Can paroxetine cause erectile dysfunction? Erection problems are a reported side effect of paroxetine, as are low libido and delayed ejaculation. If you have noticed changes since starting it, you are not alone and your prescriber can discuss options. Don’t reduce, skip or stop paroxetine on your own
Here's what studies show regarding this issue, why it happens, and how to deal with it.
How Common Are Sexual Side Effects With Paroxetine?
In a 2001 Spanish study, 147 of 208 people taking paroxetine (70.7%) reported some form of sexual dysfunction, including changes in desire, erections, ejaculation or orgasm.
US clinical trial data in the paroxetine product information report the following sexual side effects in men.
Sexual side effects (men) | Paroxetine | Placebo |
Impotence (erectile problems) | 2% to 9% | 0% to 3% |
Decreased libido | 6% to 15% | 0% to 5% |
Ejaculatory disturbance, mostly delay | 13% to 28% | 0% to 2% |
The 70.7% and the 2% to 9% measure different things. The 70.7% is any sexual dysfunction including low desire, arousal and orgasm problems, among paroxetine users in a Spanish study that asked about sexual function directly. The 2% to 9% is erection problems as reported in US clinical trials. Trial reports can miss problems that patients don’t mention and the product information notes that these symptoms may be under-reported. Neither figure is the rate of ED among all men taking paroxetine.
This is an important point in Australia as antidepressants are common medicines used there. As for the statistics given by the Australian Institute of Health and Welfare, about 18% of Australians were given prescriptions connected with mental health in the 2022-23 year and 73% of them got antidepressants according to the given statistics.
Why Might Paroxetine Affect Erections?
Paroxetine increases serotonin signalling in the brain. Researchers have proposed several ways this could affect sexual function, but the exact mechanisms are not fully established.
Possible explanation | What is proposed | Possible effect |
Serotonin signalling | Higher serotonin activity may dampen sexual response | May contribute to slower arousal and delayed orgasm or ejaculation |
Nitric oxide signalling | Paroxetine has been proposed to reduce nitric oxide, a chemical involved in relaxing blood vessels in the penis | May make it harder to get or keep an erection |
Dopamine and noradrenaline | These brain chemicals are involved in arousal, and SSRIs may alter them | May contribute to lower desire |
Here are a few things to note.
- Some effects may be related to the dose, but don’t reduce your dose yourself.
- Paroxetine can affect more than erections. Low libido, delayed ejaculation and orgasm problems are also reported.
One uncommon side effect goes the opposite direction. Paroxetine is associated with priapism, an indication of a prolonged and sometimes painful erection that requires immediate medical assistance.
Is It the Paroxetine or the Depression?
It is a fair question, because depression and anxiety can also affect sexual function.
Factor | What the research found |
Untreated depression | 35% to 50% of people with untreated major depression have some sexual dysfunction before treatment |
Depression and ED | A meta-analysis of 46 publications found depression was linked to a 1.39-fold higher risk of ED |
Paroxetine dose | Some sexual side effects may be dose-related. Ask your prescriber before changing your dose |
Age | Odds of ED rise 11% with each year of age after 45 in Australian men |
2.66 times the odds of moderate or complete ED | |
1.86 times the odds |
Timing can be a clue. If sexual difficulties began soon after you started paroxetine or changed the dose, mention this to your prescriber. It doesn’t prove the medicine is the cause, because depression, anxiety and other factors can also affect sexual function. If the difficulties were there before treatment, tell your prescriber that too.
Post-SSRI Sexual Dysfunction (PSSD): When Problems Continue After Stopping
Some people report sexual problems that continue after stopping an SSRI. This is called post SSRI sexual dysfunction (PSSD). The TGA states that sexual symptoms can persist after stopping and that how often this happens is unknown. The European Medicines Agency recognised PSSD in 2019 and a 2023 review could not establish how common it is or what causes it.
PSSD is separate from withdrawal. Withdrawal symptoms, such as dizziness, nausea and anxiety, can occur when paroxetine is reduced or stopped suddenly. If you notice sexual changes after reducing or stopping paroxetine, speak to your prescriber
When it is time to see a doctor
Make an appointment if:
- Your erection, arousal or orgasm changes after taking paroxetine or increasing the dose;
- The issue is not going away for several weeks;
- You feel a decrease in your mood.
- You should not stop taking paroxetine to check whether it is the cause.
See the doctor who prescribes your paroxetine if erection difficulties recur, worry you or begin after starting paroxetine or changing the dose. Also make an appointment if you notice a drop in mood.
Do not reduce, skip or stop paroxetine to test whether it is the cause. Withdrawal symptoms can occur if the dose is reduced or stopped suddenly.
Treatment and Management: What Can Help
One rule comes first: speak to your prescriber before reducing, skipping or stopping paroxetine. Stopping suddenly can cause withdrawal symptoms such as dizziness, nausea, anxiety and electric shock sensations. If your dose is reduced, your prescriber will plan how and tapering is individual and can take weeks or months.
Common options available for discussion with the doctor:
Strategy | How it works | What to know |
Wait and monitor | Sexual side effects sometimes ease with time | Not always. Your prescriber can advise whether waiting is reasonable, particularly if the medicine is helping your depression |
Review the dose | Side effects may ease at a different dose | Prescriber-led only. Do not reduce or skip doses yourself |
Switch antidepressant | Some antidepressants are less likely to cause sexual side effects | A prescriber decision. Switching needs a planned approach |
Add another medicine | A prescriber may consider an additional medicine in some cases | Using bupropion for antidepressant-related sexual side effects is off label in Australia. Prescriber led only |
Prescription ED treatment | A prescriber can consider whether this suits you alongside paroxetine | Needs a doctor’s assessment of your health and all your medicines |
Therapy | A sex or general therapist can help couples talk and adapt | Helps when worry and avoidance feed the problem |
Do not skip doses before sex (sometimes called a “drug holiday”) unless your prescriber has told you to. Skipping doses can cause withdrawal symptoms and a return of depression symptoms.
ED Treatment Options
If sexual side effects continue, your first step is to speak with the clinician who prescribes your paroxetine. They can review your dose, your other medicines and your overall health and discuss options with you.
Talk to An Australian Doctor Online
Your first step is a review with the clinician who prescribes your paroxetine as they know your history and can plan any change safely. DirectMeds also offers online consultations with AHPRA-registered doctors, subject to availability. Tell the doctor you take paroxetine, your dose and how long you have taken it, and let your prescriber know about any changes. Start your online ED assessment with DirectMeds.
Frequently Asked Questions
Is it true that paroxetine can cause impotence?
Erection problems are a reported side effect. In US clinical trials, men taking paroxetine reported impotence in about 2% to 9% of cases. A 2001 Spanish study found that 70.7% of paroxetine users reported some form of sexual dysfunction but that covers any sexual problem, not erection problems alone. Talk to your prescriber if you notice changes.
Does paroxetine have an impact on sexual function?
Yes. Sexual side effects can include low libido, delayed ejaculation and erection problems. In US trials, men taking paroxetine reported decreased libido in 6% to 15% and ejaculatory disturbance, mostly delay, in 13% to 28%. Talk to your prescriber if you notice changes.
Is paroxetine worse for sexual side effects than other SSRIs?
Paroxetine is one of several antidepressants associated with sexual side effects. In a 2001 Spanish study, any sexual dysfunction was reported by 70.7% of paroxetine users, 62.9% of sertraline users, 57.7% of fluoxetine users and 72.7% of citalopram users. Mirtazapine showed lower rates (24.4%). These figures come from one older study and do not show that one medicine is worse for any one person. Do not change your medicine without speaking to your prescriber.
Will paroxetine’s sexual side effects resolve?
They sometimes ease, but not always. Harvard Health notes that side effects may subside with time. Sexual symptoms have also been reported to continue after stopping an SSRI and how often this happens is unknown. Do not reduce, skip or stop paroxetine without speaking to your prescriber. Withdrawal can be unpleasant and tapering is individual.
Can I take ED medicines while taking paroxetine?
Only after a doctor has assessed you. A doctor needs to check your health and all your medicines including paroxetine before recommending any ED treatment. Do not start or combine medicines without medical advice.
Could my ED be caused by depression instead?
Yes, it can be. Harvard Health states that around 35 to 50% of people with major depression untreated have sexual problems, and studies have shown that depression increases the risk of developing ED by 1.39 times. Thus, it is necessary to see a doctor to find out the cause of this problem.