Do antidepressants cause erectile dysfunction? Yes, certain antidepressants can cause erectile dysfunction (ED) as a recognised side effect, affecting approximately 25–73% of patients, though rates vary by drug class. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are most commonly associated with sexual difficulties. However, depression itself impairs sexual function in 35–50% of untreated cases, making it challenging to distinguish medication effects from the underlying condition. The MHRA acknowledges these side effects and has warned that sexual dysfunction can sometimes persist after stopping SSRIs and SNRIs. If you experience erectile difficulties whilst taking antidepressants, discuss this with your GP rather than stopping medication abruptly.

Do Antidepressants Cause Erectile Dysfunction?

Yes, certain antidepressants can cause erectile dysfunction (ED) as a recognised side effect. Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance, typically present for at least 3 months. Sexual dysfunction, including ED, is one of the most commonly reported adverse effects of antidepressant therapy, affecting approximately 25–73% of patients taking these medications, though rates vary considerably by drug class and individual studies.

It is important to recognise that depression itself can significantly impair sexual function. Low mood, reduced energy, loss of interest in activities, and altered self-esteem all contribute to sexual difficulties independent of medication. This makes it challenging to determine whether erectile problems are caused by the underlying condition, the treatment, or a combination of both. Research suggests that untreated depression is associated with sexual dysfunction in approximately 35–50% of cases.

The Medicines and Healthcare products Regulatory Agency (MHRA) acknowledges sexual side effects, including erectile dysfunction, in the product information for many antidepressants. While these effects are often dose-dependent, the MHRA has issued a Drug Safety Update warning that sexual dysfunction can sometimes persist after stopping selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs). Not all patients experience sexual side effects, and for many, the benefits of treating depression outweigh the potential impact on sexual function. If you are experiencing erectile difficulties whilst taking antidepressants, it is essential to discuss this with your GP rather than stopping medication abruptly, as sudden discontinuation can lead to withdrawal symptoms and relapse of depression.

Which Antidepressants Are Most Likely to Affect Erections?

Selective serotonin reuptake inhibitors (SSRIs) are the antidepressants most frequently associated with erectile dysfunction. Commonly prescribed SSRIs include sertraline, citalopram, escitalopram, fluoxetine, and paroxetine. These medications work by increasing serotonin levels in the brain, which improves mood but can simultaneously interfere with sexual arousal and erectile function. Studies suggest paroxetine may have higher rates of sexual side effects among SSRIs, though individual responses vary considerably and direct comparisons between agents should be interpreted cautiously.

Serotonin-noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine, also carry a significant risk of sexual dysfunction, including erectile difficulties. These medications affect both serotonin and noradrenaline pathways, and whilst they may be effective for certain types of depression and anxiety, sexual side effects remain a common concern.

In contrast, some antidepressants are associated with lower rates of sexual dysfunction. Mirtazapine, an atypical antidepressant, generally causes fewer sexual side effects due to its different mechanism of action. Vortioxetine may have a more favourable sexual side effect profile than some SSRIs, though it is not typically used as a first-line treatment in the UK. Agomelatine, a melatonin receptor agonist, also demonstrates a favourable sexual side effect profile, but requires liver function monitoring before and during treatment and is contraindicated in hepatic impairment.

Bupropion is associated with minimal impact on sexual function but is not licensed for depression in the UK (it is licensed only for smoking cessation). Any use for depression would be off-label and typically initiated by specialists.

Tricyclic antidepressants (TCAs), such as amitriptyline and imipramine, can cause erectile dysfunction, though they are now prescribed less frequently as first-line treatments. Trazodone, another antidepressant, carries a risk of priapism (prolonged, painful erection requiring urgent medical attention). Monoamine oxidase inhibitors (MAOIs) similarly carry sexual side effect risks but are rarely used due to dietary restrictions and drug interactions.

Why Do Some Antidepressants Cause Sexual Side Effects?

The mechanisms underlying antidepressant-induced erectile dysfunction are multifactorial and likely relate to the complex neurochemistry of sexual function. Several proposed mechanisms have been identified, though the evidence varies between different antidepressants.

Serotonin is thought to play a central role in this process. Whilst increased serotonin levels in certain brain regions improve mood and reduce anxiety, elevated serotonin in other areas may inhibit sexual desire, arousal, and erectile function. Serotonin appears to have an inhibitory effect on dopamine and possibly nitric oxide pathways, both of which are considered essential for normal erectile function.

Dopamine is believed to be crucial for sexual motivation and arousal. Antidepressants that increase serotonin may indirectly suppress dopamine activity in reward pathways, potentially reducing libido and impairing the physiological processes necessary for achieving an erection. Additionally, some antidepressants may affect the autonomic nervous system, which controls the vascular changes required for penile erection. The balance between sympathetic (inhibitory) and parasympathetic (facilitatory) nervous system activity is essential for erectile function.

Nitric oxide is the primary mediator of penile erection, causing smooth muscle relaxation and increased blood flow to erectile tissue. Some evidence suggests certain antidepressants might interfere with nitric oxide signalling, though this varies by drug class. Hormonal factors may also play a role, as some antidepressants can affect prolactin levels, and elevated prolactin is associated with sexual dysfunction.

Individual susceptibility to these effects varies considerably based on genetic factors, baseline sexual function, concurrent medications, and other health conditions such as diabetes or cardiovascular disease. Understanding these proposed mechanisms helps clinicians and patients make informed decisions about treatment options when sexual side effects occur.

Managing Erectile Dysfunction While Taking Antidepressants

If you experience erectile dysfunction whilst taking antidepressants, several evidence-based management strategies are available. The first step is to discuss the issue openly with your GP. Many patients feel embarrassed to raise sexual concerns, but healthcare professionals recognise these as common and clinically significant side effects that warrant attention.

Watchful waiting may be appropriate initially, as sexual side effects sometimes diminish after 2–3 months as the body adjusts to the medication. However, if symptoms persist or significantly affect quality of life, active intervention is warranted. Your GP may consider dose reduction if your depression is well-controlled, as sexual side effects are often dose-dependent. This approach requires careful monitoring to ensure mood stability is maintained.

Switching to an alternative antidepressant with a lower risk of sexual side effects is another option. Mirtazapine or vortioxetine may be suitable alternatives depending on your specific clinical situation. Agomelatine has a favourable sexual side effect profile but requires liver function monitoring and is not typically first-line. Any medication change should be undertaken gradually under medical supervision to minimise withdrawal effects and monitor for relapse.

Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil can be effective for treating antidepressant-induced erectile dysfunction. Sildenafil 50 mg is available from pharmacies without prescription following assessment by a pharmacist, while other strengths and PDE5 inhibitors require a prescription. These medications are not suitable for everyone, particularly those taking nitrates or riociguat (contraindicated) or alpha-blockers (require caution). A cardiovascular risk assessment is advisable before starting treatment.

Timing strategies may help some patients, though evidence is limited. Taking the antidepressant after sexual activity or scheduling intimacy for times when drug levels are lowest might reduce impact in some cases. However, 'drug holidays' are not recommended due to the risk of withdrawal symptoms and depression relapse. Psychological support, including couples counselling or sex therapy, may address the emotional and relational aspects of sexual dysfunction. Lifestyle modifications—regular exercise, stress management, limiting alcohol, and smoking cessation—support both mental health and sexual function.

When to Speak to Your GP About Sexual Side Effects

You should contact your GP about sexual side effects if erectile dysfunction is causing significant distress, affecting your relationship, or impacting your quality of life. Sexual health is an important component of overall wellbeing, and concerns about erectile function are valid reasons to seek medical advice. Many patients delay discussing these issues due to embarrassment, but healthcare professionals are accustomed to addressing sexual health concerns as part of routine care.

Speak to your GP if:

• Erectile difficulties persist beyond 2–3 months of starting or changing antidepressant medication

• Sexual side effects are affecting your relationship or causing psychological distress

• You are considering stopping your antidepressant due to sexual side effects

• You experience other concerning symptoms alongside erectile dysfunction

• You wish to explore treatment options for managing sexual side effects

Never stop taking antidepressants abruptly without medical guidance. Sudden discontinuation can lead to unpleasant withdrawal symptoms (discontinuation syndrome) and increase the risk of depression relapse. Your GP can work with you to find solutions that address both your mental health and sexual function.

Your GP may conduct a comprehensive assessment to exclude other causes of erectile dysfunction. Initial investigations may include blood pressure measurement, HbA1c or fasting glucose, fasting lipid profile, and morning testosterone (9-11am). A cardiovascular risk assessment is often appropriate as erectile dysfunction can be an early marker of cardiovascular disease. Additional tests such as thyroid function or prolactin may be arranged if clinically indicated.

If first-line management strategies are unsuccessful, your GP may refer you to specialist services such as urology/andrology for non-responders, endocrinology for hormonal issues, psychiatry for complex medication management, or psychosexual therapy services. Remember that effective treatments are available, and open communication with your healthcare team is essential.

Seek immediate medical attention if you experience priapism (an erection lasting 2 hours or more), which is a rare but serious side effect of some antidepressants, particularly trazodone.

If you suspect your medication has caused side effects, you can report this through the MHRA Yellow Card Scheme, which helps monitor medication safety.

Frequently Asked Questions