Can Antidepressants and Anti-Anxiety Drugs Cause Erectile Dysfunction?

So, you’ve been seeing a therapist, and you’ve started your depression or anxiety regimen. You haven’t noticed any changes to your mental health yet, but you’ve started to experience a side effect known as erectile dysfunction (ED). The truth is, there are a slew of medications that cause ED or make it worse. A good chunk of these are mental health medications.

Here, we’ll discuss six of the most common anxiety and depression treatments that can cause or worsen ED.

1. Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They’re known to cause ED in many people, though.

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This class of medications includes several popular prescription medications, including:

• Sertraline (Zoloft)

• Fluoxetine (Prozac)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Paroxetine (Paxil)

Not all SSRIs are equal. ED is more common with some SSRIs than others. For example, paroxetine can affect up to three-fourths of people who use it, while fluoxetine and sertraline have a lower risk of sexual side effects. Still, all SSRIs carry the risk of affecting your sexual performance to some degree.

2. Serotonin and norepinephrine reuptake inhibitors

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another common class of antidepressants. They include medications such as venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). They work similarly to SSRIs, but while SSRIs are primarily used to treat depression and anxiety, some SNRIs can also manage nerve pain.

SNRIs are similar to SSRIs when it comes to sexual problems.

3. Benzodiazepines

Benzodiazepines are a type of sedative. These medications help calm the brain. Common benzodiazepines include:

• Alprazolam (Xanax)

• Lorazepam (Ativan)

• Clonazepam (Klonopin)

• Diazepam (Valium)

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Benzodiazepines are useful medications that can be taken as needed for situations such as anxiety attacks and insomnia. Some people may also take them every day in select cases. However, benzodiazepines have a number of risks attached to them. This includes the potential to cause ED or make it worse.

Men who take benzodiazepines may be 2 to 3 times more likely to experience ED.

4. Antipsychotics

Some antipsychotic medications have ED rates of over 30%. This includes haloperidol (Haldol), risperidone (Risperdal), and more.

Antipsychotics primarily work by blocking a brain chemical called dopamine. But they can also increase the levels of a hormone called prolactin. Too much prolactin can contribute to ED symptoms.

Thankfully, not all antipsychotics have significant effects on prolactin. Aripiprazole (Abilify) and quetiapine (Seroquel) are top examples. These antipsychotics are less likely to cause ED than most SSRIs, SNRIs, and benzodiazepines.

5. Tricyclic antidepressants

Tricyclic antidepressants (TCAs) are sometimes prescribed to treat depression and anxiety. They’re used less often than SSRIs and SNRIs because they typically cause more side effects. TCAs tend to be most helpful if you have chronic pain or migraines in addition to anxiety or depression.

Amitriptyline, imipramine (Tofranil), doxepin (Silenor), and other TCAs have all been linked to ED. Estimates suggest that sexual side effects affect about 30% of people taking these medications.

6. Atypical antidepressants

Atypical antidepressants are a broad class of antidepressants. Generally speaking, they’re less likely to cause ED than other antidepressants. But this side effect can potentially happen with some of them, such as trazodone and dextromethorphan / bupropion (Auvelity).

Other atypical antidepressants are less of an issue. For instance, sex-related side effects aren’t common with bupropion (Wellbutrin SR, Wellbutrin XL). Some people even experience relief from SSRI-related sexual side effects after switching to vortioxetine (Trintellix). Vilazodone (Viibryd), mirtazapine (Remeron), and nefazodone are also unlikely to cause ED.

How do these medications cause erectile dysfunction?

It’s not confirmed why these medications cause ED. But health experts believe it’s because many of them affect your body’s supply of serotonin. Serotonin is also known as the “happy” hormone — it’s well-known for its role in mood. But it’s also one of the many chemicals in your body responsible for promoting and maintaining an erection. If there’s too much or too little, ED symptoms can appear.

Be aware that this is not a complete list of all medications that can cause ED as a side effect. Ask the pharmacist who fills your prescriptions if anything you’re taking could cause ED. Also, make sure you let your healthcare professional know if you suddenly begin to experience ED symptoms after starting a new medication.

If your medicine is causing ED, your healthcare professional may take a few steps to help you resolve the issue. They might:

• Wait and see: You may experience ED symptoms when you start taking antidepressants or anti-anxiety medications. But this could just be temporary. Your healthcare professional may want you to wait a few weeks until your body has a chance to adjust to the new medication before changing anything. In many cases, ED symptoms go away.

• Change it up: If your current medication regimen isn’t working well enough to manage your depression or anxiety and it’s causing ED side effects, talk to your healthcare professional about trying a different medication. There are many antidepressant and anti-anxiety options available. Some are more likely to cause ED than others.

• Add it on: If your current medication regimen is working well for your depression or anxiety, you might be hesitant to change it. So, what can you do if it’s causing ED? Adding bupropion to your routine can help improve your ED symptoms. Medications like sildenafil (Viagra) or tadalafil (Cialis) are also options.

Does buspirone have sexual side effects?

Buspirone is an anti-anxiety medication with milder side effects than many other anxiety medications. You can take it alone or with medications like SSRIs or SNRIs. Buspirone is FDA approved to treat generalized anxiety disorder.

What’s more, some studies have found that taking buspirone can improve sexual side effects, such as ED, when used as part of an anti-anxiety treatment. It’s also recommended by the American Psychiatric Association to help treat ED among people living with depression.

Keep in mind that this is considered an off-label use. Buspirone’s ability to treat ED symptoms hasn’t been formally evaluated by the FDA.

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Written by:

Mandeep Sohal, PharmD

Mandeep Sohal, PharmD, has more than 7 years of experience in the pharmaceutical industry and is licensed in California. In his career, he’s had experience with specialty pharmacy, community pharmacy, pharmacy benefit management, and pharmaceutical manufacturers.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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