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Happiness is more than a state of mind. It is a cultural preoccupation that drives most – if not all – popular forms of media and culture. Self-help books and articles in print and online purport to offer secrets, tips, and advice on how to be happier or increase overall joyfulness. Hollywood movies perpetually throw fantasy-hungry audiences impossibly perfect happy endings. Happy people are a feature of advertising and marketing, too, causing us to associate purchasing power with control over our troublesome emotions.

This deep drive toward attaining ultimate happiness may not be realistic, but it is understandable. A sense of wellbeing provides a feeling of stability. It blocks out the unpleasantness of life – the stress, the trauma, the sorrow, and even the minor irritations that agitate and raise ire.

Or at least it does so for a certain amount of time.

Despite the endless focus on wellbeing and happiness in our culture, the hardships of life still find their way into our heads and hearts, causing stress and upset. In a state of distress, some look to medication to assuage the pain.

Use of psychotropic medications has significantly increased in the past few decades. Antidepressants, which are used mainly to treat depression and anxiety disorders, are the most commonly prescribed. Again, this is not surprising given the fact that they promise to curb feelings of sadness and anxiety. But are the possible complications worth it? A look at the potential side effects of using antidepressants is a worthwhile exercise.

Antidepressants and sexual dysfunction

There is no question that a great many medications can help people who are struggling with a host of different disorders, but there can be some drawbacks. For example, antidepressants are linked to an increased risk of many negative sexual side effects including decreased libido, vaginal dryness, erectile dysfunction, ejaculation and orgasm difficulties, and priapism. Ironically, these side effects can make some experience a decrease in overall happiness and satisfaction.

Antidepressants work by ensuring greater availability of the chemicals serotonin (5HT), dopamine (DA), and norepinephrine (NE) in the brain. But not all antidepressants work in the same way. The older classifications of antidepressants – the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) – work by targeting all three NE, 5HT, and DA systems. The newer antidepressants – the selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitor (SNRIs) – are becoming increasingly more popular as treatment options. These antidepressants have unique mechanisms of action from the older class given they do not target all three NE, 5HT, and DA systems. More specifically, the mechanism of action of SSRIs involves the aggressive inhibition of 5HT reuptake. The SNRIs work to block the reuptake of both 5HT and NE but not DA. Alternatively, the atypical antidepressants – the norepinephrine and dopamine reuptake inhibitors (NDRIs) – act on the NE and DA systems but not 5HT.

What does this mean for sexual functioning?

Different classes of antidepressants interact differently with all or some of the 5HT, DA, and NE systems. This is meaningful because these three systems also play a role in regulating sexual function. Alter these systems with medications and the result is a change in sexual functioning. Unfortunately, this change is often a negative one.

Although antidepressants in general have been found to negatively affect sexual functioning, antidepressants that interact the most on the serotonin system appear to be the worst offenders in this regard. This is concerning given that SSRIs are the most commonly used antidepressant and drug overall. SNRIs are only slightly less detrimental to sexual functioning than SSRIs likely because the NE reuptake inhibitor mechanism of SNRIs counteracts some of the negative effects of the 5HT mechanism. The atypical medication, bupropoion (Welbutrin), is arguably the best ally for sexual functioning because it does not interact with the serotonin system at all.

Choose wisely

Knowledge is key in deciding how to best avoid undermining your overall wellbeing. When deciding to take medications, first, one should stop and assess their options based on the benefits and risks involved. The possible risk of not taking medications is that disorders, such as depression, can result in sexual dysfunctions themselves. As we have found, however, antidepressant medications can also result in sexual dysfunction. The patient should have an open discussion with their doctor about finding a “happy medium” between the two extremes.

Choose a medication with a lower risk of adverse sexual side effects such as Welbutrin. Changing dosages of current medication can also be an option to alleviate some of the negative sexual side affects. Keep in mind, however, that individuals vary in their psychological characteristics and their genetic makeup, which then varies each person’s experience of sexual dysfunction induced by their medication. Thus, one person might be highly affected negatively by one medication or a different dose, whereas another individual might not be affected at all.

There are alternative treatments for anxiety and depression, however, they do not involve taking antidepressants. There are aromatherapy and herbal remedies such as St John’s Wort, for example. Therapeutic approaches include cognitive hypnotherapy and cognitive-behavioral therapy, acupuncture and light therapy. Sex therapy can also be used as a strategy for the management of the sexual side effects of antidepressants.

Please note: alternative approaches do not always work for everyone and medications may be vital to your functioning. However, complimentary and holistic approaches should arguably not be ruled out without consideration and discussion with a doctor.  

Protect your mental health wisely and well

The preservation of overall wellbeing and happiness is important. But approach this business wisely. Consider options and weigh the pros and cons of each “cure.” Medications can come to the rescue but sometimes at the price of unwanted damage to your sexual functioning. Take the time to engage in an open discussion with a physician about all available options. When choosing to take the pharmacological route, the doctor should select the best option – especially when there is a concern about the possibility of sexual dysfunction as a side effect.

Sexology International, like all of our work, is for people of all sexual preferences and all forms of gender expression, including people whose identity is something other than male or female. As such, we like to use gender-neutral pronouns. More recently accepted alternatives include words like “ze” and “hir” or the universal pronoun “they.” Throughout our work, we will be doing our best to use alternative pronouns, such as “they,” whenever gender or plurality is unimportant. In doing so we hope it helps everyone to feel included in the discussion and that it inspires you to think outside of traditional sex and gender binaries.



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