SNRIs Do NOT Increase Sexual Drive in Women
SNRIs (serotonin-norepinephrine reuptake inhibitors) cause sexual dysfunction in women, including difficulty reaching orgasm and hypoactive sexual desire disorder (HSDD), rather than increasing sexual drive. 1
Evidence of Sexual Adverse Effects
The most recent and highest-quality guideline evidence from BJOG (2023) explicitly states that "SSRI and SNRI may cause sexual adverse effects, including difficulty reaching orgasm or hypoactive sexual desire disorder (HSDD)" in women. 1 This is consistent across multiple clinical practice guidelines:
The NCCN Survivorship Guidelines (2017) identify SSRIs and SNRIs as medications that contribute to sexual dysfunction and recommend identifying these as potential contributing factors when evaluating women with sexual concerns. 2
The American College of Physicians guideline (2008) reports that paroxetine (an SSRI) was associated with higher rates of sexual dysfunction than other antidepressants, and notes that absolute rates of sexual dysfunction are likely underreported. 3
Important Clinical Caveat: Context-Dependent Effects
There is one specific exception where duloxetine (an SNRI) may indirectly improve sexual function:
In women with stress urinary incontinence (SUI), duloxetine improved Female Sexual Function Index (FSFI) scores from 19.9 to 25.7 (p < 0.001), with improvements in arousal, lubrication, orgasm, satisfaction, and pain/discomfort. 4
This improvement is indirect, occurring through treatment of the underlying incontinence and associated depression, not through direct enhancement of sexual drive. 4
This does not represent a primary effect of SNRIs on sexual function, but rather improvement secondary to treating a condition that was itself causing sexual dysfunction. 4
Clinical Recommendations
When managing women on SNRIs who report sexual concerns:
Review all medications, particularly SSRIs and SNRIs, as potential contributors to sexual dysfunction. 2
Consider that SNRIs are used therapeutically for vasomotor symptoms and depressive symptoms in menopausal women, but clinicians must be aware of their sexual adverse effects. 1
For women with HSDD, consider FDA-approved non-hormonal therapies such as flibanserin or bremelanotide, or topical testosterone (though not studied in all populations). 1
Do not prescribe SNRIs with the expectation of improving sexual drive—the evidence demonstrates the opposite effect in the general population. 1, 3