Must I choose between mental health and pleasure?
If, like me, you’re chronically online, you’ll likely remember the Kamala Harris meme that features her repeating the line, “do not come, do not come” paired with the caption, “my antidepressants to me.” And even if you haven’t seen it, you’re perhaps familiar with what the joke is getting at. Maybe you have even experienced it yourself. That is, how antidepressants have sexual side effects, namely their impact on the ability to orgasm.
While we joke and make memes, for many people taking antidepressants this is a very real experience. A 2025 survey across all 50 U.S. states found that one in six adults report currently using antidepressants. In another study, 2026 research shows that around 40% of patients taking antidepressant medication experience some form of sexual side effect. Among patients treated with SSRIs (selective serotonin reuptake inhibitors), reported rates of sexual “dysfunction” range from 25% to 73%.
What’s more, antidepressants are not only prescribed for depression—which means that even if you and your partner(s) don’t experience depression, you may still experience the effects of anti-depressants. They are commonly prescribed to help treat insomnia, pain, fibromyalgia, and more. For this reason, it’s helpful for everyone to be educated and informed about the side-effects and stigmas associated with anti-depressants.
A note on “dysfunction”
Understanding why antidepressants affect sexuality, and how to talk about potential ways antidepressants are impacting your sex life, can be a challenge in and of itself. Once we start looking at sexuality within the context of the medical field, we tend to see a binary emerge between what is “functional” and “dysfunctional” from a medical—and by extension cultural—perspective. In fact, there’s a medical diagnosis for not being able to have an orgasm called anorgasmia. This points to a long and messy history of medical and research institutions deciding what is “normal” and “functional” in sexuality, and what goes beyond the norm and needs to be treated as a “dysfunction.” I’m not here to say there shouldn’t or can’t be a way to medically evaluate orgasms, but it is important to remember that these terms are not necessarily neutral, and that the language of diagnosis can affect how someone experiences their sexuality. Additionally, labeling someone’s sexuality as “dysfunctional” can create a sense of personal failure.
Beyond that, this concept of “dysfunction” is perpetuated by a goal-oriented view of sex, within a larger culture of productivity—one in which orgasm is presented as the sole purpose and end point. In unpacking “dysfunction,” we ought to remind ourselves that orgasm isn’t and shouldn’t be the only goal of sex—rather pleasure, connection, and intimacy are all important too.
Still, while I want to challenge the idea that our relationship to orgasms can be “dysfunctional” at all, it’s true that many people feel they aren’t having the orgasms they want because of their medication—something that should be taken seriously.
How do antidepressants affect pleasure?
When it comes to how antidepressants actually affect our experience of sex, this feels like another moment in which the medical field and our lived experiences of gender and sexual identity don’t totally align. The conclusions drawn by much medical research about antidepressant side effects are based on a cis-hetero assumption that people with penises are men who are having sex with women, and people with vulvas are women who are having sex with men. Here, I invite us to take what we need from the medical perspective and apply what is relevant to the world of queer and fluid bodies, gender identity, and sexuality.
Addressing the neurological and physiological implications of antidepressants, Erik Larson PMHNP-BC, a psychiatric-mental health nurse practitioner, explains: “Antidepressants increase serotonin levels, which suppresses the dopamine system, which is responsible for motivation, pleasure, and sexual arousal. As a result, overall sexual response is reduced, arousal is delayed, orgasm becomes less intense, and the body's response to stimulation becomes less sensitive.”
He continues: “People with a penis are more likely to experience delayed or absent ejaculation, while those with a vagina may have reduced sensitivity to stimulation and difficulty achieving orgasm. But in both cases, the cause is an altered balance of serotonin and dopamine, which affects the autonomic nervous system."
It might seem like there is an easy and obvious solution: just switch to a different type of antidepressant and avoid the side effects! Sadly it is not that simple. The research on the sexual impact of antidepressants rarely looks at specific medication or dosage, leaving us with very little data about which types of medications are linked to what specific side effects. Different people also can experience the same medication differently.
Still, while the sexual side effects can feel deeply demoralizing and frustrating, for many people, those same antidepressants can have a truly positive impact on other areas of life. It is a delicate balance to navigate mental health and sexuality, because the two can be deeply interconnected. Untreated depression and anxiety can also have an impact on self-esteem, desire, arousal, pleasure, and orgasms, too. And by the same token, changes in experiences of orgasm, pleasure, and desire can also contribute to feelings of depression and anxiety. It can feel like a vicious cycle.
How to navigate medication and changing desire
The first thing I’ll say is that any changes you want to make to your medications should be done in collaboration with your doctor. As Larson suggests, “If changes persist and start causing stress, discuss possible adjustments with your doctor. It may be necessary to adjust the dosage, switch to a different antidepressant with a less pronounced effect on sexual function, or add a medication that helps offset the drop in dopamine activity."
My experiences don’t constitute medical advice. But, from my own journey, what I can offer are suggestions for ways to reframe what might feel like a forced choice between orgasm and mental health.
Talk to your partner(s)
Sharing your experience with a partner—whether you’re casual, in a longer term relationship, or hooking up for the first time— can be a huge step. There is a lot wrapped up in being able to orgasm with another person, and likewise in being able to support a partner to have their own orgasm. We can often feel as though we’re not competent or not desirable when a partner doesn’t orgasm with us. And similarly, we can place a lot of pressure on ourselves to have an orgasm with a partner, to assure them we’re having a good time. Unexpressed, these feelings can put a damper on your experiences. Just like having a conversation about boundaries and STIs, talking openly about our anxieties and expectations for orgasm can be hugely supportive in creating an environment with less pressure and more pleasure.
“Open communication about sex and mental health is incredibly important for couples,” says psychotherapist Julia Fogelson. “Set up a time to have a talk when both people are feeling calm and relaxed.” She suggests conversation starters like, "I wanted to let you know that I have been feeling a shift sexually since I started taking antidepressants. Here is what I need..." This could be longer foreplay, longer time with a vibrator, or direct stimulation, or perhaps something else.
For new partners, Dr. Stephanie Buehler, psychologist and certified sex therapist, suggests starting with something like, “There's something about me I'd like you to know. I am on an antidepressant that's been so helpful, but it's affected my drive. I do best with a partner who is okay initiating sex,” (if that’s true for you), or “Do you know anything about sexual side effects of medications for depression? No? Well, let me share a few things that are happening with me…”
Communication is a lesson I’ve personally had to learn again and again. My relationship to orgasm has been long, winding, and often frustrating. In the past, I feel I’ve been so hard on myself trying to have an orgasm with a partner that I blocked myself from enjoying the experience overall. To remedy this, I started trying out saying something like, “I just want you to know that I might not have an orgasm with you and that doesn’t mean I’m not really into this—it’s just probably not going to happen for me. But what really brings me pleasure is…”. I also found that once I open up to a partner, they are more open with me about their own relationship to orgasms. First, this showed me it’s something so many of us hold anxiety and shame around, and second, it made sex so much more fun and free.
Redefining our relationship to orgasms
Before communicating about it with someone else, it can be helpful to take some time to explore your own relationship to sex and pleasure, solo. Society tends to teach us that penetration and genital orgasm are the be-all and end-all of pleasure—especially in cis-heterosexual models, and that anything else is “foreplay.” One thing I love about being queer is how queer sex allowed me to question norms I had learned, and helped me to decenter what I had been taught “counts” as sex. I think we can apply that same idea to orgasm. If we remove genital orgasm from the center of what pleasure is, what possibilities emerge?
Yes, I’m talking about erogenous zones—those sensitive spots on our bodies ranging from nipples, to ears, to necks, to toes, and everywhere in between. Do you know where else on your body brings you pleasure? What does that pleasure feel like? If we limit ourselves to only experiencing the pleasure that looks, sounds, and feels like a genital orgasm, how many other flavors of pleasure are we missing out on?
The world of kink and BDSM has so much to offer when it comes to exploring and expanding our relationship to pleasure. You can try out power dynamics, introduce toys, experiment with light bondage, play with hot wax, and more—all of which may pave the way to experiencing pleasure beyond “traditional” parameters. And antidepressants are just one element of the story. People may choose to look beyond penetration for a variety of reasons. For example, those suffering from endometriosis (and, as a result, painful sex) have found new opportunities for pleasure in BDSM.
Unbound experience
If all of this feels hard to grasp, I want you to think of your favorite thing to eat. Imagine taking a big bite, sip, or gulp, and think about the feelings it brings you. Could one of them be pleasure? Pleasure from the taste in your mouth? Pleasure from the texture against your tongue? Pleasure in the memory the smell evokes for you? All of this is to say that we have infinite access points to pleasure in life—why do we limit that concept when it comes to orgasms and sex?
Antidepressant use is widespread in culture, and many people have had some experience with either taking them themselves, or being intimate with someone who does. The sexual side effects of these medications should be better understood, and understood through a less hetero-normative and orgasm-centric framework. In fact, questioning conventional conversations around anti-depressants and sexual “dysfunction”—and scrutinizing the very language we use to talk about both—opens up the possibility for conversation about the centrality of orgasm in sex more generally. And with the potential to lead to better, less pressured sex for all involved, it’s been a long time coming.
Curious about exploring more about the spectrum of your own desires? Discover yourself—and others—on Feeld.
