Antidepressants and sex drive – Does my medication affect my sex drive?

Hello Maj,

I’m a 19 year-old girl. I’ve been with my boyfriend for 1.5 years. We truly love each other and I definitely see a future with him – we often talk about the future and having a family and I truly believe in this.

BUT about 6 months ago, I fell into depression and this is still my reality.

I’ve been on anti-depressants for 4 months, which helps a little bit but not enough (I’m still figuring out the correct brand/dose). Antidepressants and sex drive is not a good combination for me – because I can feel it in my own body! Since starting this medication, my sex drive has decreased and this has affected our relationship as it’s making my boyfriend believe that there’s something wrong with him.

I’ve explained to him several times that it has nothing to do with him and that it’s due to the medication, but I’m finding myself getting slightly annoyed with him. Anything really can make me feel annoyed and this is making me doubt whether it truly is just the medication causing the decrease in my sex drive?

I also started talking to an old friend, whom I, before my current boyfriend, spoke to a lot. Most people actually thought that we were dating because we’d always be together and we’d hug, hold hands and often do sleep-overs (we’d cuddle and kiss a bit but never more than that). When we started talking again, recently, I thought that we could easily meet up and enjoy the friendship we had – without any feelings involved of course, as we’re both seeing other people today. We met up about a week ago and went out and had such a lovely time but, unfortunately, seeing him sparked a lot of old feelings in me too and we hugged and held hands too.

This isn’t major, of course, but I still felt really bad that I enjoyed this and I felt very wrong feeling the way I did… Since then, I haven’t been able to think about anything but this problem and about him…

Seeing this old friend again truly made me doubt whether my boyfriend is the right guy for me. I’ve never felt lust for any other guy than my boyfriend expect for when I saw him – my old friend…

Also, I don’t know whether my boyfriend and I are just going through a rough patch. I am obviously aware that these do happen in long-term relationships. Or do I just not really fancy him anymore?

I don’t know if I can keep seeing my friend without making thing worse. I’m worried I won’t be able to stop the old feelings and that I’ll just like him more and more?

At the same time, it’d hurt me not to see him again, as our friendship really is strong and close and also without feelings involved.

Kind regards,

The Girl in Despair

Antidepressants and sex drive – Does my medication affect my sex drive? – Does my medication affect my sex drive?

Dear Girl in Despair,

First and foremost, let me just say that I’m so glad you wrote to me; I’ll do my best to answer your questions!

As I see it, your problem can be divided into two:

1. Depression and sex drive / Antidepressants and sex drive

2. Your friend and old feelings

Let’s start with the first one!

Depression and sex drive / Antidepressants and sex drive

You’re telling me that about 4 months ago, your doctor diagnosed you with depression. Now, I don’t know the how severe your depression is; whether it’s classified as mild, moderate or severe. I do have a bit of an idea that it’s mild or moderate, since a severe depression often means that you have difficulties even just getting out the door and, by the sounds of it, this is not where you’re at.

I don’t know if your doctor has provided you with information on what a depression is? So! I’ll put my old school-teacher hat back on and give you a bit of a run-down.

Cognitive therapy and depression

In cognitive therapy – this is the area of psychology which deals with cognition (thoughts) – depression is classified as us having three different types of thoughts (this is the simple explanation).

There are the self-critical thoughts; you telling yourself off in your mind, i.e. “You’re never good enough”, “why can’t you just be happy?”, “why do you always say stupid things?”, “why am I so upset all the time, why can’t I just pull it together?” etc.

Then there are the thoughts about the future being absolutely hopeless; you believe that the future you’re headed towards isn’t really the future you want, i.e. “this never gets better”, “I can’t stand this, why does my life have to be this way?”, “I thought it would be awesome to be an adult but now life is just a hassle”, “what if I never feel happy again?”, “maybe I’ll never be happy with my life” etc.

And finally, the negative thoughts about other people and what other people think of you; these are the type of thoughts that’s all about what other people might think of what you do, say, behave etc. I.e. “I can tell that he doesn’t like me”, “they probably think I’m an idiot”, “I’m sure they can tell how insecure I really am”, “no one really cares about me”.

Perhaps you recognize some of these thoughts?

To some extent?

To put it simply, a rule of thumb is that the more thoughts from each of these different categories you find yourself having, the worse your depression is.

These thoughts are absolutely draining!

You speculate, you try to analyze everything to find an answer, you worry about things you said last week and most of your day revolves around being emotionally affected by the thoughts you’re having.

Now, THAT is EXHAUSTING.

Depression and sex drive - Antidepressants and sex drive

And obviously, all of these thoughts release a shit-ton of feelings. You feel upset, angry, unhappy, frustrated, hopeless… you name it. And then you start worrying and wondering about all of that too…

It becomes a negative spiral and more often than not, it’s heading one way and one way only. And that’s down.

All your energy is spent trying to analyze everything to find answers and to “feel better” by just thinking your way through it all.

The problem is though that this is very rarely a constructive, strategic and structured way to work with your thoughts – which, by the way, are all over the place, and this is why you rarely “get” anywhere.

You don’t actually look at the how much truth these thoughts hold and you certainly don’t test them – are they valid?

Hint: they rarely are.

Metacognitive therapy and depression

In metacognitive therapy – that’s the area of psychology which is all about meta-cognition (the thoughts you have about your thoughts– I know, it sounds a bit complicated but hear me out, it does make sense!) – depression is classified as you spending a lot of time mulling things over.

The meta-cognitive therapy does not concern itself with WHAT you’re mulling over and what you’re worrying about (so this is all you mulling/ruminating over the past – worrying are thoughts about the future) but for HOW LONG and HOW MUCH TIME you spend on these intense pondering processes throughout the day.

Whereas the cognitive therapy challenges the thoughts you’re having – it takes an actual look at the thoughts and their level of actual truth – the meta-cognitive therapy helps you regain control over your thought processes, making YOU the one in charge of when you want to do your mulling/rumination and how much time you want to spend on this.

It also challenges your reasoning for what you gain from all this mulling, rumination and speculation – and you’ll find that when you (from my experience this happens pretty quickly –within the first 2-3 weeks) discover that you DO actually have a lot more control over what happens in your mind, your depression will start to fade away.

It sounds simple – it’s not always simple.

It can be really challenging to “let go” of the idea that you need to think everything through or that you HAVE to find an answer – in my experience, the clients I help through their anxiety, depression or stress (when their sexuality is giving them a hard time) are so relieved that they no longer need to have SUCH a big focus on all of these thoughts + they discover that some thoughts shouldn’t be taken THAT seriously. To many people, this is a bit of an eye-opener.

Again – it might sound simple but that’s not necessarily the case.

If you’ve been depressed for a long time of if you’ve been struggling with anxiety your entire life, it might require more sessions than the ‘normal’ amount of 8-10 sessions before you’re completely on-top of it all. It may also require you to have a few short 15-minute follow-up sessions by phone/skype, just to keep you on the right track.

I feel sad whenever I see someone present meta-cognitive therapy as a quick fix; I certainly don’t agree with that.

I believe – and this is what I see too – that this is VERY effective and cognitive therapy is too when done correctly, but, of course, it takes time to alter and challenge and change the strategies and patterns your mind is so used to running. Quick fix or not, it’s a gentle form of therapy (it’s actually the only PTSD treatment which doesn’t enter into the trauma), where you won’t need to sit and go over all those thoughts you’re already spending huge amounts of time on.

Antidepressants and sex drive - Does my medication affects my sex drive

This is what I experience my clients to really like about this. I often meet my clients for other reasons than depression, anxiety or stress-treatment.

I meet them, when they, like yourself, come to me because of how their sexuality is suddenly giving them a hard time.

Or due to problems in their relationship caused by medication, depression, anxiety or how stress affect their relationship. Or when the consequences of cheating and infidelity just mentally sticks and, for years, you’re plagued by deeply unsettling thoughts and visual images and you’d very much like not to be.

When I explain to them the connection between depression, anxiety, stress and sexuality, a lot of people choose to do meta-cognitive sessions to help them conquer their anxiety, stress and/or depression. It’s not until we’ve done this that we begin working on the sexuality and/or relationship – if this still needs work that is.

Sometimes, it’s not even necessary to work on the sexuality/relationship because balance has been restored and you’re already “returning to life” in an emotionally and mentally healthy and balanced way.

Sometimes I do need to help couples reestablish intimacy and perhaps help them communicate about what they just went through. But more often than not, when the balance has been restored – both mentally and emotionally – and you start to feel energetic and full of vitality as well as being intimate and sexual with your partner again, I find that the problems actually sort themselves out.

Antidepressants and sex drive

When you’re on anti-depressants, it sort of ‘clouds’ your thoughts (this is SIMPLIFIED) and this is why you’re experiencing the depressing thoughts ease up a bit – the anxiety too, if you’re struggling with that too.

The problem with anti-depressants can be that they may cause some problems sexually; that’s a side effect.

This is actually quite common. These are side effects that your doctor might not even have told you about, and you might feel frightened when you encounter them yourself.

In fact, some of the SSRI (anti-depressants) can be so good at ‘clouding your thoughts’ (this is SIMPLIFIED) that it is actually used as treatment for men who, due to psychological issues, experience pre-mature ejaculation. This treatment is, of course, done under the supervision of a doctor.

In Sweden, one of the medications used called Dapoxetin is now registered as a treatment for this exact thing (*Source: “Menns Seksualitet” by Haakon Aars).

Depression in itself can reduce sex drive or make it disappear completely; this can, among other things, be due to the fact that your mental energy levels are very low and you’re just feeling flat and run-down.

Please do be aware of this. It doesn’t JUST have to be because of the medication or your relationship – the depression itself can also be playing a role in your sex drive being low.

One of the known side effects of SSRI medications (anti-depressants) is that they affect your sexuality.

This is something we KNOW and something which continues to be backed up by different users of these medications. Depending on the type of SSRI you’re on, it can vary from 0-90% (*Source: “Sex og psyke” by Ellids Kristensen).

Depression and sex drive

Normal side effects to anti-depressants are:

– A reduced sexual interest (probably what you call ‘lust’ and “sex drive”)

– A reduced ability to have an orgasm

– Prolonged ejaculation time

– Reduced vaginal wetness

– Erectile dysfunction

And when I put ‘normal side effects’, they are actually fairly common…

About half of the people on anti-depressant medications experience these sexual side effects.

Again, it depends on what medication you’re on, so please do talk to your doctor about this. You could also talk to your doctor about being referred to a psychologist who’ll create structured and accurate cognitive or meta-cognitive therapy for you.

Regardless, I’ll recommend you to consider whether you could do something yourself, such as therapy, for you to, gradually, stop taking the medications (and hereby ditch the side effects).

Whether your sex drive is affected by your medication or whether there’s something else in the mix too, I don’t know, but there’s a large chance that the medication is affecting your sex drive a lot – along with the depression in itself – so this is where I’d start.

Now, let’s move on to your other problem…

Your friend and old feelings

You’re telling me that you love your boyfriend and you want a future with him. If this is your true wish, then I’d stop being in contact with your friend; that’s just playing with fire.

What you’re describing to me is both a good friendship but also intimate contact – and this is making you feel guilty and I understand that; you’ve crossed your own boundaries for what, to you, is OK to do when you’re in a relationship. This is why you feel guilty and have a bad taste in your mouth.

This is what you said: “I don’t know if I can keep seeing my friend without making thing worse. I’m worried I won’t be able to stop the old feelings and that I’ll just like him more and more?”

This tells me that you do know what to do. The fact that you like someone else doesn’t mean that there’s something wrong with your relationship. A lot of people tend to jump to that conclusion but this isn’t always the case.

There are many people out there who’ll get a bit of a crush on other people, or feel fascinated by other people, and still be in well-functioning relationships. What it comes down to is whether you choose to act on it or not.

You’re heading down that road and you’ve already crossed several boundaries. You’re doing something about it; you’re taking action and this makes you worry whether you can control your feelings or if you’ll just keep getting more and more feelings for him. And yes, it does sound like you would, but this doesn’t mean that you suddenly don’t love your boyfriend anymore. Not necessarily. Some people can easily love more than one person at the time.

Some can’t.

We’re all different.

You have to decide for yourself what you want to spend your energy on.

Please be aware that a depression will often affect a relationship.

You’re actually telling me that your boyfriend is affected by the fact that your sex drive has decreased due to your depression and/or medication. And you’re affected by the way in which he’s handling your lack of sex drive.

You might experience that insecurity enters the relationship, when someone falls sick or experience any form of imbalance for a certain period of time. This is what’s to be expected and it’s completely natural. It sounds to me like this is where you two are at right now.

You might want to give your relationship a chance to get back on track while you work on getting rid of your depression?

depression-and-relationship - Antidepressants and sex drive

So…

Do you want to spend your time and energy on making your relationship with your boyfriend even stronger, or do you want to spend your time building on the relationship with your old friend – knowing that this will probably cause you to feel romantic feelings towards him?

You’re telling me that you and your boyfriend is going through a bit of a rough patch and it’s hard for you to tell whether you actually still love him or if ‘things are just hard right now’.

As I mentioned before, since you’re struggling with depression, it can actually be quite difficult to ‘see clearly’. This is normal and this might not be the time for you guys to decide whether you’re going to be together forever or not.

What you might want to do is start focusing on your relationship – spend your energy here, for now. Stop being in contact with your friend (you can always pick this up again later on, if you discover that this is the right thing to do – at a later stage), and really focus on your relationship.

Make an effort to get back on the right track and see what happens.

My experience tells me that it can be a good idea to make a huge effort for a period of time in order to figure out if you can ‘find your way back to each other’.

And, if you also get rid of your depression (my recommendation here is for you to do therapy in order for you to lay off the medications (and the side effects of this)), then I actually believe that the decision will be easy for you to make – whether you should stay or go.

Time will tell.

Maj-Wismann-Depression-and-sex-drive

Look after yourself.

Love & take care,
Maj Wismann – Clinical sexologist and couple’s therapist with private clinic since 2006 – read about Maj here <—

1 Comment

Monica on June 28, 2018 at 3:15 am

You may not be aware that there are two different types of antidepressant – SSRI, which stands for selective serotonin reuptake inhibitor, and NDRI which stands for norepinephrine/dopamine reuptake inhibitor. And the NDRI ( there is only one, called Wellbutrin), is not supposed to have sexual side effects. You may want to ask your doctor about this.
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