Science knows this for certain: There are many possible causes of depression. And one of them is sexual dissatisfaction.
For example, a study in the International Journal of Impotence Research, involving more than 27,000 men and women aged 40 to 80 found that participants with sexual dysfunction were more likely to report depressive symptoms. [1]
In a similar study, published in the Journal of Sexual Medicine, lower sexual satisfaction was linked to more depressive symptoms. [2]
And here is what makes those findings so troubling: Sexual dysfunction is a common side effect of antidepressants. In other words, antidepressants have a side effect that can worsen depression.
The scientific literature linking antidepressants to sexual problems is strong.
A paper in Drug, Healthcare and Patient Safety showed that six out of ten people taking an antidepressant develop sexual dysfunction [3] and 60 percent may be an underestimate.
In one study cited in the paper, 93 percent of men and women taking the tricyclic antidepressant Anafranil (clomipramine) suffered from either partial or total anorgasmia, the inability to have an orgasm.
In one of the most recent studies on antidepressants and sexual dysfunction, published in BMC Psychiatry in April 2025, researchers found that 89% of women and 85% of men on antidepressants suffered with sexual dysfunction. Talk about depressing. [4]
The types of sexual side effects caused by antidepressants include: less sexual desire (low libido); less sexual excitement (and even complete loss of sensation in the penis or vagina); diminished or delayed orgasm; erectile dysfunction; and painful ejaculation.
There’s a side effect of those side effects as well: Patients may stop taking their antidepressants. In fact, some research shows that sexual dysfunction is the most common reason people discontinue what might otherwise be an effective treatment.
In one study, 42% of men and 15% of women admitted that they had stopped their antidepressant medication at some point during their treatment based because of sexual side effects. [5]
Serotonin up, dopamine down
Why do antidepressants cause sexual dysfunction? No one knows for sure. But the probable mechanism of action looks like this:
Most antidepressants—especially SSRIs—work by increasing brain levels of the neurotransmitter serotonin. That’s great for mood. But there’s a possible downside.
Serotonin suppresses dopamine, the neurotransmitter most closely tied to sexual desire, arousal, and orgasm. In other words, the very mechanism that relieves depression may dampen the brain’s sexual award system.
But as I discuss in my new book on functional psychiatry for depression—Finally Hopeful: The Personalized, Whole-Body Plan to Find and Fix the Root Causes of Your Depression—there is a simple herbal therapy that shows promise in controlling or reversing antidepressant-caused sexual dysfunction.
Pine bark extract: A supplement with sex appeal
In a study published in Physiology International in 2019, researchers in eastern Europe studied 72 people with depression who were taking Lexapro. [6]
They divided them into two groups: 37 took Lexapro and Pycnogenol, a pine bark extract; 35 continued to take Lexapro only. After one month of treatment, those who were taking Pycnogenol had much less sexual dysfunction.
The researchers speculate the pine bark extract worked by improving circulation and reducing inflammation.
And pine bark extract may help not only with low libido; it may help improve mood itself. In an eight-week study of 38 women with menopausal symptoms, Pycnogenol effectively treated loss of libido—and mood swings, hot flashes, night sweats, and vaginal dryness. [7]
Try a different antidepressant
The 2025 study in BMC Psychiatry I mentioned above showed that not all depressants are created equal when it comes to causing sexual side effects.
The researchers found that women who used Wellbutrin (bupropion) “experienced lower levels of sexual dysfunction” compared to those on SSRIs or SNRIs.
“This highlights the importance of considering…medication type when addressing and managing psychotropic-related sexual dysfunction,” they concluded.
Bottom line for patients: If you’re thinking of stopping your antidepressant because of sexual side effects, talk to your doctor about possibly taking an antidepressant that is not an SSRI or SNRI.
Final thoughts
Sexual side effects from antidepressants are common but they’re not inevitable, and they’re often manageable.
The first step is bringing up the topic of antidepressants and sexual dysfunction with your patient—because patients rarely volunteer this information. If the patient is suffering with sexual dysfunction, consider adjusting the medication, or adding a supportive treatment, like pine bark extract. And don’t forget discussing the lifestyle factors that science shows can help improve sexual function, like regular exercise, a diet emphasizing whole, minimally processed foods, a regular sleep schedule, and using a stress management technique like deep breathing or mindfulness meditation.
Treating depression should improve quality of life, not diminish one of its most meaningful pleasures.
