Some people are too uncomfortable to bring up sexual side effects with their health care team — but there are available options for lessening these side effects.

You have been friends with Bea since college, but Bea’s been slower to respond lately when you try to schedule time together. Sitting down with her at a cafe, you immediately notice new violet circles under her eyes and that her cheekbones are more pronounced. Her usually bright sports top has been traded for a loose, grey sweatshirt. Concerned, you ask how she’s been for the past few months.

She begins, “Things haven’t been so great. I haven’t been able to sleep for weeks, and it’s hard to make myself get up in the morning. I feel like I’m failing at work and at home. I’m just so tired and down all the time. I feel like I cry at nothing. It’s ridiculous!

“I talked to primary care, and they said that it sounds like I’m depressed. They recommended that I consider this medication, Prozac, but I’m not so sure. I’ve heard that depression meds can really mess with your sex life. I used to enjoy sex and felt like I had a good libido, but now it just feels like so much work when I’m already so tired. What if I lose the little bit of interest in romance that I have left?”

These questions are asked by many people who are considering a medication to treat depression, anxiety or another mental health condition.

While medications such as fluoxetine (Prozac) can be very beneficial in treating depression, they do carry a risk of side effects. Fluoxetine belongs to a class of antidepressants called selective serotonin reuptake inhibitors, called SSRIs. Sexual side effects can include decreased libido, difficulty becoming and staying aroused, and delayed orgasm. Some people find it difficult to have an orgasm while taking an SSRI.

Some people are too uncomfortable to bring up sexual side effects with their health care team, so many stop their medications on their own without mentioning any side effects.

However, there are available options for lessening these side effects. These strategies can be especially helpful for people who are benefiting from the mood improvement of an antidepressant, but who are frustrated by decreased libido or diminished arousal.

Options for improving the sexual side effects of SSRIs include:

• Taking a “drug holiday,” which may mean that you skip a dose of the medication prior to planned intimacy.
• Adding another medication like bupropion, an antidepressant that can actually stimulate arousal and libido.
• Lowering the dose so that mood symptoms are still treated but side effects improve.
• Switching to other antidepressants such as bupropion and mirtazapine, which have fewer sexual side effects.

Talk to your health care team before implementing any of these changes.

Additional ways to stimulate libido include:

• Exercise. A woman’s ability to have an orgasm during sex is highest approximately 30 minutes after exercise.
• Nonphysical intimacy with a partner. This can strengthen emotional connection, which can improve sexual desire and sexual connection.
• Reduce alcohol and tobacco use. These habits may have negative effects on your sex life.
• Libido medications. Flibanserin (Addyi) and bremelanotide (Vyleesi) are FDA-approved medications to improve libido in certain women who have not yet gone through menopause.

One of the most important factors to consider when deciding whether or not to begin an antidepressant is how the symptoms of depression are affecting overall well-being. Depression can be debilitating, causing severe physical and emotional distress.

Bea had several of the common symptoms experienced by people suffering from depression. These include poor sleep, low energy, a low sense of self-worth, change in appetite causing weight loss or gain, sadness or difficulty finding joy, experiencing problems at work or home, and a diminished sex drive.

Depression itself commonly causes decreased libido, difficulty in relationships and poor body image, which can impact the ability to enjoy sex. Sexual health is dependent on physical and psychological health. Depression can become a void that takes away the joy and meaning in life, and anti-depressant medications can tremendously impact someone who is suffering.

The choice to begin a medication for depression is a personal one. Knowing the pros and cons of a medication — including the many options available to treat side effects — can be empowering.

Treating depression often comes with many benefits to mood, sleep, relationships and even sexuality. When depression is treated successfully, joy and meaning can return to life, intimacy in relationships can be restored, and self-esteem can improve, all of which can transform sexual well-being.