Antidepressants and sexual health - How pharmacogenetics can help find the right medication for you

Ruslan Dorfman, PhD, MBA29 Oct 2026

Stress, anxiety and depression can all affect sexual health, causing low desire, premature ejaculation and erectile dysfunction. Unfortunately, many common antidepressants can also cause sexual side effects. Some people hesitate to start treatment, or stop it too early, because of these effects. Sexual health is an important part of overall well-being, and there are options. Antidepressants differ in how likely they are to affect sexual function, and your genes can influence how you respond to each one. This article explains which options have fewer sexual side effects, what can help and how pharmacogenetic testing can guide the choice.

How often do antidepressants affect sexual health?

Sexual side effects are among the most common side effects of antidepressants that act on serotonin, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In studies that asked people directly, between about 25% and 80% of people taking these medications reported a sexual side effect, depending on the drug. The highest rates were seen with sertraline, venlafaxine, citalopram, paroxetine and fluoxetine. Many people do not mention these effects unless their doctor asks.

Sexual side effects can include:

Lower sexual desire
Trouble becoming aroused, including erection problems in men and reduced lubrication in women
Delayed orgasm or ejaculation, or being unable to reach orgasm

These effects usually improve when the medication is changed or stopped. Rarely, they can last after stopping. Depression itself also lowers desire, so sexual function may improve as mood improves.

Why does it matter if people stop their antidepressant?

Side effects are one of the main reasons people stop an antidepressant too soon, often without telling their doctor. Stopping early raises the risk that depression will return. A Mayo Clinic study of people with depression who had pharmacogenetic testing found that taking other medications that interfere with how an antidepressant is processed raised the risk of stopping the antidepressant by 45%. Checking your genes and your other medications can help you find a treatment you can stay on.

Which antidepressants have fewer sexual side effects?

In a large review, several antidepressants caused sexual side effects no more often than a placebo, including bupropion, mirtazapine and moclobemide. Vortioxetine has also shown lower rates than SSRIs in clinical trials. These options are available in Canada:

Medication	Brand name	Main genes and enzymes	Good to know
bupropion	Wellbutrin	CYP2B6	Works on dopamine and norepinephrine, not serotonin. Not suitable for people with seizures or eating disorders.
mirtazapine	Remeron	CYP2D6, CYP1A2, CYP3A4	Can help sleep and appetite, but often causes drowsiness and weight gain.
moclobemide	Manerix	CYP2C19, CYP2D6	A reversible MAO inhibitor. Must not be combined with many other antidepressants and some pain and cold medications.
vortioxetine	Trintellix	CYP2D6	Acts on serotonin in several ways. CYP2D6 poor metabolizers need a lower maximum dose.
trazodone	Desyrel	CYP3A4	Mostly used at low doses for sleep. Rarely causes a prolonged, painful erection (priapism), which needs urgent care.

No antidepressant is right for everyone. The best choice depends on your symptoms, other health conditions, other medications and your genes.

What can help if you have sexual side effects?

Do not stop your antidepressant on your own. Talk to your doctor or pharmacist, who may suggest one of these options:

Waiting. Some side effects ease after the first few weeks.
Lowering the dose, if your depression is well controlled.
Switching to an antidepressant with fewer sexual side effects, such as bupropion, mirtazapine or vortioxetine. In one trial, people with SSRI-related sexual side effects who switched to vortioxetine had greater improvement in sexual function than those who switched to escitalopram.
Adding bupropion to the current antidepressant. Higher-dose bupropion was the most promising option for women.
Adding an erectile dysfunction medication, such as sildenafil (Viagra) or tadalafil (Cialis). These clearly help men with antidepressant-related erection problems. In one trial, sildenafil also reduced sexual side effects in women taking SSRIs.
Psychotherapy and lifestyle changes, such as regular exercise, good sleep and limiting alcohol, which support both mood and sexual health.

How do genes affect antidepressant side effects?

Most side effects of SSRIs and SNRIs, including sexual ones, are more likely at higher blood levels of the drug. Your liver enzymes control how quickly antidepressants are broken down, and the genes for these enzymes vary from person to person:

Poor or intermediate metabolizers break the drug down slowly. Blood levels can build up and cause more side effects, so a lower dose or a different drug may be better.
Rapid or ultrarapid metabolizers clear the drug quickly. It may not work at the usual dose.

The Clinical Pharmacogenetics Implementation Consortium (CPIC) gives gene-based recommendations for many antidepressants:

CYP2C19 for citalopram, escitalopram and sertraline
CYP2D6 for paroxetine, fluvoxamine, venlafaxine and vortioxetine
CYP2B6 for sertraline

Other medications can have the same effect as a gene variant. For example, bupropion and some other medications block CYP2D6 and can raise the levels of antidepressants that CYP2D6 breaks down. This is why your genes and your full medication list should be reviewed together.

What about clomipramine and premature ejaculation?

Clomipramine (Anafranil) is a tricyclic antidepressant used mainly for obsessive-compulsive disorder. It is one of the antidepressants most likely to delay orgasm and ejaculation. For this reason, low doses are sometimes prescribed off-label to treat premature ejaculation. Clomipramine is broken down by CYP2D6 and CYP2C19, and CPIC recommends adjusting tricyclic antidepressant doses based on these genes. Dapoxetine, a short-acting SSRI used for premature ejaculation in some countries, is not approved in Canada.

How can a pharmacogenetic test help?

A Pillcheck test shows how your genes, including CYP2D6, CYP2C19, CYP2B6, CYP1A2 and CYP3A4, affect antidepressants, anxiety medications and erectile dysfunction medications. Pillcheck reports on 24 genes, increasing coverage with new guidelines and drug labels (see the genes tab), and covers 355 medications, which account for over 70% of dispensed prescriptions. A Pillcheck pharmacist reviews your results together with all your medications, checks for interactions and recommends options and doses to discuss with your doctor. Read more about how to get a pharmacogenetic test in Canada.

Summary

Sexual side effects are common with SSRIs and SNRIs and are a frequent reason people stop treatment too early.
Bupropion, mirtazapine, moclobemide and vortioxetine are less likely to affect sexual function.
Lowering the dose, switching, adding bupropion or adding an erectile dysfunction medication can help. Talk to your doctor before making changes.
Your genes, such as CYP2C19, CYP2D6 and CYP2B6, and your other medications affect antidepressant levels and side effects.
Pharmacogenetic testing with a pharmacist review can help you and your doctor find an antidepressant and dose that work for you.

Frequently asked questions

Which antidepressant has the fewest sexual side effects?

Bupropion, mirtazapine and moclobemide caused sexual side effects no more often than a placebo in a large review, and vortioxetine has lower rates than SSRIs. The best option for you depends on your symptoms, health and other medications.

Do sexual side effects go away?

They often improve with time, a lower dose or a change in medication. Rarely, they can continue after the medication is stopped. Tell your doctor if they do not improve.

Can I take Viagra or Cialis with an antidepressant?

Yes, in most cases. Sildenafil and tadalafil can be taken with most antidepressants and help with antidepressant-related erection problems. Check with your pharmacist first, especially if you take heart medications such as nitrates.

Can a genetic test tell me which antidepressant will not affect my sex life?

No test can promise that. A pharmacogenetic test shows how your body processes many antidepressants, which helps your doctor choose a medication and dose with a lower risk of side effects, including sexual ones.