Antidepressants and sex: what the rankings miss
What the antidepressant rankings measure, the questions to put to your doctor before starting, and what to do if side effects have not stopped.
Want an antidepressant that will spare your sex life? No list can tell you which one will. The studies behind the rankings counted problems only during treatment.
UK leaflets for eight SSRIs and SNRIs warn that sexual problems can continue after stopping. That’s called post-SSRI sexual dysfunction (PSSD).
Cornelia took mirtazapine, an antidepressant, for three weeks in 2020. Four years later she told Moral Medicine about sexual problems that had never gone away, and about anhedonia, the loss of pleasure in life.
Watch her describe, in her own words, what the rankings never measured: what came after the last tablet.
A study that stops counting at the last tablet would never have seen what happened to her. If sex matters to you, ask about it before your first prescription.
So what do the rankings show, and what should you ask?
Which antidepressant has the fewest sexual side effects?
Nobody can say reliably. A large review of the research rated its own evidence as low, and said it couldn’t show precisely how one antidepressant compares with another.
Some studies did find fewer problems with some medicines while people were taking them. As a charity we never rank medicines, so we don’t name them. Whatever they found, those studies stopped counting at the last tablet.
How a study asks changes the answer too. The US label for vortioxetine shows both: few men raised a sexual problem themselves, but far more had one when a questionnaire asked them directly. A list built on what people volunteered can look very different from one built on questionnaires.
Vortioxetine in men: how asking changes the answer
Can sexual side effects last after stopping an antidepressant?
For some people, yes. In 2019 the EU medicines regulator asked for a warning on ten SSRI and SNRI antidepressants.
The UK leaflet for sertraline now says that in some cases, sexual symptoms “have continued after stopping treatment”. The version for doctors mentions reports of “long-lasting sexual dysfunction”.
That’s what patients and researchers call PSSD. The proposed diagnostic criteria describe genitals that can feel numb, as if anaesthetised, and orgasms with little or no pleasure. It can last for months or years after the last tablet.
PSSD is more than sexual problems. Proposed criteria from 2022 describe a lasting change in genital sensation, often numbness, and also emotional numbing, problems with cognition and changes in other senses.
Nobody has counted how often it happens yet. A 2023 review looked and couldn’t find a reliable estimate. Reports to regulators were part of the evidence for the warning, but they can’t show how common it is.
Other antidepressants, such as Cornelia’s mirtazapine, weren’t part of the 2019 warning, and far less is known about them. The same criteria mention reports of something similar after mirtazapine, but say there isn’t enough data yet to know whether it’s the same condition. Less known isn’t the same as safe.
What should I ask before starting an antidepressant?
Ask about sex. It’s an ordinary question. NICE guidance for England says the side effects you’d most like to avoid belong in your treatment plan, and it gives effects on sexual function as an example.
Which medicine suits you is a choice for you and your prescriber, who knows your history.
Questions to take to your GP
You could start with: "Sex matters to me, so I'd like to talk about side effects before we decide."
- How common are sexual side effects with this one, and how was that counted?
- Does the leaflet say anything about after stopping?
- If my sex life or my feelings change, how will we tell the medicine apart from the depression?
- If I want to stop one day, how would we plan it?
Already on one for a while? NICE also lists “long-term effects on sexual function” among the risks to talk through if you keep taking it.
What can I do if the side effects haven’t stopped?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly.
Tell your prescriber what changed, and when: “Sertraline 50 mg from January 2023, last tablet March 2024. Touch has felt numb since.”
Many people say it took time to be taken seriously. Bring the leaflet line about stopping. You can report it without a doctor agreeing.
Not sure who can report? This two-minute NHS video answers it before you fill in the form.
Report it: it helps everyone
A doctor's note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.
- No proof needed. A suspicion is enough, even years after stopping.
- Where: the Yellow Card scheme in the UK, MedWatch in the US.
- Use the right words. If symptoms continued after an SSRI or SNRI, write Post-SSRI sexual dysfunction (MedDRA 10086208). After any other antidepressant, name it and say the symptoms continued after stopping.
Questions people also ask
How common are sexual side effects on antidepressants? Very common, when people are asked. A Spanish study that put the same questions to everyone found more than half had a new sexual problem on their antidepressant. Counted only when people speak up, the figures look much lower.
Is it the depression or the medicine? It can be either, or both. Depression itself often affects sex, a large review notes. That’s one reason trials compare the medicine with a dummy pill. Notes on how things were before, during and after the tablets help tell them apart.
Which antidepressants carry the warning? The six SSRIs and four SNRIs the EU regulator named in 2019, including sertraline, citalopram, fluoxetine and venlafaxine. Our full list gives every brand name. Being on it doesn’t mean this will happen to you.
Cornelia took her tablets for three weeks, and her story is now on the record. If your side effects didn’t stop after the last tablet, a report puts yours there too.
Sources
- Lustral (sertraline) patient leaflet, UK. Viatris, revised December 2025. Section 2, sexual problems; section 3, stopping.
- PRAC recommendations on signals, 13 to 16 May 2019. European Medicines Agency. Item 1.3: SSRIs and SNRIs, persistent sexual dysfunction after stopping. The wording is for ten medicines: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, desvenlafaxine, duloxetine, milnacipran and venlafaxine.
- MHRA, Antidepressants: use and safety. GOV.UK, updated 15 October 2026. Section 3, footnote 2: of the medicines in the 2019 review, eight are licensed in the UK (duloxetine, venlafaxine, citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline).
- Lustral (sertraline) prescribing information, UK. Viatris. Section 4.4, sexual dysfunction.
- Serretti and Chiesa, 2009. Meta-analysis of sexual problems during antidepressant treatment, from studies that asked directly. J Clin Psychopharmacol.
- Reichenpfader and colleagues, 2014. Systematic review and network meta-analysis of 63 studies. Overall strength of evidence rated low. Drug Safety.
- Trintellix (vortioxetine) US prescribing information. Section 6.1. Men at 20 mg: 5% against 2% on placebo when volunteered (6 to 8 week trials); 29% against 14% on the ASEX questionnaire.
- Montejo and colleagues, 2001. 1,022 outpatients in Spain asked directly, 1995 to 2000. Overall, 59% developed a sexual problem. J Clin Psychiatry.
- Tarchi and colleagues, 2023. Systematic review of sexual problems after stopping SSRIs. No reliable estimate of how often. Pharmacoepidemiology and Drug Safety.
- Healy and colleagues, 2022. Diagnostic criteria for enduring sexual dysfunction after antidepressants, finasteride and isotretinoin. Int J Risk Saf Med.
- NICE guideline NG222. Depression in adults: treatment and management, 2022. Recommendations 1.4.10 and 1.8.3.
- Cornelia, interviewed by Moral Medicine. YouTube, 20 November 2024.
- What is the Yellow Card Scheme?. NHS Black Country Integrated Care Board, YouTube, 4 November 2021.
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