Are There Antidepressants That Don't Cause Sexual Dysfunction?
No antidepressant is free of sexual side effects for everyone, but bupropion, mirtazapine, vilazodone and low-dose vortioxetine come closest to placebo.
By withClaro Editorial · Medically reviewed by Dr. Jason Tan , Consultant Psychiatrist · 2026-11-09 · 10 min read
Key takeaways No antidepressant is free of sexual side effects for everyone, but bupropion, mirtazapine, vilazodone and vortioxetine at low doses come closest to placebo in studies. SSRIs and venlafaxine affected 58% to 73% of people who were asked directly in a 2001 study. In 100 Reddit threads about sex on antidepressants, 283 of 423 people with their own experience said sex changed, most often through lower desire. Sexual problems are common in depression before any medicine, so it helps to note how sex is before you start. If your antidepressant works but affects sex, a dose change, a different medicine or an added treatment are options to discuss with your prescriber. On this page
Which antidepressants have the least sexual side effects? How often do antidepressants cause sexual side effects, according to people on Reddit? What did a psychiatrist who studies this say, and does it hold up? Which antidepressants cause the most sexual side effects, and why? Is it the depression or the antidepressant? What if your current antidepressant is affecting your sex life? What to tell your prescriber before starting or switching The closest thing to antidepressants that don't cause sexual dysfunction is bupropion or mirtazapine: a 2009 review found both no different from placebo. None is free of it for everyone, but the gap between drugs is large. Vortioxetine at its lowest dose was close to placebo in the trials in its FDA label. In a 2001 study that asked people directly, SSRIs and venlafaxine affected 58% to 73%.
Anita Clayton chairs psychiatry at the University of Virginia School of Medicine. She gave the same ranking on Medscape's InDiscussion podcast in April 2023. She also said most people with depression have sexual problems before they take anything. We checked her claims against FDA labels and trials: most hold up, and a few numbers are softer than she put them.
Which antidepressants have the least sexual side effects?
Bupropion and mirtazapine rank lowest, then vilazodone and vortioxetine at its lowest dose, both near placebo in their FDA labels. Vortioxetine's rate rises with dose. At 20 mg, 29% of men and 34% of women had a problem, against 14% and 20% on placebo. SSRIs, venlafaxine and duloxetine raised rates over placebo. Studies used different questionnaires, so compare the order rather than exact percentages.
Antidepressant What studies found Where it ranks Bupropion (Wellbutrin) No different from placebo in the 2009 review. 22% to 25% in a 2002 US study of 6,297 people, the lowest rates in it Among the least likely Mirtazapine (Remeron) No different from placebo in the 2009 review. 24% of 49 people in the 2001 study, but in the 36% to 43% range with SSRIs in the 2002 study Low, but studies disagree Vortioxetine (Trintellix) At 5 mg, close to placebo. Higher at 15 mg and 20 mg Low at low doses, rises with dose Vilazodone (Viibryd) Lower desire in 2% to 4% of people, against under 1% on placebo. No different from placebo in healthy adults over five weeks Low against placebo; not compared with an SSRI in depression Duloxetine (Cymbalta) Above placebo and above vortioxetine at 5 mg and 10 mg in pooled trials Above placebo SSRIs: fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine 58% to 73% in the 2001 study Most likely Escitalopram (Lexapro) Not in the 2001 study. Above placebo in the 2009 review Above placebo Venlafaxine (Effexor) 67% in the 2001 study Same as SSRIs
Which SSRI has the least sexual side effects? In the 2001 Spanish study of 1,022 people, fluoxetine had the lowest rate at 58% and citalopram the highest at 73%. Escitalopram was not in that study.
Mirtazapine has fewer studies than the others. Clayton said as much:
There's not very much data about mirtazapine, but it clearly is less likely to cause sexual dysfunction than SSRIs.
If sex matters to you, say so at your first appointment, so your prescriber can weigh it when choosing a medicine. For one of them in detail, see how bupropion affects libido and sex .
How often do antidepressants cause sexual side effects, according to people on Reddit?
About a third said sex didn't change or got better, and most of the rest said desire dropped
We read 100 recent Reddit threads about sex on antidepressants, comments included. They came from r/bupropion, r/lexapro, r/prozac, r/Trintellix, r/antidepressants and other subreddits. Between the posts and the replies, 423 people wrote about their own experience.
Of those 423, 127 said sex was unaffected or better and 283 said it changed. Our count puts unaffected and better together, and on r/bupropion many people wrote that their libido went up. People with a problem are more likely to post, and bupropion threads were a large share. Read this as what people posted, not how often each drug does it.
Someone on r/Trintellix wrote:
I haven’t experienced any sexual side effects at all with Trintellix
Desire was the most common complaint among people who said sex changed. Orgasm came next, and one person can be in more than one row:
What changed Of 283 people Lower desire 155 Delayed or no orgasm 103 Erection problems 25 Genital numbness 20
In all, 186 people said how it went over time. Two in three of them still had the problem on the same drug when they posted. Another 30 said it eased while they stayed on it, and the rest had stopped the drug. Only 66 said what helped. A smaller dose and a change of drug came up most, 13 times each. One person on r/lexapro described the change:
I absolutely noticed a significant difference in my libido and sensitivity.
Another, on r/SSRIs, had moved to a different drug:
Vilazodone hasn't affected it nearly as much.
When you talk to your prescriber, say which part changed: desire, arousal, erection or orgasm.
What did a psychiatrist who studies this say, and does it hold up?
Clayton's ranking matches the trials, but some of her numbers come from unpublished work or from no source we found. She co-authored several of the trials behind these numbers. Where she cites a drug's own studies, we checked the FDA label first.
What Clayton said What the research found Does it hold up? Bupropion doesn't add sexual problems, and as an add-on it needs 300 mg a day; 150 mg didn't work A 2013 Cochrane review: 150 mg twice a day beat placebo, once a day did not. Lowest rates in the 2002 study Yes Mirtazapine is clearly less likely than SSRIs to cause it, though data are thin 24% against 58% to 73% for SSRIs in 2001, but only 49 people took it. Level with SSRIs in her own 2002 study Mostly, but studies disagree Vortioxetine at 5, 10 and 15 mg doesn't separate from placebo; at 20 mg, closer to 10% Near placebo at 5 mg. At 15 mg, 33% of women against 20% on placebo; at 20 mg, 29% to 34% Partly: right at 5 mg; at 20 mg about 3 in 10 had a problem, not 1 in 10 Vilazodone causes it less often Sexual side effects in 8.0% against 0.9% on placebo, in 869 people with depression. No different from placebo in healthy adults Yes against placebo; we found no direct comparison with an SSRI in depression SSRIs and venlafaxine are worst, at about 70% 58% to 73% when asked directly in 2001; 36% to 43% in the 2002 study Order yes; 70% is the top of the range. We did not find a source for her 225 mg threshold for venlafaxine SNRIs such as duloxetine and desvenlafaxine cause it less often, about 45% Duloxetine raised rates above placebo and above vortioxetine at 5 mg and 10 mg. Venlafaxine, also an SNRI, matched SSRIs Partly; we did not find the 45% figure About 70% of people entering antidepressant trials already have sexual problems Before treatment in vilazodone trials: 68% of women, 50% of men Yes for depression, higher in women Adding bupropion, buspirone or mirtazapine can counter the side effect In the 2013 Cochrane review, high-dose bupropion helped; so did sildenafil or tadalafil in men Partly: bupropion yes; buspirone and mirtazapine not shown in trials In healthy people on paroxetine, orgasm was hit by day 4 and desire by day 14 Her study was not published. A 2019 trial in healthy adults found paroxetine worsened sexual function against placebo Direction yes; we could not check the timing Drug holidays don't help, and fluoxetine wasn't in the study A 1995 study of 30 people: weekend breaks helped on sertraline and paroxetine, not on fluoxetine Partly wrong: fluoxetine was studied. No control group, so it proves little
On bupropion as an add-on, she was specific about the amount:
when we're talking about bupropion, you need to get to doses of 300 milligrams a day.
That is her view from trials, and the dose is your prescriber's decision. On vortioxetine at its top dose, she said:
At 20 milligrams a day sometimes we do see that but still at very low rates, closer to 10% than the 45 or 70% with the others.
The Trintellix label shows a higher total rate at that dose than her figure, though still under the SSRI range. Bring the name and dose of your current medicine when you ask about any of these.
Which antidepressants cause the most sexual side effects, and why?
SSRIs and venlafaxine cause them most often. In the 2001 study, paroxetine affected 71% of people and citalopram 73%, the highest rates in the study. Venlafaxine, at 67%, was in the same range. Older drugs such as imipramine and phenelzine were also higher than placebo in the 2009 review.
Clayton's explanation is that serotonin dampens sexual response, while dopamine and noradrenaline drive it. Drugs that mainly raise serotonin would then affect sex most. This fits the ranking, but it is a working explanation, not an established mechanism.
The problem tends to start early, not after months. She described an unpublished study in healthy adults on paroxetine:
So we know sort of the pattern with SSRIs about when it starts. It's not like it starts late. It's just that it starts within a few days after steady state is reached.
Note the date you first notice a change, so you can tell your prescriber how soon after starting it began. For one SSRI in detail, see what Prozac does to desire and orgasm .
Is it the depression or the antidepressant?
Often it's both, and women are more likely to start with a problem. In vilazodone trials, 68% of women and 50% of men already had sexual problems before treatment. In the Trintellix trials, only about a third of people had none at the start. Clayton put it this way:
about 70% of people who come into clinical trials already have sexual dysfunction
If sex was already affected before treatment and nobody noted how, the cause is hard to judge later.
Researchers measure this with short questionnaires such as the Arizona Sexual Experiences Scale. You don't need a scale. Before you start, write down how desire, arousal and orgasm are now, to compare with in a month.
What if your current antidepressant is affecting your sex life?
You don't have to choose between your mood and your sex life, and you don't have to sort it out alone. Clayton worried that people skip doses, stop the medicine, or put up with a lower quality of life. In a 2003 review of 31 trials, depression came back in 41% of people moved to placebo, against 18% who stayed on their antidepressant. So keep taking the medicine as prescribed and raise the sexual side effects with your prescriber.
They include lower desire, difficulty with arousal, and delayed or absent orgasm. Depression itself also lowers desire, which can make the cause hard to pin down.
Your prescriber can discuss a lower dose, a medication less likely to cause them, or an added treatment. For most people sexual function returns after stopping. If it does not, tell your prescriber.
Medical review Medically reviewed by Dr. Jason Tan, Consultant Psychiatrist, on 27 October 2026, this section only. Next review: 27 October 2027.
There is trial evidence for some of these options. The Trintellix label describes an 8-week study of people with sexual problems on an SSRI. Those moved to vortioxetine improved more than those moved to escitalopram, and both kept their response.
For added medicines, the 2013 Cochrane review found benefit for high-dose bupropion and, in men, sildenafil or tadalafil. It found no trials of drug holidays. Don't try it without your prescriber.
If you and your prescriber decide on a change, see how switching from one antidepressant to another works .
What to tell your prescriber before starting or switching
Prescribers can only weigh sex against other side effects if they know it matters to you. On the podcast, Clayton said patients often don't raise sex themselves, so clinicians need to ask. You can bring it up first. These points give your prescriber what they need to compare options:
How desire, arousal and orgasm were before treatment, and before the depression if you remember. Which matters most to you: sex, weight, sleep, energy or anxiety. Antidepressants you have taken before and what happened with sex on each. Other medicines you take. When the change started, and on which dose. Whether you would rather change medicine or add a second one. The withClaro app has a daily check-in for mood, energy and sleep, linked to your dose. Your entries become a report you can share with your prescriber. Add a short note on sex in it, so the timing is clear at your next visit.
Download on the App Store Sexual side effects are easier to raise when you can show when they started and what else changed. The withClaro app lets you log mood, energy and sleep each day, linked to your dose, and turns it into a report for your prescriber.
Frequently asked questions Is there an antidepressant with no sexual side effects or weight gain? None is free of both for everyone. Bupropion had among the lowest sexual side effect rates in studies. Mirtazapine's FDA label lists weight gain in 12% of people in depression trials, against 2% on placebo. Tell your prescriber which of the two matters more to you.
Which antidepressant is best for libido? Bupropion has the best record in studies, and some people on r/bupropion said their libido went up. That is not the same as a treatment for low desire. Ask your prescriber whether it fits your symptoms and history.
How to climax on antidepressants for females? Start by telling your prescriber that orgasm is the problem, not desire. Note when it started and on which dose. Then ask whether a dose change, a switch or an added medicine suits you.
Can you take Viagra with antidepressants? In trials, sildenafil and tadalafil helped men with erection problems on antidepressants. Check with your prescriber or pharmacist first, and list every medicine you take.
Does Lexapro have fewer sexual side effects than Zoloft? We found no head-to-head study. Both escitalopram and sertraline were higher than placebo in the 2009 review. If one affected you, tell your prescriber, since another SSRI may not differ much.
Do sexual side effects of antidepressants go away? Sometimes. In our count of Reddit threads, more people said the problem was still there than said it eased on the same drug. Raise it at your next appointment rather than waiting it out.
Related articles
Sources Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. Journal of Clinical Psychopharmacology, 2009 TRINTELLIX (vortioxetine) prescribing information, US Food and Drug Administration via DailyMed Montejo AL, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Journal of Clinical Psychiatry, 2001 Clayton AH, interviewed by Trivedi MH. Sexual Dysfunction Associated With Major Depressive Disorder and Antidepressant Treatment. Medscape InDiscussion: Major Depressive Disorder, season 2, episode 3, April 6, 2023 Clayton AH, et al. Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychiatry, 2002 VIIBRYD (vilazodone) prescribing information, US Food and Drug Administration via DailyMed Clayton AH, et al. Effects of vilazodone on sexual functioning in healthy adults: results from a randomized, double-blind, placebo-controlled, and active-controlled study. International Clinical Psychopharmacology, 2017 Jacobsen PL, et al. Treatment-emergent sexual dysfunction in randomized trials of vortioxetine for major depressive disorder or generalized anxiety disorder: a pooled analysis. CNS Spectrums, 2016 r/Trintellix: Has anyone used Trintellix for anxiety or agoraphobia without sexual side effects? r/lexapro: Women - what is your experience? I’m scared to start Escitalopram bc of the sexual side effects r/SSRIs: Has anyone had a loss of libido/want for a partner due to SSRI's Clayton AH, et al. Effect of vilazodone on sexual functioning during the treatment of major depressive disorder. Journal of Sexual Medicine, 2013 Jacobsen P, et al. Paroxetine, but not vortioxetine, impairs sexual functioning compared with placebo in healthy adults: a randomized, controlled trial. Journal of Sexual Medicine, 2019 Taylor MJ, et al. Strategies for managing sexual dysfunction induced by antidepressant medication. Cochrane Database of Systematic Reviews, 2013 Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. American Journal of Psychiatry, 1995 Geddes JR, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet, 2003 REMERON (mirtazapine) prescribing information, US Food and Drug Administration via DailyMed, revised November 2021 Claro articles are for self-monitoring and educational purposes only. They are not a medical device, therapist, or diagnostic tool, and do not replace care from your prescribing clinician. If you are in crisis, contact your care team, emergency services, the Samaritans (UK: 116 123), or the Crisis Text Line (US: text HOME to 741741).
