Mirtazapine sexual side effects: can they last?
Mirtazapine's UK leaflet barely mentions sex. Some people report sexual problems that continued after stopping, much like PSSD. What is known so far.
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Yes, mirtazapine can affect sex, and some people say the problems can last after stopping, much like post-SSRI sexual dysfunction, or PSSD. Its UK leaflet lists only one sexual side effect: a prolonged, painful erection.
PSSD is more than sex, whatever the name says. The 2022 criteria describe a lasting change in genital sensation, often numbness, with emotional numbing, problems with thinking and changes in other senses.
Mirtazapine isn’t an SSRI or an SNRI, and the EU’s 2019 warning that sexual problems can last after stopping covered only those. People who took it have very little in writing when something doesn’t come back.
The story in 3 lines
- The UK mirtazapine leaflet (November 2024) lists a prolonged, painful erection, and no other sexual side effect.
- It has no line about sexual problems continuing after stopping. The 2019 EU warning covered SSRIs and SNRIs only.
- Researchers note reports of lasting problems resembling PSSD after mirtazapine, but say there isn't enough data to know if it's the same condition.
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Cornelia took mirtazapine for three weeks in 2020. Four years later she sat down with Moral Medicine to talk about what had happened since. Watch it to hear, in her own words, how symptoms beyond sex changed her daily life.
She describes sexual problems that haven’t gone away since, along with anhedonia (being unable to feel pleasure) and insomnia. She says these symptoms have left her out of work and socially isolated.
Does mirtazapine cause sexual side effects?
It can, but you’d hardly know it from the UK paperwork. The UK patient leaflet, in its November 2024 version, names one sexual side effect, “prolonged painful erection of the penis”, and says its frequency isn’t known. Low sex drive, orgasm problems and numbness aren’t on it. The NHS page on mirtazapine doesn’t mention sex at all.
The US label for Remeron, the original brand, lists impotence among the less frequent reactions in its trials, and abnormal ejaculation as a rare one.
One Spanish study asked everyone directly, with a questionnaire about desire, erections, orgasm and satisfaction. Its authors wrote that sexual problems are underestimated without one. They also put mirtazapine among the medicines that “seem to have fewer sexual side effects”.
Still, in their results, about 1 in 4 people taking it reported a sexual problem. There was no placebo group to compare with.
That study only counted people while they were taking the medicine. Our article on antidepressants and sex explains what that misses.
Can mirtazapine’s sexual side effects last after stopping?
For some people, they seem to. The UK leaflet doesn’t say so.
In 2019 the EU medicines regulator asked for a warning on six SSRIs and four SNRIs: sexual problems have sometimes continued after stopping. Mirtazapine wasn’t one of them, and the recommendation doesn’t mention it.
Researchers have noticed it, though. Doctors and scientists who wrote criteria for PSSD in 2022 mention reports of a lasting sexual problem that resembles PSSD after mirtazapine. They say there isn’t enough data yet to know whether it’s a related condition or a different one.
Nobody has measured how often this happens after mirtazapine. A missing warning doesn’t mean it can’t happen.
Lists a prolonged, painful erection. Nothing about problems continuing after stopping.
Lists impotence and abnormal ejaculation among its less frequent reactions.
Covers SSRIs and SNRIs. Mirtazapine isn't named.
Mention reports of lasting problems resembling PSSD after mirtazapine. Not enough data to say if it's the same condition.
Is it PSSD if mirtazapine isn’t an SSRI?
Not by the 2022 criteria. They define PSSD as following a medicine that keeps more serotonin around the nerve cells, like the antidepressants linked to PSSD in the EU warning. Mirtazapine works in a different way.
That’s why they list mirtazapine separately, under other medicines. Moral Medicine describes Cornelia’s condition as PSSD. For now, nobody knows which name fits.
For you, the pattern matters more than the name. Did sex, feelings or thinking change after you started, and did they stay different after you stopped? A doctor or a regulator can look into it once someone writes that down.
What can I do?
These medicines help many people. If you have side effects, that’s a decision for you and your prescriber. Don’t stop suddenly.
If the problems haven’t lifted since you stopped, tell your GP and give your dates: “Mirtazapine 15 mg from March 2023, last tablet May 2023.” Say what changed, such as “no desire” or “touch feels numb”, and what sex was like before.
Three questions for your GP
- Could mirtazapine explain what I've noticed, even after stopping?
- What else should we rule out, such as depression or other medicines?
- Can this be written in my notes as a suspected side effect?
You could start with: “Things changed after mirtazapine, and they haven't come back since I stopped.”
Many people say it took time to be taken seriously. You can report it without a doctor agreeing.
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. Name mirtazapine, describe what changed and write that it continued after stopping. The term Post-SSRI sexual dysfunction (MedDRA 10086208) exists, but its name points to SSRIs.
The MHRA’s short video shows each step of a Yellow Card report, so you know what to expect before you start.
Our reporting guide walks you through it
What else do people ask?
Can mirtazapine increase sex drive? It can for some people. The US label lists an increased sex drive among its less frequent reactions. A 2009 case report described a woman who had spontaneous orgasms on mirtazapine. Hers eased after she stopped.
Could it be my depression? It can play a part, because depression itself often lowers desire. That’s why the PSSD criteria ask what sex was like before the medicine. Our guide to telling PSSD and depression apart goes through the signs.
Does it affect women too? Women report it as well. The Spanish study asked women as well as men, and Cornelia is one of the women who describe lasting problems. Our article on PSSD in women covers what is known about symptoms such as genital numbness.
Cornelia took mirtazapine for three weeks. If sex or feelings have been different ever since your last tablet, report it, and read more about PSSD.
Sources
- Mirtazapine 15, 30 and 45 mg Tablets (Milpharm), patient leaflet, Electronic Medicines Compendium (EMC 531), leaflet last revised November 2024, read 21 October 2026. Section 4, side effects of unknown frequency: “prolonged painful erection of the penis”. No other sexual side effect, and no line about effects continuing after stopping. Two other UK mirtazapine leaflets on the EMC (oral solution, EMC 2023, revised October 2023; 30 mg tablets, EMC 100083, revised July 2024) carry the same single line, read 21 October 2026. The matching summary of product characteristics, revised 2 December 2024, lists priapism under reproductive system disorders and no other sexual reaction in section 4.8.
- NHS, Mirtazapine, page last reviewed 18 August 2026. Read 21 October 2026; it does not mention sex.
- Remeron and RemeronSolTab (mirtazapine), US prescribing information, Organon, DailyMed version of 8 August 2025. Section 6.1, other adverse reactions: impotence “infrequent” (1 in 100 to 1 in 1,000 patients), abnormal ejaculation “rare” (fewer than 1 in 1,000), libido increased “infrequent”. Section 6.2, priapism after approval.
- European Medicines Agency, Pharmacovigilance Risk Assessment Committee (PRAC). PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting. EMA/PRAC/265212/2019, section on SNRIs and SSRIs: persistent sexual dysfunction after drug withdrawal. Names citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, desvenlafaxine, duloxetine, milnacipran and venlafaxine. Mirtazapine is not mentioned.
- Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Section 3: an enduring change in genital sensation after treatment stops; ancillary symptoms include emotional numbing, cognitive impairment and other sensory problems. The PSSD criteria require “prior treatment with a serotonin reuptake inhibitor”. Section 8, other drugs: reports of a persistent sexual dysfunction resembling PSSD after psychotropic drugs that are not SRIs, including mirtazapine; “insufficient data” to know whether it is a related or different syndrome.
- Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry 2001;62 Suppl 3:10-21. Open-label, no placebo group; people with previously normal sexual function, asked with the Psychotropic-Related Sexual Dysfunction Questionnaire. The background says such problems are underestimated without a specific questionnaire, and that mirtazapine and some other antidepressants “seem to have fewer sexual side effects”. Mirtazapine: 12 of 49 (24%). During treatment only.
- Shalev H, Ben-Zion I, Shiber A. A case of mirtazapine-induced spontaneous orgasms in a female patient. J Psychopharmacol 2009;23(1):109-10. A single case report; the symptoms subsided after mirtazapine was stopped.
- Moral Medicine, Woman’s Life Ruined by Mirtazapine Induced Post SSRI Sexual Dysfunction (PSSD), interview with Cornelia, 20 November 2024, 23 minutes 24 seconds. The title is the channel’s own. Our account of her symptoms follows her story page, which follows the video’s own description. Her story on our site: Cornelia’s story: 3 weeks of mirtazapine.
- MHRA, Yellow Card - How to report, 12 November 2024, 1 minute 33 seconds.
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
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