Ask a Sex Therapist: Ever since I’ve been on antidepressants, I can’t cum

Sex therapist Laura Miano explains the sexual side effects of antidepressants and how to maintain a satisfying sex life if you’re taking them.

Laura Miano is a sex therapist, director of Miano Clinical Sexology based in Melbourne. Her mission is to empower people to create a more fulfilling sex life and to support those who might like to explore their sexuality beyond cultural norms. To learn more about her,  follow @lauramianosexology or contact her here.

“Ever since I’ve started on antidepressants, I can’t cum. Is this normal? Ironically it’s making me more depressed.”  – Girl Seeking Orgasm

Hey Girl Seeking Orgasm,

Antidepressants are among the most commonly prescribed medications for managing mental health conditions such as depression, anxiety, and chronic stress. They work by helping to balance chemicals in the brain, improve mood, enhance energy, and promote overall wellbeing. 

For many people, these medications can be life-changing, offering relief from persistent emotional struggles and supporting daily functioning. At the same time, antidepressants can sometimes bring side effects that impact sexual desire, arousal, or orgasm.

For more sex advice, head to our Life section.

While I encounter this regularly in my therapy practice, these sexual changes are often not openly talked about, leaving many people feeling isolated or unsure. 

Understanding how antidepressants may affect your sexual life is an important step toward taking care of both your mental health and your sexual wellbeing, as both are important factors of good health. 

Antidepressants and sexual functioning

In my sex therapy practice, antidepressants are an important consideration when I assess someone with a sexual concern. People taking them may experience low sexual desire, delayed orgasm, erectile difficulties or less arousal during sexual experiences, which may lead to sexual pain and dryness.

While there are benefits of taking antidepressants, sexual side effects can also have a big impact on a person’s mental health, so it’s worth investigating and understanding more.  

When it comes to types of antidepressants, there are different classes that interact with the brain in different ways, the most common being SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors) and atypicals. Generally these classes have varied impacts on sexual functioning, specifically atypicals are thought to have less sexual side effects than SSRIs and SNRIs.

The Therapeutic Goods Administration (TGA) also reported last year that, while rare, after taking SSRIs and SNRIs some people continue to experience sexual challenges months or years after stopping the medication. Specifically, they shared that of the 89 people who reported sexual dysfunctions with SSRI and SNRI use, 4 reported persistent concerns for 1 to 3.5 years. This is of course a small number of people, but nonetheless important to consider if you are taking or are thinking about taking anti-depressants. 

The impacts

In my practice, I see quite a few impacts that can flow on from antidepressant-induced sexual concerns, notably the emotional side effects. These include a drop in self-esteem, shifts in identity and increased body image worries.

A person might also feel increasingly disconnected from their sexuality and from being a sexual person. All of this can trigger feelings of confusion, sadness, grief, shame and more. 

Relationships may also be impacted as low desire or erectile dysfunction, for example, can change a couple’s sex life, making it more challenging to have the kind of sex they were having before medication. This can lead to both partners feeling emotions like guilt, shame, rejection, and sadness, to name a few.

These feelings might lead them to avoid intimacy altogether and only widens the emotional distance between them. Without open communication about their feelings, they may stay stuck in an unhelpful cycle that becomes harder to resolve with time. 

How to tackle this in sex therapy

Understand your individual differences

One misunderstanding about the sexual side effects of antidepressants that often comes up is that there’s no way to resolve it. This isn’t exactly the case, as your sexual functioning isn’t black or white – it doesn’t either work or not work. It’s more so on a spectrum, meaning the more turn ons that are present, the more you’re able to get aroused.

The important part is they just need to outweigh the turn offs. One turn off being the antidepressants, in this case. This is when the fun part starts in sex therapy! Understanding what your turn ons are will help you to navigate towards the parts during sex that you like, similarly understanding your turn offs means you will know what to reduce and move away from.

In spite of having your sexual system impacted by the medication, if you can increase enough of your turn ons, you can have satisfying and physiologically ‘functional’ sex! 

The caveat is, each person is different. Some people might love slow, drawn-out foreplay and dislike when sex turns from kissing straight to intercourse. Another person may enjoy kinky play and banter before sex starts, and dislike sensuality. Another might need a full day of flirting and anticipation to enjoy sex, and dislike when sex is unprimed. 

Improve communication 

Talking openly to your partner about how the medication has impacted will help the two of you brainstorm alternatives, problem solve and stay on the same page, in spite of the shift. Transparency and empathy from both partners helps to work through this issue in a constructive and helpful way.

Try saying something like: ‘I’ve noticed my desire has dropped and I’m conscious that this might be hard for you, could we connect in other ways?’

Communication may also be useful to discuss how you can change your sexual repertoire to make space for the recent changes. Try statements like ‘I’ve noticed I’m struggling to orgasm during oral since this medication, I’d love it if you could touch my breasts/hold my hand/caress my leg, while you go down on me.’

Being able to talk openly about your new circumstance means you can adjust your sex life to fit what you need.

Solutions beyond sex therapy

Talking to your healthcare provider about alternatives to SSRis and SNRIs is an option, if you are open to changing. Atypical antidepressants generally have less sexual side effects than SRIs and SNRIs, making them a good option to switch to if your healthcare provider deems them suitable for you. Medication add ons may also be an option to manage the sexual changes. 

Lifestyle changes may also be a useful consideration as quality sleep, good diet, adequate hydration and regular exercise all positively impact general health, consequently improving sexual functioning. Managing stress and reducing stressors by increasing mindfulness and other emotion-regulation techniques, may also have positive impacts on your sexual functioning. 

Final thoughts 

Sexual side effects from antidepressants are more common than many people think, and experiencing them doesn’t mean something is wrong with you. These changes are part and parcel of some medications and unfortunately, unavoidable in many cases.

The good news is they can be managed with the right support, adjustments and strategies. Remember, your mental health is undeniably important and you deserve, equally, to have a satisfying sex life – you don’t have to choose one over the other. 

For more articles on sex drives in relationships, try this.