Signs it may be time to get help
- Lower sex drive, trouble with arousal, or delayed or absent orgasm since starting an antidepressant
- Feeling emotionally flat or numb: fewer lows, but fewer highs too
- Weight gain, fatigue or sleep changes that make it hard to stay on treatment
- Having stopped a medication that worked because the side effects were not worth it
How I evaluate it
We sort out what the medication is causing and what is part of the depression itself, since low sex drive and emotional flatness can be symptoms of depression too. I review every medication you have tried, the doses, and what each one did for you, good and bad. These can be awkward topics to bring up; I will ask directly so you don’t have to.
Treatment options
- A plan that treats the depression without trading one problem for another
- Careful, gradual changes so you don’t lose the progress you have made
- Checking in on side effects at every visit, not only on mood
Options that often go undiscussed
Most common antidepressants (SSRIs and SNRIs) work through serotonin, and that is where most sexual side effects and emotional blunting come from. These alternatives work differently or can be combined:
- Bupropion
- Works on dopamine and norepinephrine rather than serotonin. It rarely causes sexual side effects or emotional blunting and usually does not cause weight gain. It can replace a current antidepressant or be added to one to offset sexual side effects.
- Mirtazapine
- Low rates of sexual side effects, and it often helps sleep and appetite. It can cause drowsiness and weight gain, so it suits some people better than others.
- Vortioxetine
- Acts on several serotonin receptors and in studies has caused fewer sexual side effects than typical SSRIs, with some evidence of less emotional blunting.
- Gepirone
- A newer antidepressant (approved in 2023) that did not cause more sexual side effects than placebo in clinical trials.
- Adjusting what already works
- A lower dose, a different time of day or a switch within the class can sometimes keep the benefit and lose the side effect.
- Treating the side effect directly
- Medications such as sildenafil have evidence for antidepressant-related sexual side effects, in women as well as men, when switching is not the best choice.
What telehealth can and can’t do
Please don’t stop an antidepressant suddenly on your own. Some cause uncomfortable withdrawal symptoms when stopped abruptly, and depression can return. We plan any change together, including how to taper.
This page is general information, not medical advice. Your plan is made together at your visit.