Does Abilify Affect Sex Drive? What the Antipsychotic Studies Found
Share
Does Abilify affect sex drive? On the evidence that exists it is one of the least likely antipsychotics to. Aripiprazole, the generic behind the brand, sits in the low band of the one meta-analysis that pooled per-drug data: 16% to 27% for aripiprazole, quetiapine (Seroquel), ziprasidone and perphenazine, against 40% to 60% for olanzapine, risperidone, haloperidol, clozapine and thioridazine. The split follows prolactin, the hormone some antipsychotics raise sharply and others leave alone. That same paper says how hard it is to separate what a drug did from what an illness did. Across 72 studies of 21,076 people with schizophrenia, 56.4% reported sexual dysfunction, and rates were already high in people who had never taken an antipsychotic. Abilify is the least likely suspect in its own class, and something still changed for you.
Read this part first
Do not stop or change your medication without your doctor. Stopping an antipsychotic on your own risks relapse, and shaving a dose to test a theory is the same decision in a smaller size. If your desire changed after a start or a dose change, say so at your next appointment and ask whether a prolactin blood test makes sense. Every change to the prescription belongs to the person who wrote it.
- In the one meta-analysis reporting per-drug rates, quetiapine, ziprasidone, perphenazine and aripiprazole carried 16% to 27%, while olanzapine, risperidone, haloperidol, clozapine and thioridazine carried 40% to 60%. Those are pooled bands across groups of studies, and no figure inside them belongs to one drug.
- The same authors flag the limitation running through the whole subject: the difficulty of disentangling what the drugs did from what the illness did.
- Across 72 studies from 33 countries and 21,076 participants with schizophrenia, 56.4% reported sexual dysfunction (95% CI 50.5 to 62.2), with considerable heterogeneity and conflicting results regarding antipsychotic classes.
- Rates were already high before any antipsychotic: 16.8% to 70% across five studies of 770 drug-naive or drug-free people, and 50% in the ultra-high-risk state.
- Aripiprazole is the drug this literature switches people to, with high certainty of evidence for lowering raised prolactin above 50 ng/ml. A review of six randomized trials still concluded that no clinical recommendations can be made, and the women-specific evidence is thin.
Figures from Serretti and Chiesa 2011 (PMID 21191308), Korchia et al. 2023 (PMID 37703012) and Potkin et al. 2017 (PMID 28252452). The first two pool observational data, so those are associations. The third is one randomized trial authored by employees of the sponsoring companies, in people with schizophrenia aged 18 to 60.
"Is it the Abilify, or is it me?"
Type the question into a search bar and the answers come back with more confidence than the research has. One page says antipsychotics flatten desire, full stop. The next says the illness does all of it. The measured picture is more specific.
Three things run at once. Antipsychotics differ a lot from one another, along a line you can measure in a blood test. The illness carries a large share of the difficulty by itself. And the ordinary causes that flatten desire in everybody, sleep and mood and alcohol and weight, do not step aside because you have a diagnosis.
This is the fourteenth article in a series on medications and desire, and the shape repeats. We wrote it about lamotrigine and sex drive, for what doctors do not say about antidepressants and low libido, for the SSRI libido drop, and for Adderall and sex drive. A drug gets blamed for the whole experience, and the evidence hands back a shorter list with names on it.
What the drug-by-drug pooling found
One meta-analysis anchors the comparison. Serretti and Chiesa pooled studies that measured sexual function with proper instruments and reported single drugs separately, which is what makes a drug-against-drug comparison possible at all. The primary outcome was the overall rate, and desire was among the secondary measures.
Quetiapine, ziprasidone, perphenazine and aripiprazole were associated with relatively low rates, 16% to 27%. Olanzapine, risperidone, haloperidol, clozapine and thioridazine were associated with higher rates, 40% to 60%. The authors describe that split as partially consistent with the traditional dichotomy between prolactin-raising and prolactin-sparing antipsychotics.
Two cautions travel with the bands and both are the authors' own. Sensitivity analyses showed a significant impact of several variables on the rates, so the bands are not fixed properties of the molecules. And the paper names the harder problem: the difficulty of disentangling difficulty related to the drugs from difficulty related to the illness itself. Read the bands as two groups of studies with a wide gap between them. Abilify sits in the lower group, and so does Seroquel.
The two bands, from one paper
Pooled rates of sexual difficulty by drug group, Serretti and Chiesa 2011. Each bracket spans the band its group was pooled into.
Source: Serretti A, Chiesa A, International Clinical Psychopharmacology 2011 (PMID 21191308). The bands are pooled rates across the studies in each group and are not per-drug estimates. Several variables moved the rates in sensitivity analyses.
Seroquel, Latuda, and the ones with no pooled figure
Quetiapine, the generic behind Seroquel, lands in the same low band as aripiprazole. That is one paper, and quetiapine turns up again below in a Cochrane review where switching to it produced nothing. Olanzapine (Zyprexa) and risperidone (Risperdal) sit in the higher band, and risperidone reappears through the prolactin literature more than any other atypical.
Lurasidone (Latuda) and brexpiprazole (Rexulti) are the two brands this evidence cannot answer for. Neither appears in the pooled per-drug set, and no review cited here supplies a figure for either one. Anyone quoting you a percentage for them is quoting something else. Raise both with your prescriber by name.
Brand, generic, prolactin lane
Low band, 16% to 27%. Prolactin-sparing, and the drug the trials switch people to.
Low band, from the same single pooling. One small switching trial found no evidence of benefit.
High band, 40% to 60%. One small open-label trial found switching to it improved function in 54 people.
High band, and a named risk factor in a review of 89 studies alongside first-generation drugs.
The comparator below. Mean prolactin rose 464.7 mIU/l on it over 28 weeks.
Lurasidone and brexpiprazole. No pooled figure in the reviews cited here, in either direction.
Built from PMID 21191308, 31711954, 28252452 and 23152218. Group-level findings, and none is a reason to change a prescription.
Schizophrenia and sex drive, measured on its own
The largest pooling of the illness side is a 2023 review in JAMA Psychiatry: 72 of 1,119 screened studies, from 33 countries, covering 21,076 participants with schizophrenia. Pooled prevalence of sexual dysfunction was 56.4% (95% CI 50.5 to 62.2), 55.7% in men (95% CI 48.1 to 63.1) and 60.0% in women (95% CI 48.0 to 70.8). Loss of libido in men came out at 41% (95% CI 30.7 to 51.4), amenorrhea in women at 25% (95% CI 17.3 to 35.0).
What that paper did with the drugs matters more than the headline. On the drugs themselves the authors report conflicting results regarding antipsychotic classes. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection problems, at regression coefficients of -6.30 and -13.21, the shift that came with those prescriptions in a pooled observational model. Their own suggestion is that addressing co-occurring depression could improve sexual health.
A second meta-analysis compared people with schizophrenia against healthy controls across 10 observational studies and 3,570 participants, 1,161 of them with schizophrenia. The relative risk was 2.24 (95% CI 1.66 to 3.03) in the three studies reporting both sexes, 2.63 (95% CI 1.68 to 4.13) in the seven reporting men, heterogeneity 82.7%, and 2.07 (95% CI 1.46 to 2.94) in the five reporting women, heterogeneity 79.7%. The authors graded that evidence low, moderate and low respectively.
What the numbers look like before any drug is taken
The cleanest test of whether the medication is the whole story is to measure people who are not on one. A systematic review did that, restricted to patients drug-naive or drug-free for at least three weeks. Five papers met the bar, covering 770 cases. Prevalence ran from 16.8% to 70%, and in the ultra-high-risk state, before a first episode, it was 50%. Both groups came out higher than healthy controls. The authors call the studies scarce and heterogeneous.
A wider review, 89 studies and 25,490 participants aged 18 to 70, reported sexual difficulty in 30% to 82% of people with schizophrenia. In women the most frequent problem was loss of libido, 31% to 100% across studies. In men it was erection problems. The risk factors were illness severity, depressive symptoms, and the antipsychotics themselves, especially first-generation drugs, risperidone, and taking more than one at a time. Switching to a prolactin-sparing antipsychotic showed effectiveness in some studies, especially aripiprazole. Antidepressants were not associated with sexual difficulty in this population.
Those two give the suspect list an order. The drug's prolactin lane first, then the illness and its depressive pole, then several antipsychotics at once, then everything ordinary that flattens desire in anybody.
The one randomized head to head
Nearly all of this evidence is observational, which is why one randomized comparison carries weight out of proportion to its size. QUALIFY randomized people with schizophrenia aged 18 to 60 to aripiprazole once-monthly or paliperidone palmitate, and measured sexual difficulty and serum prolactin alongside its main outcome.
At week 28 the odds of sexual difficulty were lower on aripiprazole, at an adjusted odds ratio of 0.29 (95% CI 0.14 to 0.61, P = 0.0012). In men it was 0.33 (95% CI 0.13 to 0.86), in women 0.14 (95% CI 0.03 to 0.62), and in patients aged 18 to 35 it was 0.04 (95% CI under 0.01 to 0.34). Mean prolactin fell 150.6 mIU/l on aripiprazole and rose 464.7 mIU/l on paliperidone, and six paliperidone patients had prolactin-related adverse events.
Three things keep that from being the last word. It is one trial, its authors were employees of the sponsoring companies, and the population was people with schizophrenia on long-acting injections, a long way from someone taking a low dose of Abilify on top of an antidepressant. The direction travels. The size does not.
What lowers prolactin, and what the reviews decline to recommend
Prolactin has its own literature because it is measurable, and antipsychotic-induced high prolactin occurs in up to 70% of patients with schizophrenia. A network meta-analysis pooled 31 studies with 1,999 participants to ask what brings it down, and the answer depended entirely on where the level started. Below 50 ng/ml, nothing beat placebo. Above 50 ng/ml, adjunctive aripiprazole lowered it at every dose studied, by a mean difference of -64.26 at 5 milligrams (95% CI -87.00 to -41.37), -59.81 at 10 milligrams and -68.01 above that, with high certainty of evidence. Switching to aripiprazole in titration came out at -74.80 (95% CI -134.22 to -15.99), and adjunctive high-dose vitamin B6 at -91.84 with moderate certainty.
Then comes the part the internet skips. A systematic review of randomized trials found six of them, all testing different interventions, so the data could not be combined. Two reported a reduction, one on adjunctive sildenafil and one on adjunctive aripiprazole. Results were limited by small sample size, brief duration and the potential for bias, and the authors state flatly that no clinical recommendations can be made. The same review notes that prolactin is not a reliable marker for sexual difficulty.
The Cochrane review is the floor under all of it: four studies, 138 people, two weeks to four months. One trial of 32 men found better erection outcomes on sildenafil than on placebo (mean difference 3.20, 95% CI 1.83 to 4.57). Switching from risperidone to quetiapine showed no evidence of improvement in 36 people (mean difference -2.02, 95% CI -5.79 to 1.75). Switching to olanzapine improved sexual functioning in 54 people (mean difference -0.80, 95% CI -1.55 to -0.05), in a small open-label trial. That is what the Cochrane update had to work with.
Every line of evidence in one table
| Drug | Pooled band | Other evidence | Population | How certain |
|---|---|---|---|---|
| Aripiprazole (Abilify) | 16% to 27% | Odds 0.29 against paliperidone at week 28; lowers raised prolactin above 50 ng/ml | Schizophrenia, 18 to 60 | Prolactin evidence high certainty; one company-sponsored trial |
| Quetiapine (Seroquel) | 16% to 27% | Switching to it from risperidone: no evidence of improvement | Schizophrenia, 36 people | One pooling; the switch trial is tiny |
| Olanzapine (Zyprexa) | 40% to 60% | Switching to it improved sexual functioning | Schizophrenia, 54 people | Small and open-label |
| Risperidone (Risperdal) | 40% to 60% | A named risk factor across 89 studies, with first-generation drugs | Schizophrenia, 18 to 70 | Consistent, all observational |
| Paliperidone (Invega) | Not in the pooled set | Mean prolactin rose 464.7 mIU/l over 28 weeks | Schizophrenia, 18 to 60 | One randomized trial, company-sponsored |
| Lurasidone (Latuda), brexpiprazole (Rexulti) | No pooled figure in the reviews cited here | Nothing, in either direction | Not covered | No estimate. Ask by name |
"I just want to feel normal again"
Plenty of people reading this take an antipsychotic for something other than schizophrenia. Abilify and Rexulti get added to an antidepressant that stalled, and Seroquel gets prescribed for bipolar disorder and sometimes for sleep. If that is you, the schizophrenia figures do not describe your population, and nobody has pooled yours.
The suspect list still carries over. The antidepressant underneath has its own measured effect on desire, covered in our antidepressant guide and in what happens after stopping one. The mood problem being medicated flattens desire in its own right, which is depression and low libido. A sedating drug at night does not guarantee the restoring kind of sleep, which is sleep, libido and testosterone. Add alcohol, stress, and the weight these drugs put on. If your bloodwork came back unremarkable, normal labs, low libido was written for that position, and why is my libido so low walks the wider list.
What to take to your prescriber
Six things are worth raising, built from PMID 21191308, 31711954, 35790713 and 31585803. The appointment will be shorter than you want, so take them in this order:
- Say it out loud in the first two minutes. Desire gets skipped when it waits for the end.
- Give the timing. A change that began the week a dose went up is a different conversation.
- Hand over the full medication list, including anything for sleep or blood pressure.
- Ask about the depressive pole. It was a risk factor in the reviews and treatable on its own terms.
- Ask whether a prolactin test makes sense, and what your level means if you already have one.
- Ask about a switch, and let the answer be theirs. Do not stop or change your medication without your doctor, including shaving a dose to test a theory.
The everyday levers, and where a botanical fits
Before anything else here: plenty of people reading this take blood pressure medication or live with a cardiovascular or kidney condition. NUUD's own label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. For a good share of the people who reach this page, that sentence is the whole answer. If you take a prescription for a psychiatric condition, your prescriber decides whether any supplement belongs in the picture. Botanicals interact with medications.
Separate from anything clinical, a few ordinary things move desire in most people, and the free ones do more work than the internet admits: mood taken as seriously as the diagnosis, sleep in quantity and quality, alcohol honestly counted, movement you enjoy, time with no expectation attached. A botanical supplement, if you want one, is the smallest lever there.
NUUD is a botanical supplement built around desire in general. It does nothing for psychosis, nothing for bipolar disorder, nothing for depression, nothing for prolactin, and it has no role in managing a medical condition of any kind. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If your prescriber has read the label and has no objection, that is what our women's libido gummies are for, and there is a men's version. Talk to your doctor first and bring the label.
"Nothing is wrong with you"
You have probably been handed two unhelpful answers already: a shrug in an appointment that ran nine minutes, and a confident voice online saying the pill took your sex life and here is the protocol that gets it back. The research supports neither. These drugs differ from each other by a wide margin, Abilify sits in the lower group and is the one the trials switch people to, the illness carries a great deal of this on its own, and the reviews that went looking for a fix came back saying no clinical recommendations can be made. The women-specific evidence is thin, and no pooled number here can tell you what happened in your body.
What it can tell you is that you are not imagining it and you are not the exception. If you have been quietly wondering whether you are broken: no. Low libido in women and low libido in men walk the rest of it.
Keep reading
- Lamotrigine and sex drive
- Depression and low libido
- The SSRI libido drop and what helps
- Normal labs, low libido
- Why is my libido so low?
Frequently asked questions
Does Abilify lower sex drive?
It is the least likely antipsychotic in its class to. In the one meta-analysis that pooled per-drug data, aripiprazole sat in the low band at 16% to 27% with quetiapine, ziprasidone and perphenazine, while olanzapine, risperidone, haloperidol, clozapine and thioridazine sat at 40% to 60%. Aripiprazole is also the drug this literature switches people to: adjunctive aripiprazole lowered raised prolactin above 50 ng/ml with high certainty of evidence, and a company-sponsored randomized trial found lower odds of sexual difficulty against paliperidone at week 28 (odds ratio 0.29, 95% CI 0.14 to 0.61). The women-specific evidence is thin, and those authors flag how hard it is to separate drug from illness. Do not stop or change your medication without your doctor.
Does Seroquel lower sex drive?
Quetiapine, the generic behind Seroquel, sits in the same low band as aripiprazole in the only pooled per-drug comparison, at 16% to 27%. That band comes from one meta-analysis whose authors report that several variables moved the rates, and it describes groups of studies and never one person's experience. Quetiapine appears once more in a Cochrane review of four small studies, where switching to it from risperidone showed no evidence of improvement in 36 people (mean difference -2.02, 95% CI -5.79 to 1.75). Do not stop or change your medication without your doctor.
Which antipsychotics are most linked to sexual side effects?
The higher pooled rates belonged to olanzapine, risperidone, haloperidol, clozapine and thioridazine, at 40% to 60%, against 16% to 27% for quetiapine, ziprasidone, perphenazine and aripiprazole. The authors call that split partially consistent with the traditional dichotomy between prolactin-raising and prolactin-sparing antipsychotics. A review of 89 studies adds first-generation drugs, risperidone and taking more than one at a time to the risk-factor list. Those are group rates from pooled observational studies, and a review of six randomized trials concluded that no clinical recommendations can be made.
Is it the antipsychotic or the illness?
Both, and the illness carries more of it than most people expect. A meta-analysis of 72 studies from 33 countries covering 21,076 people with schizophrenia found 56.4% reporting sexual dysfunction (95% CI 50.5 to 62.2), with conflicting results regarding antipsychotic classes. A pooling of 10 observational studies found a relative risk against healthy controls of 2.24 (95% CI 1.66 to 3.03) in the three studies reporting both sexes, graded low certainty. And five studies of 770 drug-naive or drug-free people found rates of 16.8% to 70% before any antipsychotic was taken. All of it is observational and heterogeneous, and the lever those authors keep pointing at is co-occurring depression.
Can I take a botanical supplement with an antipsychotic?
Ask your prescriber first, before you buy anything. Botanicals interact with medications, and if you take a prescription for a psychiatric condition your prescriber decides whether any supplement belongs in the picture. NUUD is a botanical supplement built around desire in general, it does nothing for psychosis, bipolar disorder, depression or prolactin, and it has no role in managing a medical condition of any kind. Our label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. Bring it to the appointment.
References
- Serretti A, Chiesa A. A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics. International Clinical Psychopharmacology. 2011;26(3):130-140. https://pubmed.ncbi.nlm.nih.gov/21191308/
- Korchia T, Achour V, Faugere M, et al. Sexual Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2023;80(11):1110-1120. https://pubmed.ncbi.nlm.nih.gov/37703012/
- Zhao S, Wang X, Qiang X, et al. Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. The Journal of Sexual Medicine. 2020;17(8):1476-1488. https://pubmed.ncbi.nlm.nih.gov/32299716/
- Vargas-Caceres S, Cera N, Nobre P, Ramos-Quiroga JA. The Impact of Psychosis on Sexual Functioning: A Systematic Review. The Journal of Sexual Medicine. 2021;18(3):457-466. https://pubmed.ncbi.nlm.nih.gov/33504468/
- Dumontaud M, Korchia T, Khouani J, et al. Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2020;98:109804. https://pubmed.ncbi.nlm.nih.gov/31711954/
- Potkin SG, Loze JY, Forray C, et al. Reduced sexual dysfunction with aripiprazole once-monthly versus paliperidone palmitate: results from QUALIFY. International Clinical Psychopharmacology. 2017;32(3):147-154. https://pubmed.ncbi.nlm.nih.gov/28252452/
- Lu Z, Sun Y, Zhang Y, et al. Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis. Translational Psychiatry. 2022;12(1):267. https://pubmed.ncbi.nlm.nih.gov/35790713/
- Allen K, Baban A, Munjiza J, Pappa S. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. The Journal of Sexual Medicine. 2019;16(12):1978-1987. https://pubmed.ncbi.nlm.nih.gov/31585803/
- Schmidt HM, Hagen M, Kriston L, et al. Management of sexual dysfunction due to antipsychotic drug therapy. Cochrane Database of Systematic Reviews. 2012;11(11):CD003546. https://pubmed.ncbi.nlm.nih.gov/23152218/
This article is for general education and is not medical advice. Schizophrenia, bipolar disorder and depression are conditions only a licensed clinician can diagnose and manage. Do not stop or change your medication without your doctor, since stopping an antipsychotic on your own risks relapse. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing psychosis, bipolar disorder, depression, or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement.
