Scarleteen

I just got home with a prescription for Zoloft and the only thing that’s making me hesitant about taking the first pill is in doing my research I saw some accounts of the sexual side effects not going away even after the drug was stopped. I am aware that this seems to be rare. I have left a message for the psychiatrist who prescribed it saying I have a question about the side effects. For the record my sexual life only involves myself, no partners. I would very much like to take the pill so I can start feeling better but if I believed I would be doing something that could affect the rest of my life, I would want to give it a second thought. Has anyone experienced permanent side effects from Zoloft or know of a situation where someone has?

Hey there Lucy,

Persistent sexual dysfunction can occur after stopping Zoloft, though you’re right that it is rare. When deciding whether or not to take it, it’s important to consider side effects, but it can help to look at it as weighing the pros and the cons. So, while a con is the potential for sexual side effects, a big pro is feeling better and less depressed. Sexual side effects, especially lowered sex drive, can also occur when you’re depressed, so there is reason to believe that the opposite effect could occur.

I want to say, too, while there are anecdotes coming out that these sexual side effects can be permanent, there is also evidence that those side effects can respond to treatment. Persistent sexual dysfunction after Zoloft use can show up as lack of sexual desire, anorgasmia, vaginal dryness, and more. But, there are interventions and steps you can take to alleviate those symptoms. Some folks find that lowering their dose, taking a medication “holiday,” or taking it at a certain time so your side effects come when you’re not having sex, can really help with those side effects. Using lubrication to alleviate vaginal dryness, talking in therapy about any issues, and regularly practicing sexual self-care can be helpful ways to manage any side effects.

In any case, you’ll want to discuss any side effects with your doctor, and they can help you manage your dose with any potential side effects. They may also be able to talk with you about other antidepressants with less sexual side effects if you didn’t talk about them yet. But all that’s to say: you won’t immediately and negatively impact the rest of your life by taking this, and there are ways to manage the effects if they do happen. What’s more likely, though, is that the medicine may help you feel less depressed.

I can tell you from personal experience taking Zoloft for several years that when I experienced sexual side effects, they weren’t permanent and responded well to therapy and adjusting the dose, but that’s another anecdote that should also be taken with a grain of salt. I’m wondering, though, how *you* feel about this, and what sort of worries creep in when thinking about this. Would it help you to list out here some of the pros-and-cons you’re considering, or some of the thoughts you’re having about this?

I also always want to add, with a question like this, that untreated depression and anxiety are much, much more likely to cause issues with sex and desire than medications to treat them are.

By all means, if you want to talk to your prescribing psychiatrist about this, I think it's a good idea. There are some SSRIs, SNRIs and other medications like these that have greater or lesser associations with sexual side effects, so it can help for someone prescribing for you to know that that is something you care about so they can choose accordingly for you.

I guess the concern is the interpretation of how antidepressants affect the sex drive. Supposedly it’s because they prevent the hormones that cause our bodies to respond to sex from transmitting their message to our brains. I don’t know what this would mean in the way of it being permanent in rare cases. I’m still trying to reach the doctor. I would take it to mean that it messed with the hormones that were fine in the first place. Thats really the only negative thing to me about taking it. I actually experienced some similar changes when I started taking allergy medicine over ten years ago but that seems different to me as the side effects are said to be temporary and don’t have anything to do with brain chemistry or hormones.

Hi there Lucy,

from what I know (and a quick research) it seems like the exact mechanism of the sexual side-effects isnt yet known, it might even be different in each person. However, although some forms of sexual side effects are more or less common with certain antidepressants, those persisting after stopping the medications are incredibly rare. And even if they persist for some time, that doesn’t even mean they are forever, because as Kier said, there are many ways to manage them or they just get better on their own.

I understand that starting a new medication with possible unpleasant side effects can feel like a really big decision (I started Zoloft just a few weeks ago!), so I want to reiterate what Heather said about talking about this with your doctor. They want to help you and if they think that some medication can be helpful for you they should do their best to work out with you which type, dose, schedule etc. would be the best so you can stick with taking it. Does that sound like something you want to try?

These are also very reversible side-effects, so the best way to know how a medication effects you is to trial it and make adjustments with your doctor as needed.

I admit was a bit annoyed when I only found after the fact that this was a common side effect, but if you know that this is a possibility going in, I think it's worth giving it a fair go feeling well informed, and getting started so you can know for sure.

I also find that doctors are much more willing to work with you to adjust or switch medications if you've followed their initial recommendations and can report back about why they are or aren't working for you.

I reached the psychiatrist a little while ago and he said I’d need to make an appointment to ask my questions. I don’t feel like I can wait that long to take the pill so I’m thinking of taking it, then making an appointment to discuss it further. My only concern is if the drug did mess with the hormones it already doing that in the meantime.

Hi Lucy4!

Taking the pill and making an appointment to discuss your concerns seems like a sound course of action. If the drug does start to cause side effects in the meantime, we can suggest methods to manage them. It will also be useful information for your doctor, who can help you make adjustments to your medication.

Just to be clear, there are a whole bunch of neurochemicals involved in sexual desire, arousal and enjoyment, and SSRIs are really only about and work with serotonin, just one of them, and impact another, dopamine. What they do with that serotonin is to re-up it, which effectively means your body kind of doesn't think it needs the dopamine, since it's feeling pretty good already. But desire and sexual function are about a lot more than those two neurochemicals.

Hi,
I’ve been taking the pill for a few days. There’s just one thing I couldn’t seem to understand when I was doing my research and it’s when sexual side effects are permanent, why is that scientifically? I read all the ways one can manage it but the meaning of “it” seemed unclear which made me think it must mean damage of some sort.

No one knows, but in the capacity of what I know as a sex educator of 25+ years, I would posit that it probably is more psychological and behavioral than chemical once off the medication. Why it happens when on it is about the influx of serotonin, but obviously that's stopped once someone stops taking it. Mind you, this isn't common in the first place, but my bet is that once the drug is out of people's systems, if issues with sex persist for weeks, months or years after, it's either about an issue that wasn't actually related to the medication, or it's because a person basically got used to the headspace/behaviours of not being sexual, or sexual in the ways where there were issues, and get stuck in a rut.