Why Your Doctor is Prescribing an SSRI for Low Libido
Your doctor is likely prescribing an SSRI to treat an underlying condition causing your low libido—such as depression or anxiety—not to directly improve libido, since SSRIs actually cause sexual dysfunction in 40-90% of patients. 1
Understanding the Clinical Rationale
Your physician is addressing the root cause rather than the symptom. Here's the logic:
Depression itself causes low libido in a significant proportion of patients, independent of medication effects. 2 When depression is successfully treated, sexual function often improves despite the SSRI's direct negative effects on sexual function.
The net benefit calculation: Your doctor has determined that treating your underlying mood or anxiety disorder will provide greater overall improvement in sexual function and quality of life than the sexual side effects will detract. 3
SSRIs remain first-line therapy for major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder—conditions that themselves profoundly impair sexual function. 4
Critical Caveat: This May Be the Wrong Approach
If you do not have depression or anxiety, prescribing an SSRI for low libido alone is contraindicated, as SSRIs cause:
- Decreased libido in a dose-dependent manner 1, 3
- Delayed or absent orgasm 3, 5
- Arousal difficulties 6
- Sexual dysfunction rates of 40-90% depending on assessment method 1
What You Should Discuss With Your Doctor
1. Clarify the Primary Diagnosis
- Ask explicitly: "Am I being treated for depression, anxiety, or another psychiatric condition?"
- If the answer is no, question why an SSRI is being prescribed, as this would be off-label and potentially harmful for isolated low libido. 7
2. If Depression/Anxiety IS Present: Request a Sexual-Function-Friendly Alternative
Bupropion should be your first-line antidepressant when sexual function is a major concern, with sexual dysfunction rates of only 8-10% compared to 40-90% with SSRIs. 1, 7 The American College of Physicians explicitly recommends bupropion as first-line therapy when depression requires treatment and sexual function is a priority. 7
Important contraindications to bupropion:
- Seizure disorders (increased seizure risk) 7
- Agitated patients 7
- Patients on tamoxifen for breast cancer (though less problematic than paroxetine/fluoxetine) 7
3. If an SSRI Must Be Used: Choose Wisely
Avoid paroxetine at all costs—it has the highest sexual dysfunction rate at 70.7%, significantly worse than all other SSRIs. 1, 7, 5
Better SSRI options (in order of preference for sexual function):
- Escitalopram or fluvoxamine (lowest SSRI-related sexual dysfunction) 7
- Sertraline or citalopram (intermediate rates: 14% ejaculatory failure, 6% decreased libido) 7
- Fluoxetine (moderate-high rates) 7
4. Dose Matters Significantly
- Sexual side effects are strongly dose-related—higher doses increase both depression efficacy AND sexual dysfunction frequency. 1, 3, 5
- Request the minimum effective dose for depression control as primary management strategy. 1
Timeline and Monitoring
- Sexual side effects emerge within the first week of SSRI treatment in most cases. 1
- Only 5.8% of patients experience spontaneous resolution of sexual dysfunction within 6 months; 81.4% show no improvement at all. 5
- Only 24.5% of patients tolerate their sexual dysfunction well, contributing to high discontinuation rates. 5
If You're Already on an SSRI and Experiencing Sexual Dysfunction
Switch to bupropion—this is the American College of Physicians' standard recommendation for SSRI-induced sexual dysfunction. 1, 7 Approximately 62% of patients who switch antidepressants achieve treatment response. 7
Critical safety warning: Never abruptly discontinue SSRIs. Gradual taper over 10-14 days is required to prevent withdrawal syndrome (dizziness, nausea, headache, flu-like symptoms). 1, 7 Fluoxetine requires systematic tapering due to its long half-life. 1
Bottom Line
Have a direct conversation with your doctor about whether you actually have depression or anxiety requiring treatment. If yes, insist on bupropion first unless contraindicated. If no psychiatric diagnosis exists, an SSRI for isolated low libido is inappropriate and will likely worsen your sexual function. 7