Serotonin-noradrenaline reuptake inhibitors (SNRIs) are widely prescribed antidepressants that can cause erectile dysfunction as a recognised adverse effect. Sexual dysfunction, including difficulties achieving or maintaining an erection, is listed as a common side effect in UK product information for licensed SNRIs such as venlafaxine and duloxetine. The mechanism is thought to involve elevated serotonin levels interfering with neurotransmitter pathways essential for sexual arousal and function. Not everyone taking SNRIs will experience erectile problems, and severity varies considerably between individuals. If you develop erectile difficulties whilst taking an SNRI, it is essential to discuss this with your GP rather than stopping treatment abruptly, as sudden discontinuation can cause withdrawal symptoms and worsen your mental health.
Summary: Yes, SNRIs commonly cause erectile dysfunction as a recognised adverse effect, though not everyone experiences this side effect.
- SNRIs such as venlafaxine and duloxetine list sexual dysfunction (including erectile dysfunction) as a common adverse reaction in UK product information.
- Elevated serotonin levels from SNRIs may interfere with dopamine and nitric oxide pathways involved in achieving and maintaining erections.
- Management options include dose adjustment, switching to alternative antidepressants with lower sexual side effect profiles, or prescribing PDE5 inhibitors such as sildenafil.
- Never stop taking SNRIs suddenly without medical advice, as abrupt discontinuation can cause withdrawal symptoms and mental health relapse.
- Your GP should assess cardiovascular risk factors and exclude other causes of erectile dysfunction through blood tests and physical examination.
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Do SNRIs Cause Erectile Dysfunction?
Serotonin-noradrenaline reuptake inhibitors (SNRIs) are commonly prescribed antidepressants used to treat depression, anxiety disorders, and certain chronic pain conditions. Sexual dysfunction—including erectile dysfunction (ED)—is a recognised adverse effect of this medication class. According to the Summaries of Product Characteristics (SmPCs) for UK-licensed SNRIs, sexual dysfunction is listed as a common or very common adverse reaction, though the exact frequency and type of sexual side effect varies between individuals and specific medications.
The mechanism behind SNRI-induced erectile dysfunction is not fully understood but is thought to be multifactorial. These medications work by increasing levels of serotonin and noradrenaline in the brain, which helps improve mood and reduce anxiety. However, elevated serotonin levels may interfere with the sexual response cycle through effects on neurotransmitter pathways involved in sexual arousal and function. It is hypothesised that increased serotonin activity may affect dopamine and nitric oxide pathways, both of which play important roles in achieving and maintaining an erection, though the precise mechanisms require further research.
It is important to note that not everyone taking SNRIs will experience erectile dysfunction , and the severity can vary considerably between individuals. Factors such as the specific SNRI prescribed, dosage, duration of treatment, underlying health conditions, and individual physiology all play a role. Depression and anxiety themselves can also cause sexual dysfunction, which can make it challenging to determine whether the medication or the underlying condition is primarily responsible. If you are experiencing erectile difficulties whilst taking an SNRI, it is essential to discuss this with your GP rather than stopping the medication abruptly, as sudden discontinuation can lead to antidepressant discontinuation syndrome (characterised by withdrawal symptoms) and worsening of your mental health condition.
Which SNRIs Are Most Likely to Cause Erectile Dysfunction?
The two main SNRIs licensed in the UK are venlafaxine and duloxetine. Whilst both carry a risk of sexual side effects, the likelihood and severity can differ between individual medications and between patients.
Venlafaxine (Efexor XL and generics) is one of the most commonly prescribed SNRIs. According to the MHRA/EMC SmPC, sexual dysfunction (including erectile dysfunction, abnormal ejaculation, and decreased libido) is listed as a common adverse reaction (occurring in 1 in 10 to 1 in 100 patients). Clinical studies and real-world experience suggest that the risk may be dose-dependent, with higher doses potentially more likely to cause sexual difficulties. At lower doses, venlafaxine acts primarily on serotonin reuptake, but at higher doses it increasingly affects noradrenaline reuptake, which may influence the profile of side effects.
Duloxetine (Cymbalta, Yentreve, and generics) is prescribed for depression, generalised anxiety disorder, and neuropathic pain. According to the MHRA/EMC SmPC, sexual dysfunction (including erectile dysfunction, ejaculation disorder, and decreased libido) is listed as a common adverse reaction. The frequency and severity of sexual side effects appear broadly similar to venlafaxine, though individual responses vary.
Desvenlafaxine (Pristiq), the active metabolite of venlafaxine, is not currently licensed in the UK and is therefore not available for prescription here.
It is worth noting that individual responses vary considerably. Some men may experience significant erectile dysfunction on one SNRI but tolerate another well. Additionally, the timing of sexual side effects can differ—some men notice difficulties within the first few weeks of treatment, whilst others may develop problems after several months. Your GP can discuss which SNRI might be most appropriate for your circumstances, taking into account both the primary indication for treatment and the potential for sexual side effects.
Managing Erectile Dysfunction While Taking SNRIs
If you develop erectile dysfunction whilst taking an SNRI, several management strategies may help without necessarily requiring you to stop your antidepressant treatment. The approach will depend on the severity of symptoms, how well the SNRI is controlling your mental health condition, and your individual preferences.
Watchful waiting may be appropriate initially, as some sexual side effects can improve spontaneously after the first 2–3 months of treatment as your body adjusts to the medication. However, if erectile dysfunction persists or significantly affects your quality of life and relationships, more active management is warranted.
Dose adjustment is often the first strategy considered. If your mental health condition is well-controlled, your GP may suggest reducing the SNRI dose to the lowest effective level. This can sometimes reduce sexual side effects whilst maintaining therapeutic benefit for depression or anxiety. Any dose changes should be made gradually under medical supervision to minimise the risk of discontinuation symptoms or relapse.
Switching to an alternative antidepressant with a lower risk of sexual side effects is another option. Medications such as mirtazapine, agomelatine, or vortioxetine may have lower rates of sexual dysfunction. Vortioxetine is recommended by NICE (TA367) as an option for treating major depressive episodes and may be associated with a lower burden of sexual side effects. Agomelatine requires baseline and regular liver function test (LFT) monitoring as per the SmPC. Bupropion is not licensed for depression in the UK (it is licensed only for smoking cessation). Switching medications carries risks, including potential worsening of mental health symptoms during the transition period, so this decision requires careful discussion with your GP or psychiatrist.
Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) can be prescribed to treat SNRI-induced erectile dysfunction. These medications work by enhancing blood flow to the penis and have been shown to be effective for antidepressant-related erectile difficulties. According to the BNF and NICE CKS, PDE5 inhibitors are contraindicated in patients taking nitrates or riociguat, and should be used with caution in those taking alpha-blockers. Your GP will assess your cardiovascular risk before prescribing, as recommended by NICE CKS: Erectile dysfunction.
Additional strategies include addressing lifestyle factors such as regular exercise, smoking cessation, and reducing alcohol intake, all of which can improve erectile function. Psychosexual counselling may be beneficial, particularly if relationship difficulties have developed as a result of the sexual dysfunction. Vacuum erection devices are a non-pharmacological option that may be considered in some cases.
When to Speak to Your GP About Sexual Side Effects
You should contact your GP if you experience erectile dysfunction or other sexual side effects whilst taking an SNRI. Many men feel embarrassed discussing sexual problems, but these are recognised medical side effects that your doctor will be familiar with and able to address professionally. Early discussion allows for timely intervention and prevents the issue from affecting your mental health, relationships, and quality of life.
Specific situations that warrant prompt GP consultation include:
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Erectile dysfunction that develops after starting an SNRI or following a dose increase
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Sexual side effects that persist beyond 2–3 months of treatment
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Difficulties that are causing significant distress or relationship problems
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Any consideration of stopping your medication due to sexual side effects
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Erectile dysfunction accompanied by other concerning symptoms such as loss of libido, delayed ejaculation, or inability to achieve orgasm
It is particularly important never to stop taking your SNRI suddenly without medical advice, even if you are experiencing troublesome side effects. Abrupt discontinuation can cause antidepressant discontinuation syndrome, characterised by flu-like symptoms, dizziness, sensory disturbances, anxiety, and mood changes. Additionally, stopping antidepressant treatment prematurely increases the risk of relapse of depression or anxiety, as outlined in NICE guideline NG222: Depression in adults.
When you see your GP, be prepared to discuss:
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When the erectile difficulties began in relation to starting the SNRI
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The severity and frequency of the problem
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Any other sexual side effects you have noticed
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How well your mental health condition is currently controlled
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Whether you have other medical conditions or take other medications that might contribute to erectile dysfunction
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Your preferences regarding management options
Your GP may perform a physical examination and arrange blood tests to exclude other causes of erectile dysfunction. According to NICE CKS: Erectile dysfunction, assessment should include:
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Blood pressure measurement
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HbA1c or fasting glucose (to screen for diabetes)
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Lipid profile (cardiovascular risk assessment)
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Morning total testosterone level (and prolactin if clinically indicated, e.g., low testosterone or reduced libido)
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Thyroid function tests if clinically indicated
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Renal and liver function as appropriate
Erectile dysfunction can sometimes be an early indicator of cardiovascular disease, so your GP will assess your cardiovascular risk factors as part of the evaluation.
Referral to a specialist may be considered in certain situations, including:
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Suspected hypogonadism or other endocrine disorder
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Peyronie's disease or penile deformity
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Persistent erectile dysfunction despite first-line measures
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Complex comorbidity or high cardiovascular risk requiring specialist assessment
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Need for psychosexual therapy
Your GP will work with you to develop an individualised management plan that balances effective treatment of your mental health condition with minimising sexual side effects and maintaining your overall quality of life.
If you experience severe worsening of mood or suicidal thoughts, seek urgent help by contacting your GP, calling NHS 111, or attending your local emergency department.
Reporting side effects: If you experience erectile dysfunction or any other side effect whilst taking an SNRI, you can report it via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store. Reporting helps improve the safety information available about medicines.
Frequently Asked Questions
Can venlafaxine cause erectile dysfunction?
Yes, venlafaxine commonly causes erectile dysfunction, listed as a common adverse reaction occurring in 1 in 10 to 1 in 100 patients according to UK product information. The risk may be dose-dependent, with higher doses potentially more likely to cause sexual difficulties.
How long does it take for SNRI-related erectile dysfunction to improve?
Some sexual side effects may improve spontaneously after the first 2–3 months of treatment as your body adjusts to the medication. If erectile dysfunction persists beyond this period or significantly affects your quality of life, speak to your GP about management options such as dose adjustment or switching medications.
Can I take Viagra whilst on an SNRI for erectile dysfunction?
Yes, PDE5 inhibitors such as sildenafil (Viagra) can be prescribed to treat SNRI-induced erectile dysfunction and have been shown to be effective for antidepressant-related erectile difficulties. Your GP will assess your cardiovascular risk and check for contraindications such as nitrate use before prescribing.
What is the difference between SNRI and SSRI side effects on sexual function?
Both SNRIs and SSRIs commonly cause sexual dysfunction, including erectile difficulties, through similar mechanisms involving elevated serotonin levels. SNRIs also affect noradrenaline reuptake, which may influence the side effect profile, though individual responses vary considerably between medication classes and specific drugs.
Which antidepressants are less likely to cause erectile problems than SNRIs?
Antidepressants such as mirtazapine, agomelatine, and vortioxetine may have lower rates of sexual dysfunction compared to SNRIs. Your GP can discuss switching medications if erectile dysfunction persists, though this decision requires careful consideration of potential mental health risks during the transition period.
Should I stop taking my SNRI if I develop erectile dysfunction?
No, never stop taking your SNRI suddenly without medical advice, even if you experience troublesome sexual side effects. Abrupt discontinuation can cause antidepressant discontinuation syndrome (withdrawal symptoms) and increase the risk of mental health relapse, so always discuss concerns with your GP first.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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