Your Provider's Recommendation is Incorrect
SSRIs are strongly contraindicated for treating decreased libido—they are a well-established cause of sexual dysfunction, not a treatment for it. This recommendation contradicts all available evidence and represents a fundamental misunderstanding of SSRI pharmacology.
Why This Recommendation is Wrong
SSRIs Cause Sexual Dysfunction, Not Treat It
- SSRIs consistently cause decreased libido in both men and women, with sexual dysfunction rates ranging from 40% to over 90% depending on the specific agent and assessment method 1, 2, 3, 4
- Paroxetine has the highest sexual dysfunction rate at 70.7%, significantly higher than other SSRIs 1, 2
- Citalopram causes decreased libido in 3.8% of males (likely underreported) and 1.3% of females in FDA-monitored trials 5
- The mechanism is clear: SSRIs increase serotonin, which inhibits sexual desire, arousal, and orgasm through multiple pathways including dopamine suppression, prolactin elevation, and nitric oxide inhibition 3, 6
The Only Legitimate Use of SSRIs for Sexual Function
- SSRIs are used therapeutically to delay ejaculation in men with premature ejaculation—the exact opposite of enhancing sexual desire 7, 8
- The American Urological Association recommends SSRIs specifically because they cause ejaculatory delay and sexual dysfunction 7
- This therapeutic use exploits the sexual side effects of SSRIs, not any libido-enhancing properties 7, 8
What Actually Treats Decreased Libido
If You Need an Antidepressant
- Bupropion is the only antidepressant that improves or maintains sexual function, with sexual dysfunction rates of only 8-10% compared to 40-90% with SSRIs 1, 2
- The American College of Physicians recommends bupropion as first-line therapy when sexual function is a concern 1
- Bupropion should not be used in patients with seizure disorders or severe agitation 1
If You're Currently on an SSRI
- Switching from an SSRI to bupropion is the standard management strategy for SSRI-induced sexual dysfunction 1, 2
- Dose reduction of the SSRI to the minimum effective level may help, as sexual side effects are strongly dose-dependent 2, 9
- Never abruptly discontinue SSRIs—taper gradually over 10-14 days to prevent withdrawal syndrome 1, 2
Alternative Antidepressants with Lower Sexual Dysfunction
- Mirtazapine has lower sexual dysfunction rates than SSRIs but causes sedation and weight gain 1
- Among SSRIs, if one must be used, sertraline or citalopram have lower sexual dysfunction rates than paroxetine or fluoxetine 1
Critical Safety Concerns
Why This Matters Beyond the Wrong Recommendation
- 40% of patients discontinue SSRIs within 12 months due to sexual side effects, treatment disappointment, and concerns about taking antidepressants 8, 9
- Sexual dysfunction from SSRIs severely impacts quality of life and treatment compliance 3, 9
- Sexual side effects typically emerge within the first few weeks of SSRI treatment 1, 2
What to Ask Your Provider
- What is the actual indication for prescribing an SSRI? (Depression, anxiety, premature ejaculation?)
- If the goal is to treat decreased libido, why are they recommending a medication class that causes this problem?
- Have they considered bupropion or other alternatives that don't impair sexual function?
Common Pitfalls in This Scenario
- Confusing premature ejaculation treatment with libido enhancement: SSRIs delay ejaculation but suppress desire 7, 8
- Underestimating the true incidence of sexual dysfunction: Clinical trial data vastly underreports these side effects because patients and physicians are reluctant to discuss them 1, 5, 4
- Failing to inquire about baseline sexual function: Always establish sexual functioning before starting any psychotropic medication 4
Bottom Line
Seek a second opinion immediately. This recommendation suggests either a serious knowledge gap or a miscommunication about your actual diagnosis. If you have depression or anxiety requiring treatment and are concerned about sexual function, bupropion is the evidence-based first choice 1. If you're being treated for premature ejaculation, SSRIs are appropriate—but that's the opposite of treating decreased libido 7, 8.