When do SSRI sexual side effects start?

SSRI sexual side effects can start within days of the first tablet, or sooner. UK leaflets warn they have sometimes continued after stopping, a condition known as post-SSRI sexual dysfunction, or PSSD.

The UK sertraline leaflet says when restlessness is most likely: “during the first few weeks”. For sexual problems it names no day or week. If you’re about to start an SSRI, or a week in and sex already feels different, note the day anything changes.

Rosie started escitalopram (Lexapro) around August 2020. Looking back, she says the changes were there from “the first pill”. She didn’t see them as side effects.

Play video: Rosie on her first weeks on escitalopram (Moral Medicine, extract)

Her anxiety had gone, and she knew she didn’t feel anything else either. “I just thought it meant the medication was working,” she says. She took it for four and a half months and, more than three years after her last tablet, said she hadn’t recovered.

Can SSRI sexual side effects start in the first week?

Yes. In one trial of sertraline where staff asked about sex at every visit, problems were noted by day 7. A second trial, of another SSRI, found more orgasm problems than on a dummy pill from the second week.

The NHS page on ejaculation problems points to a similar speed. It says SSRIs “also delay ejaculation”. Where they are prescribed for that reason, it says some men see a change “a few days after treatment begins”.

On the sertraline leaflet, the effect on ejaculation is a side effect: “ejaculation failure”, listed as very common.

Some people say they noticed within a day. Connor, in our article on sertraline’s sexual side effects, told the BBC his sex drive went within 24 hours of his first tablet. Our article Can PSSD happen after a few pills? looks at whether a short course can lead to lasting problems.

Can SSRI sexual side effects start months later?

Some reports say they can start later. The Dutch drug-safety centre went through its reports of lasting sexual problems after an SSRI. The start ranged from days to years into treatment, and in most it was days.

Those are reports people chose to send in, so they can’t show what’s typical.

Noticing can also come later than starting. Katie was single when she was prescribed fluoxetine (Prozac), and the sexual problems “weren’t immediately noticeable”, she says. In time she realised they had started while she was taking fluoxetine.

Play video: Katie on why she didn't notice at first (Moral Medicine, extract)

How long do SSRI sexual side effects last?

Medsafe, New Zealand’s medicines regulator, put it this way in a June 2026 paper: sexual side effects of these medicines “usually persist for as long as the medicine is taken and resolve after discontinuation”. The sertraline leaflet says side effects in general “often disappear or lessen with continued treatment”. In the sertraline trial, though, the sexual problems were still there when it ended, after 16 weeks.

That is one regulator’s summary, written for its advisory committee. The same paper adds that continued symptoms have been reported.

The UK leaflet doesn’t say what usually happens after stopping. It warns that in some cases the symptoms “have continued after stopping treatment”. The NHS page on antidepressants says these problems “may carry on after stopping antidepressants”.

That’s PSSD. A 2023 review found no reliable figure for how often it happens. For some people it has lasted years after stopping. Nobody knows yet who will be affected, or whether it will ease.

Do SSRI sexual side effects ever go away? sets out what is known. When does it count as PSSD? explains the three-month mark in the 2022 criteria.

When SSRI sexual side effects have been reported to start

First days

Where most Dutch reports beganReports of sexual problems that lasted.

By day 7

Seen in one sertraline trialStaff asked about sex at every visit.

Later, up to years in

Some reports begin laterOthers are only noticed later.

After stopping

Sometimes they continueThe UK leaflet's warning. Patients call it PSSD.

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.

Write the timing down as it happens: “Sertraline 50 mg from 3 March 2026. Orgasm harder to reach from 9 March. Still taking it.” Your prescriber can work from dates like these.

Add what sex was like before the first tablet. Depression can lower sex drive by itself, and our article on PSSD or depression shows how the dates help to tell them apart.

Many people say it took time to be taken seriously. Bring the leaflet line. 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. If symptoms continued after stopping, write Post-SSRI sexual dysfunction (MedDRA 10086208).

Our reporting guide walks you through it

What else do people ask?

Can sexual side effects start after I stop an SSRI? The 2022 diagnostic criteria for PSSD say a lasting problem “may only appear when the drug is stopped”. In an online survey of 135 people who said they had PSSD, about 1 in 8 said their symptoms came only after they had stopped the medicine. The rest had them while taking it too.

How long can they linger after the last tablet? The 2022 criteria say ordinary sexual side effects “may linger for some days or weeks” after stopping. They name no exact day. By our estimate from its half-life, sertraline leaves the blood within days. If sexual problems carry on after you stop, tell your GP.

Does it matter which SSRI I take? On timing, the documents don’t say. We opened three UK leaflets, for sertraline, fluoxetine and escitalopram. Each carries the same warning, and none gives a start time for sexual problems. As a charity we don’t rank medicines. Our article on antidepressants and sex covers the warning every SSRI leaflet carries.

Rosie read her first changes as the medicine working. If something changes in your first days or weeks, write the date down and tell your prescriber.

Sources

1. Lustral (sertraline) 50 mg and 100 mg film-coated tablets, patient leaflet, Viatris, electronic medicines compendium (emc 2835), last revised December 2025. Section 2, “Sexual problems”: “Medicines like Lustral (so called SSRIs) may cause symptoms of sexual dysfunction (see section 4). In some cases, these symptoms have continued after stopping treatment.” The leaflet gives no time of onset for sexual problems. Section 2 also says restlessness (akathisia) “is most likely to occur during the first few weeks of treatment”. Section 4: “The side effects depend on the dose and often disappear or lessen with continued treatment”; “ejaculation failure” is listed as very common.
2. The other two UK leaflets we opened: Fluoxetine 20 mg capsules (emc 15755, last revised September 2022) and Cipralex (escitalopram) (emc 7718, last revised May 2025). Each carries the line “In some cases, these symptoms have continued after stopping treatment”, and neither gives a time of onset for sexual problems. The UK prescribing information for Lustral (emc 1070, text revised December 2025) gives none either; its section 4.4 says “There have been reports of long-lasting sexual dysfunction where the symptoms have continued despite discontinuation of SSRIs.”
3. Segraves RT, Kavoussi R, Hughes AR and colleagues. Evaluation of sexual functioning in depressed outpatients: a double-blind comparison of sustained-release bupropion and sertraline treatment. J Clin Psychopharmacol 2000;20(2):122-8. We read the abstract only. 248 outpatients with normal sexual function at the start, 16 weeks, structured interview at every clinic visit. “Sexual dysfunction was noted as early as day 7 in sertraline-treated patients at a dose of 50 mg/day and persisted until the end of the 16-week treatment phase.” One trial; the abstract describes no placebo group.
4. Coleman CC, King BR, Bolden-Watson C and colleagues. A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Clin Ther 2001;23(7):1040-58. We read the abstract only. 456 patients, up to eight weeks, sexual function checked by trained staff at weekly visits. Orgasm problems were more frequent on fluoxetine than on placebo “beginning at week 2 and continuing throughout the study”. The two trials measured different things and cannot be compared with each other.
5. NHS, Ejaculation problems, page last reviewed 9 February 2023 (its next review was due on 9 February 2026). It says SSRIs “are a type of antidepressant, but they also delay ejaculation”, and “Some men may experience an improvement a few days after treatment begins.” We cite the page only to show how fast the effect on sex can be.
6. Netherlands Pharmacovigilance Centre Lareb, SSRIs and persistent sexual dysfunction, quarterly report, 26 October 2012. Nineteen reports up to 22 February 2012, 15 of them from consumers. “Latencies ranged from days to years, however in most cases patients experienced sexual dysfunction after days of SSRI use.” Spontaneous reports, with no comparison group.
7. Medsafe (New Zealand Medicines and Medical Devices Safety Authority), Update on sexual dysfunction (post SSRI sexual dysfunction, PSSD) following discontinuation of serotonin reuptake inhibitors, a paper written by its pharmacovigilance team for the advice of the Medicines Adverse Reactions Committee, meeting of 11 June 2026. Published on Medsafe’s website; the file there is dated 13 July 2026. Section 2.2.2: “Sexual side effects of SRIs usually persist for as long as the medicine is taken and resolve after discontinuation. However, continued symptoms despite discontinuation have been reported”. Section 2.2.1: sexual dysfunction in depression, mostly low sex drive.
8. NHS, Antidepressants, page last reviewed 12 June 2025: problems with sex are listed as a common side effect, and “for some people, these problems may carry on after stopping antidepressants”. NHS, Sertraline, page last reviewed 8 September 2025, lists sexual problems and gives no time of onset for them.
9. 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. We read the abstract only: “It was not possible to determine reliable estimates of prevalence.”
10. 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. Ordinary sexual side effects “may linger for some days or weeks following discontinuation of treatment”; an enduring problem “may only appear when the drug is stopped”.
11. Patacchini A, Cosci F. Exposure to serotonin selective reuptake inhibitors or serotonin noradrenaline reuptake inhibitors and sexual dysfunction: results from an online survey. Int J Risk Saf Med 2021;32(3):229-42. We read the abstract only. 135 people who described themselves as affected by PSSD answered an online survey: “118 subjects had symptoms both during and after SSRI/SNRI administration, and 17 only after”. That is 17 of 135, about 1 in 8. The group chose to take part, and the abstract describes no comparison group.
12. BBC News, Antidepressants: I wasn’t told about the side effects, 9 August 2023. Connor is a pseudonym: “within 24 hours of his first pill, his sex drive disappeared”.
13. Moral Medicine interviews on YouTube, all from the automatic captions. Rosie, published 9 July 2024 (33 minutes), embedded as an extract from 5:57 to 7:17. Four and a half months including her taper, from about August 2020, at 6:03; “the first pill” at 6:23; anxiety gone and feeling nothing else at 6:51; “I just thought it meant the medication was working” at 6:39; her last tablet on 7 December 2020 and not having recovered at 11:18 and 15:22. Katie, published 26 May 2026, embedded as an extract from 2:37 to 3:13: “weren’t immediately noticeable” at 2:40, single at 2:44, a sexual problem “which started while taking fluoxetine” at 3:08.
14. Their stories on our site: Rosie and Katie.
15. MedDRA lowest level term Post-SSRI sexual dysfunction, code 10086208.