From the Research
Introduction to Antidepressants and Libido
Antidepressants are commonly used to treat depression, but they can have a significant impact on sexual function, including libido. The relationship between antidepressants and libido is complex, and different antidepressants can have varying effects on sexual desire.
Effects of Antidepressants on Libido
Most antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), can decrease libido as a side effect 1. This is thought to be due to the stimulation of post-synaptic serotonin 5HT2 receptors. However, some antidepressants, such as mirtazapine, may have a beneficial effect on sexual functioning, including libido 2.
Antidepressants with Potential Benefits for Libido
Some antidepressants, such as:
- Mirtazapine, which has alpha 2 adrenergic antagonist and serotonin 5-HT2 and 5-HT3 receptor-blocking activity, may improve sexual function, including libido 2
- Bupropion, which has been shown to improve sexual dysfunction in some studies, particularly at higher doses 3
- Nefazodone, which is no longer available for clinical use, but was found to have lower rates of sexual dysfunction compared to other antidepressants 3
Strategies for Managing Antidepressant-Induced Sexual Dysfunction
Several strategies can be used to manage antidepressant-induced sexual dysfunction, including:
- Switching to an alternative antidepressant with lower rates of sexual side effects
- Adding a medication to treat the sexual dysfunction, such as sildenafil or tadalafil for erectile dysfunction
- Reducing the dose of the antidepressant
- Using adjunctive pharmacotherapy
- Implementing drug holidays
Treatment Considerations
When treating depressed patients with antidepressants, it is essential to consider the potential impact on libido and sexual function. This can be achieved by:
- Starting treatment with an antidepressant that has a lower risk of sexual side effects
- Monitoring patients for sexual dysfunction and adjusting treatment as needed
- Using strategies to manage antidepressant-induced sexual dysfunction
Caveats and Differentials
It is crucial to note that:
- Sexual dysfunction can be a symptom of depression itself, making it challenging to determine the cause of sexual dysfunction in depressed patients
- Different classes of antidepressants can have varying effects on sexual function
- Patients may not always report sexual dysfunction, and healthcare providers should actively inquire about sexual function and libido when treating depressed patients with antidepressants 4, 5