Does escitalopram cause erectile dysfunction? Yes, escitalopram—a selective serotonin reuptake inhibitor (SSRI) widely prescribed for depression and anxiety—can cause erectile dysfunction as a recognised side effect. According to UK product information, erectile dysfunction affects up to 1 in 100 people taking this medication, whilst broader sexual problems such as reduced libido and ejaculation difficulties are more common. The mechanism relates to how SSRIs increase serotonin levels, which can interfere with dopamine and nitric oxide pathways essential for normal erectile function. If you're experiencing this side effect, it's important to discuss it with your GP rather than stopping treatment abruptly, as several management options are available.

Does Escitalopram Cause Erectile Dysfunction?

Escitalopram, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression and anxiety disorders, can cause erectile dysfunction (ED) as a recognised adverse effect. According to the UK Summary of Product Characteristics (SmPC), decreased libido and ejaculation disorders are common side effects (affecting up to 1 in 10 people), whilst erectile dysfunction is classified as uncommon (affecting up to 1 in 100 people). Broader sexual dysfunction—including reduced desire, arousal difficulties, and delayed orgasm—affects a substantial proportion of patients taking SSRIs, though rates vary considerably across studies.

The mechanism underlying this side effect relates to escitalopram's primary action on serotonin pathways in the brain. SSRIs work by increasing serotonin levels in the central nervous system, which helps alleviate symptoms of depression and anxiety. However, elevated serotonin can simultaneously inhibit sexual function through several pathways. Serotonin modulates dopamine and nitric oxide—both crucial for normal erectile function—and increased serotonergic activity in certain brain regions can dampen sexual desire and arousal. Additionally, SSRIs may affect the autonomic nervous system, which controls the vascular changes necessary for achieving an erection.

The onset of erectile dysfunction typically occurs within the first few weeks of starting escitalopram, though it can develop at any point during treatment. The severity ranges from mild difficulties to complete inability to achieve an erection sufficient for sexual intercourse. It is important to note that depression itself can cause sexual dysfunction, making it sometimes challenging to distinguish between medication-related effects and symptoms of the underlying condition.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a Drug Safety Update advising that sexual dysfunction associated with SSRIs and SNRIs can, in some cases, persist after stopping treatment. If you are experiencing erectile dysfunction after starting escitalopram, it is essential to discuss this with your healthcare provider rather than discontinuing the medication abruptly, as sudden cessation can lead to withdrawal symptoms and relapse of your mental health condition. You can report suspected side effects via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Managing Erectile Dysfunction Whilst Taking Escitalopram

Several evidence-based strategies can help manage erectile dysfunction whilst continuing escitalopram treatment for your mental health condition. The approach should be individualised based on the severity of symptoms, the effectiveness of escitalopram for your depression or anxiety, and your personal circumstances.

Dose adjustment may be considered as a first-line strategy. Some patients experience improvement in sexual function with a reduced dose of escitalopram, whilst still maintaining adequate control of their mental health symptoms. However, any dose modification must be supervised by your GP or psychiatrist to ensure your depression or anxiety remains well managed. This approach requires careful monitoring and should never be attempted without medical guidance. 'Drug holidays'—skipping doses to improve sexual function—are not recommended, as they increase the risk of withdrawal symptoms and relapse.

Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) can be prescribed alongside escitalopram to treat SSRI-induced erectile dysfunction. Research demonstrates that these medicines are generally safe and effective when used concurrently with SSRIs. However, your doctor will need to assess your cardiovascular health and check for contraindications before prescribing. PDE5 inhibitors are absolutely contraindicated if you take nitrates (for angina) or riociguat (for pulmonary hypertension), and caution is required if you take alpha-blockers or have unstable cardiovascular disease. Your GP may assess your cardiovascular risk (for example, using QRISK) and review your blood pressure, blood glucose, and lipid levels before starting treatment. These drugs work by enhancing blood flow to the penis, counteracting some of the physiological effects of SSRIs on erectile function.

Psychosexual therapy or talking therapies may be helpful, particularly if psychological factors are contributing to erectile difficulties. Your GP can discuss referral options if appropriate.

Lifestyle interventions should not be overlooked. Regular physical exercise, maintaining a healthy weight, limiting alcohol consumption, stopping smoking, and managing stress can all contribute to improved erectile function. These measures support both cardiovascular health—essential for erections—and overall mental wellbeing, potentially allowing for lower antidepressant doses over time.

When to Speak to Your GP About Sexual Side Effects

Open communication with your GP about sexual side effects is crucial for optimising both your mental health treatment and quality of life. Many patients feel embarrassed discussing erectile dysfunction, but it is important to remember that sexual side effects are a well-recognised consequence of SSRI therapy, and your doctor will have encountered this issue frequently in clinical practice.

You should contact your GP if:

• Erectile dysfunction develops or worsens after starting escitalopram or increasing the dose

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

• You are considering stopping your medication due to sexual problems

• The erectile dysfunction persists despite trying initial management strategies

Seek urgent medical attention (call 999 or go to A&E) if you experience:

• Chest pain, severe breathlessness, or symptoms suggestive of a heart attack

• A prolonged, painful erection lasting more than 2 hours (priapism)

• Sudden severe penile pain or curvature

• New neurological symptoms such as weakness, numbness, or loss of bladder or bowel control

Timing is important—whilst some sexual side effects may improve within the first 2–3 months of treatment, persistent problems warrant medical review. Your GP can conduct a thorough assessment to determine whether the erectile dysfunction is indeed medication-related or whether other factors might be contributing. Conditions such as diabetes, cardiovascular disease, hormonal imbalances, and psychological factors can all cause or exacerbate erectile problems. Erectile dysfunction can be an early indicator of cardiovascular disease, so your GP may recommend a cardiovascular risk assessment.

During your consultation, your doctor will likely review your current medication regimen, as some other drugs can interact with or compound the sexual side effects of escitalopram. They will also assess how well your depression or anxiety is controlled, as this influences treatment decisions. Your GP may check your blood pressure, body mass index (BMI), blood glucose or HbA1c, lipid profile, and, if indicated, morning testosterone, thyroid function, or prolactin levels. Be prepared to discuss the severity and frequency of erectile difficulties, any other sexual symptoms (such as reduced libido or delayed ejaculation), and how these issues are affecting your wellbeing.

Never discontinue escitalopram abruptly without medical supervision. Sudden cessation can trigger discontinuation syndrome, characterised by dizziness, sensory disturbances, anxiety, and flu-like symptoms. Moreover, stopping antidepressant treatment prematurely significantly increases the risk of relapse. Your GP can help you weigh the benefits of continuing escitalopram against the impact of sexual side effects and develop an appropriate management plan.

Alternative Antidepressants and Sexual Function

If erectile dysfunction persists despite management strategies, switching to an alternative antidepressant with a lower risk of sexual side effects may be appropriate. This decision should be made collaboratively with your GP or psychiatrist, considering the effectiveness of escitalopram for your mental health condition, the severity of sexual side effects, and your individual risk factors.

Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), generally causes fewer sexual side effects than SSRIs. Its unique mechanism of action affects serotonin receptors differently than escitalopram, potentially reducing the impact on sexual function. Common side effects include sedation and increased appetite, which may be beneficial or problematic depending on your symptoms.

Vortioxetine, a multimodal antidepressant licensed in the UK for major depressive disorder, has been associated with lower rates of sexual dysfunction compared with some other SSRIs in clinical trials. Your GP or psychiatrist can discuss whether this option is suitable for you.

Agomelatine, a melatonergic antidepressant, has demonstrated low rates of sexual dysfunction in clinical trials. It works primarily through melatonin receptors rather than serotonin reuptake inhibition. However, it requires strict monitoring of liver function tests (LFTs) at baseline, 3, 6, 12, and 24 weeks, and then as clinically indicated. It is contraindicated in patients with hepatic impairment or elevated liver enzymes, and local formulary restrictions may apply.

Moclobemide, a reversible monoamine oxidase inhibitor (MAOI), may be considered in selected patients under specialist guidance. It generally has a lower risk of sexual side effects but requires dietary precautions and careful monitoring for interactions.

Important note on bupropion: Bupropion is not licensed for the treatment of depression in the UK. It is licensed only as Zyban for smoking cessation. Any use of bupropion for depression would be off-label and should only be initiated by a specialist with appropriate informed consent and monitoring.

Switching process: Transitioning between antidepressants requires careful medical supervision. Your doctor will develop a tapering schedule for escitalopram whilst introducing the new medication, a process that typically takes several weeks. During this transition period, close monitoring is essential to manage any withdrawal symptoms and ensure your mental health remains stable. Some patients may experience a temporary worsening of depressive or anxiety symptoms during the switch. NICE guidance on depression in adults (NG222) and NICE Clinical Knowledge Summaries provide detailed advice on switching and stopping antidepressants safely.

It is worth noting that no antidepressant is entirely free from the risk of sexual side effects, and individual responses vary considerably. What works well for one person may not be suitable for another. NICE guidelines emphasise the importance of individualised treatment decisions, balancing efficacy for mental health symptoms against tolerability and side effect profiles.

Frequently Asked Questions