a serotonin and norepinephrine reuptake inhibitor (SNRI), has well-documented effects on sexual function:
- According to the FDA drug label, sexual dysfunction is a common adverse reaction with duloxetine treatment 1
- The drug label specifically notes that duloxetine-treated male patients experienced significantly more sexual dysfunction compared to placebo-treated patients 1
- Sexual side effects include:
- Decreased libido (sexual desire)
- Difficulty with arousal
- Erectile dysfunction in men
- Difficulty reaching orgasm
- Decreased orgasm satisfaction
Evidence from Clinical Studies
The evidence consistently shows that duloxetine is associated with sexual dysfunction rather than increased libido:
- In a long-term study of duloxetine for depression, 73.4% of patients met criteria for sexual dysfunction at study entry, and after open-label duloxetine treatment, the probability of continued sexual dysfunction was 53.2% for treatment responders 2
- In patients without sexual dysfunction at baseline, the probability of developing new sexual dysfunction with duloxetine was 33.2% for treatment responders 2
- In comparative studies with escitalopram, duloxetine showed a 33.3% incidence of treatment-emergent sexual dysfunction at 8 weeks of treatment 3
Impact of Depression vs. Medication
An important consideration is distinguishing between the effects of depression itself and medication effects:
- Depression commonly causes decreased libido and sexual dysfunction
- When patients respond to antidepressant treatment, their overall sexual function may improve due to improvement in depression, despite medication side effects 2
- In patients who achieved remission of depression, improvement in global sexual functioning was observed regardless of treatment 3
Special Circumstances
While duloxetine typically causes decreased rather than increased libido, one specific study showed an exception:
- In women with stress urinary incontinence (SUI) treated with duloxetine, there was an improvement in sexual function scores 4
- This improvement likely occurred indirectly through:
- Reduction in stress incontinence symptoms (which themselves impair sexual function)
- Improvement in depression symptoms
- Enhanced quality of life
Clinical Implications
When considering duloxetine treatment:
- Be aware that decreased libido and sexual dysfunction are common side effects
- Monitor for sexual side effects during treatment
- Consider that improvement in depression may offset some medication-related sexual side effects
- In patients where sexual function is a priority, consider alternatives with lower rates of sexual side effects
- For patients already experiencing sexual dysfunction from depression, the benefits of treating depression may outweigh the risk of medication-related sexual side effects
Alternative Medications
For patients concerned about sexual side effects:
- Bupropion has been associated with lower rates of sexual dysfunction compared to SNRIs and SSRIs
- Mirtazapine may have fewer sexual side effects than duloxetine
- For neuropathic pain, pregabalin may be considered as an alternative with potentially fewer sexual side effects 5, 6
Remember that while duloxetine is effective for depression and neuropathic pain, its impact on sexual function should be carefully considered when selecting treatment options, particularly for patients who prioritize maintaining sexual function.