Duloxetine is among several classes of medications known to affect sexual desire or performance. Antidepressants, mood stabilizers, diuretics and antihistamines all can affect sexual activity. The top offenders include serotonin-reuptake inhibitors, the most commonly prescribed antidepressants, along with oral contraceptives and Propecia, New York sex therapist Dr. Stephen Snyder told MedTruth. 

The medical world has only recently recognized low libido as a common side effect of certain drugs, Snyder, author of “Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship,” said.

“When serotonin-reuptake inhibitors were first developed, sexual side effects were considered rare, since patients rarely mentioned them in clinical studies,” he said. “But later, when patients were asked specifically about these side effects, they turned out to be extremely common.”

Low libido also can spill over into other aspects of life, affecting interpersonal relationships, self-esteem, body positivity and mental state, Phoenix-based sexual health educator Angelica Lindsey-Ali wrote in an email to MedTruth.

“Since the orgasmic reaction is 90% mental, especially for women, lack of sexual desire, reduced libido and erectile dysfunction can wreak havoc on emotional health,” Lindsey-Ali said. “Sex is one tangible manifestation of intimacy and connection, so to limit that interaction can be detrimental and confusing.”

To identify low libido, Lindsey-Ali said to look for a “marked decrease” in sexual appetite compared to usual urges.

For some folks, changing medications can fix the problem and in others, starting at the lowest dose possible can lessen the effect on libido. 

Even so, Philip said he hasn’t mentioned his side effects to his doctor. It’s a potentially uncomfortable conversation, and duloxetine is also the first drug that’s really worked for his mental health. 

“So, while I'm feeling a lot better, mood-wise, I don't really want to rock the boat, you know?” he said.

Tray*, from Houston, takes lithium, seroquel and prozac. The drugs have made orgasming virtually impossible.

“I’ve been taking seroquel the longest and most consistently — about three years — but I’ve been on and off of antipsychotics and SSRIs for about four years,” they told MedTruth over email. 

Although Tray initially didn’t give their low libido much thought, “but then a few years went by and nothing changed.” 

When Tray recently went cold turkey, their libido returned within a month. They later resumed the medications after a depressive experience. 

“Now that I’m back on them, [my sex drive is] going away all over again,” they said.

With troublesome side effects like low libido, Snyder encourages people to talk to a medical provider. It also can be helpful to write or journal about health concerns and share those with a trusted provider. 

Snyder said he has heard low libido described as “living in some parallel universe, where everyone else is able to feel desire and I’m not.” 

That’s why he believes it’s essential to discuss and address sexual side effects to help people live fuller, richer lives — both in the bedroom and outside it too.

*names have been changed