SNRI sexual side effects: can they last?
Effexor and Cymbalta often lower sex drive and delay orgasm. Their UK leaflets warn this has sometimes continued after stopping. That is called PSSD.
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Effexor (venlafaxine) and Cymbalta (duloxetine) often lower sex drive and delay or block orgasm. Their UK leaflets warn this has sometimes continued after stopping, a condition called post-SSRI sexual dysfunction (PSSD).
Both medicines are SNRIs, and the name PSSD says SSRI, so it’s easy to think the warning isn’t about you. The NHS pages on venlafaxine and duloxetine list sexual problems, but don’t say they can continue.
The story in 3 lines
- Effexor and Cymbalta often lower sex drive, delay orgasm and cause erection problems (Efexor XL leaflet).
- Their UK leaflets warn these problems have sometimes continued after stopping (duloxetine leaflet).
- Nobody has measured how often. Patients call it PSSD, a name that covers SNRIs too (diagnostic criteria).
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Riikka was prescribed Cymbalta for bladder pain, not depression, and took it for seven weeks. After she stopped, her genitals went numb, then painful, then numb again. Her desire for sex disappeared, and more than a year later none of it had come back.
“Doctor didn’t warn me,” she says. Duloxetine is given for depression, anxiety and nerve pain, and for bladder leakage in women under another brand name, Yentreve. Whatever it’s prescribed for, the leaflet carries the same warning.
What sexual side effects do Effexor and Cymbalta cause?
Both leaflets list the same problems as common: lower sex drive, trouble reaching orgasm or none at all, erection problems and changes in ejaculation. Some people notice straight away. Benjamin, who took Cymbalta for a month in 2011, says that after his first capsule “it felt like my genitals were missing”.
When one study asked people directly, about 2 in 3 of those on venlafaxine developed a sexual problem they hadn’t had before. The study had no placebo group to compare with. The problems are underestimated, the researchers wrote, and finding them takes a proper questionnaire.
Can Effexor and Cymbalta sexual side effects last after stopping?
Yes, in some cases. Both leaflets say so in the same words. In 2019 the EU medicines regulator asked for this warning on every SSRI and SNRI, venlafaxine and duloxetine included.
Efexor XL leaflet: “Sexual problems”
“Medicines like Efexor XL (so called SNRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms have continued after stopping treatment.”
Nobody has measured how often it happens. A review of the research on SSRIs could find no reliable estimate. How many people fully get their genital feeling back has “never been properly investigated”, the researchers David Healy and Dee Mangin wrote.
For some people it has lasted years after stopping. Nobody knows yet who will be affected, or whether it will ease.
Benjamin and his twin brother started Cymbalta at the same time and stopped together. His brother’s symptoms lifted. Thirteen years later, in the interview below, Benjamin was still living with PSSD.
Why is it called post-SSRI if Effexor is an SNRI?
The name says SSRI, but the condition covers SNRIs too. The 2022 diagnostic criteria, written by an international group of doctors and researchers, require earlier treatment with a “serotonin reuptake inhibitor” and list SNRIs among them. The EU regulator’s own analysis of side-effect reports called PSSD “a misnomer”, a label that doesn’t fit.
An SSRI acts on serotonin, one of the brain’s chemical messengers, and an SNRI acts on serotonin and noradrenaline. But one study found that at 75 mg a day, the usual starting dose, venlafaxine acted on serotonin alone, like an SSRI. Only at higher doses did it block noradrenaline too.
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: the Efexor XL leaflet says coming off can take several weeks or months.
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 stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208). Use it for an SNRI too.
Frequently asked questions
Does Cymbalta cause erectile dysfunction?
It can. The duloxetine leaflet lists problems getting an erection and changes in ejaculation as common side effects. So does the Efexor XL leaflet. If the problem started on the medicine and hasn’t gone since you stopped, that’s what the leaflet’s warning describes. Tell your GP, and report it.
Can sexual problems start after stopping Effexor or Cymbalta?
Yes. The 2022 diagnostic criteria say the problem “may only appear when the drug is stopped”, or get worse after stopping. Riikka’s numbness began after her last dose. If this happens to you, write down the dates, for example: “Duloxetine 60 mg from January 2023, last capsule March 2024.”
Can Effexor or Cymbalta make you feel emotionally numb?
The Efexor XL leaflet lists “lack of feeling or emotion” as an uncommon side effect. In PSSD, emotional and genital numbness “commonly go together”, the 2022 criteria note, and Riikka says she lost her joy along with her desire. Benjamin’s emotional blunting took five or six years to ease.
Seven weeks of Cymbalta for bladder pain, and more than a year later Riikka was still numb. If something like this has happened to you, report it: that’s how cases like hers get counted.
Sources
- Efexor XL 75 mg, 150 mg and 225 mg prolonged-release capsules, patient information leaflet, last revised October 2025. Electronic Medicines Compendium. Section 2, “Sexual problems”; section 4, common and uncommon side effects; section 3, “If you stop taking Efexor XL”; usual starting dose 75 mg a day.
- Duloxetine 30 mg and 60 mg gastro-resistant capsules, patient information leaflet, last revised August 2024. Electronic Medicines Compendium. Section 2 carries the same sentence on symptoms continuing after stopping; section 4 lists the sexual side effects as common.
- Cymbalta, EPAR product information (summary of product characteristics and package leaflet). European Medicines Agency. The package leaflet, section 2, carries the same sentence.
- Yentreve 20 mg and 40 mg hard gastro-resistant capsules, patient information leaflet, last revised September 2024. Duloxetine for stress urinary incontinence in women; section 2 carries the same sentence.
- NHS, Venlafaxine, last reviewed 6 July 2026, and Duloxetine, last reviewed 18 June 2026. Both list sexual problems such as low sex drive among common side effects; neither mentions problems continuing after stopping.
- European Medicines Agency, PRAC, recommendations on signals adopted at the 13-16 May 2019 meeting, EMA/PRAC/265212/2019, section 1.3: the warning for all SSRIs and for the SNRIs duloxetine, venlafaxine, desvenlafaxine and milnacipran.
- European Medicines Agency, Serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors and other antidepressants and persistent sexual dysfunction: EudraVigilance analysis, EMA/132684/2019, 20 February 2019, section 4.3.1.2.
- 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.
- 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; everyone had normal sexual function before treatment and was asked with a questionnaire. Venlafaxine: 37 of 55 people (67.3%).
- Debonnel G, Saint-André E, Hébert C and colleagues. Differential physiological effects of a low dose and high doses of venlafaxine in major depression. Int J Neuropsychopharmacol 2007;10(1):51-61. Double-blind study in 44 people with depression; 75 mg against up to 375 mg a day.
- Tarchi L, Merola GP, Baccaredda-Boy O and colleagues. Selective serotonin reuptake inhibitors, post-treatment sexual dysfunction and persistent genital arousal disorder: a systematic review. Pharmacoepidemiol Drug Saf 2023;32(10):1053-67.
- Healy D, Mangin D. Post-SSRI sexual dysfunction: barriers to quantifying incidence and prevalence. Epidemiol Psychiatr Sci 2024;33:e40.
- Videos: PSSD Network, Riikka’s story (29 June 2023); Moral Medicine, interview with Benjamin (16 July 2024), also on our site as Benjamin’s story; Dr Sanil Rege, The difference between venlafaxine and desvenlafaxine (13 March 2022).
This information does not replace medical advice. Talk to your doctor before you make any decision about your treatment.
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