What’s worse than being depressed? Arguably, being depressed and unable to orgasm.

Being unable to reach climax on SSRI medications means some patients come to accept sexual dysfunction as a given – and some stop their meds entirely. However, talking about it may be the first step to addressing it.

What You Need to Know About Orgasming on SSRIs by Jake Hall

Antidepressants and Sex: Will I Ever Cum Again?

 after taking citalopram, I cried. Nothing about the 

jerking off felt any different than it usually did. The masturbation still felt tingly and enjoyable, but whenever I could sense myself approaching orgasm, it was like the waves of pleasure were being trapped in my body before swiftly disappearing. My precious cum-shot was being ruined by some invisible forcefield. After more than 30 minutes of trying, I eventually gave up. Sweaty, exhausted and still full of pent-up horniness, I broke down in tears.

over-dramatic in retrospect, but my experience isn’t uncommon. In countries worldwide, doctors prescribe 

 –– selective serotonin reuptake inhibitors, a category of antidepressant –– like citalopram, sertraline and others to treat mental illness, especially anxiety and depression. The side effects differ from person to person, but pretty much every medical website will warn you that SSRIs can cause a loss of sex drive and make it hard to climax.

It’s crucial we talk about these issues, especially to medical professionals. “The impact of SSRIs is completely person-dependent,” says New York-based psychotherapist Michelle Kahn, LMSW. She describes “finding the right SSRI and the right dosage” as a process of trial and error, which can feel pretty arduous, but says most of her clients on medication eventually settle into a sweet spot. Kahn believes in transparency, so she’s open about the fact that she’s taken SSRIs for years. “I will speak about side effects I’ve experienced and that I know others have experienced,” she explains, “and I let clients ask general questions about SSRIs.”

Doctors will often be open to working with patients to see which medication suits them best. “When I went on antidepressants, I remember being extremely concerned when the doctor mentioned I might find orgasming difficult,” says Sallie*. “Wanking and cumming was the only joy I could find in the day at that time, so I was super alarmed I might lose that.”

Luckily, she didn’t. Sallie has regularly taken both citalopram and sertraline, and managed to orgasm on both. “It’s maybe slightly more difficult than usual,” she says, “but that also might just be in my head.” Her doctor was open to these discussions, too. “He was considerate and said that [if I couldn’t orgasm] they could adjust my medication, or add medication to help me undo it.”

Doctors will often be open to working with patients to see which medication suits them best.

The first few weeks on SSRIs are the hardest: it’s when the side effects are most likely to hit hard, and it’s when you’re adjusting to actually taking them. Personally, I stopped taking mine in the morning, because it usually made for a lousy night’s sleep. My mental health dipped in the first week or so, but the worst was over fairly quickly.

Still, anyone who has struggled with their mental health will understand how frustrating it is to feel like you’re finally making progress, but then realize that progress isn’t quite as linear as you expected. It took me almost a decade of struggling with acute anxiety to schedule a doctor’s appointment. News flash: being too depressed to get out of bed makes basic admin pretty difficult! 

When I did get a diagnosis of severe anxiety, I was given a handful of options. But private therapy was too expensive, and the free option provided by my country’s health service involved box-ticking my way through an online course which felt basic at best, useless at worst. Before agreeing to take citalopram, I had already heard anecdotes from friends unable to cum on SSRIs, but I brushed them off because I didn’t feel like there was any other viable option. “I’m a sex writer,” I thought. “I’m basically professionally horny! Surely 

“I’m a sex writer,” I thought. “I’m basically professionally horny! Surely 

Of course, I wasn’t. Not at first, anyway. Every time I thought about sex, I convinced myself the meds would get in my way. I spiraled, thinking I would never have a truly earth-shattering orgasm again. Eighteen months later, I’m glad to report that this isn’t the case. It 

still sometimes feel like a slog to reach orgasm, but on the whole, the worst of the side effects have worn off.

Not everyone is so lucky. I speak off-record to a friend who tells me she decided to stop taking SSRIs entirely because she couldn’t orgasm with her partner, an issue that ended up causing huge tension and eventually contributing to the ending of her relationship. I speak to Annie*, who tells me she “found it impossible to cum, cry or anything else on escitalopram”. (“Well,” she clarifies, “except to lie on the sofa like a house cat and demand cuddles.”) As if struggling with 

 wasn’t tough enough, some of us are finding that we’re essentially being asked to sacrifice our sexual pleasure –– which, for some of us, can feel like the 

source of pleasure in our lowest moments –– to access treatment.

Switching medications can sometimes help. Slowly but surely, studies are offering insights into which SSRIs have the lowest likelihood of sexual dysfunction as a side effect. This 

 shows sertraline and fluoxetine are the best recommendations for “sexually active patients” whereas paroxetine is the worst. A 

, which involved an in-depth examination of existing literature, found “agomelatine, mirtazapine and bupropion” had the lowest risk of sexual disorder. It’s a fascinating read because it outlines a key problem: “[Sexual disorder] often remains unaddressed in everyday praxis unless the clinician directly asks the patient, which has been found to be uncommon in primary care.” Basically, if we want to find SSRIs which don’t block our orgasms, the onus often falls on us to mention this as a priority to our clinicians.

Basically, if we want to find SSRIs which don’t block our orgasms, the onus often falls on us to mention this as a priority to our clinicians.

the internet –– are talking about these issues, and we’re poking fun at our sad, SSRI wanks in the form of memes. I think often about this 

, which describes SSRIs as pills which “make it impossible to cum or lose weight,” as well as this 

endlessly-looped GIF of a truck which never quite crashes

how it feels trying to nut on antidepressants

Clinicians need to catch up. Most importantly, healthcare practitioners need to speak openly about the mental health benefits of a fulfilling sex life. “There’s a huge need for sex positivity in the mental health community in general,” says Kahn. “There’s little to no training offered to social workers around sex and sexuality, unless you’re specifically seeking out classes.” She advocates for a “holistic, person-centered and trauma-informed” approach, which treats patients as individuals and considers their sexual needs when prescribing treatment.

These conversations can be difficult, but for those of us who value sex and

, they can be crucial to finding SSRIs that don’t make cumming feel like climbing Mount Everest.