Does Prozac Affect Sex Drive? What the Fluoxetine Trials Actually Show

On Prozac and sex drive, the short answer is yes. Prozac (fluoxetine) can lower sex drive: in a 1,022-person Spanish study, 57.7% of the 279 people on fluoxetine reported a sexual problem when asked directly, and a 2009 meta-analysis ranked it fifth of ten antidepressants for this side effect. That puts it in the middle-to-upper band of the SSRIs, below paroxetine and citalopram in the Spanish data. The depression carries part of the drop too, and nobody can say for one person how much is the drug. Waiting it out has a poor record. The add-ons with a trial signal are bupropion and, for men, the erection drugs.

Figures from Montejo et al. 2001 (PMID 11229449) and Michelson et al. 2001 (PMID 11354934). Both measured sexual function with open-label fluoxetine.

Is it the Prozac, or is it me?

Fluoxetine can lower desire. So can depression, anxiety, exhaustion and a relationship under strain. If your drive went quiet after you started Prozac, the drug is a fair suspect, and the illness you took it for is a second one. No test tells you how the blame splits for you.

The strongest case for the illness comes from Michelson and colleagues (2001). They followed 501 people with depression through 13 weeks of open-label fluoxetine at 20 milligrams daily. By the end, 51.6% of women and 40.6% of men said their overall sexual function had improved. Only 13.4% of women and 17.4% of men said it was worse. The authors read that as the antidepressant effect lifting sex along with mood, more often than the drug pulled it down. That phase had no placebo arm and used a four-item scale, so it is a rough reading.

The same study then randomized people for 25 weeks: fluoxetine 20 milligrams daily, fluoxetine 90 milligrams weekly, or placebo. Sexual function did not differ significantly between the three groups. When it got worse, that was strongly linked to the depression getting worse. The authors concluded that decline on fluoxetine does not look like a late-onset drug effect. So a slide months into Prozac is worth raising as a mood question too.

Madeo and colleagues (2008) went at it from the other end. They gave 48 healthy men without depression fluoxetine 20 milligrams a day, citalopram, or placebo, 16 men per group, for about four weeks. On a standard questionnaire, every item slipped on the drugs except the desire items, and only citalopram reached significance. The authors wrote that citalopram and fluoxetine did not affect sexual desire. It was small and short, in young healthy men, so it cannot speak for a woman on Prozac for a year.

If you take fluoxetine for PMDD, a 2024 Cochrane review of SSRIs for premenstrual syndrome and PMDD found higher odds of low libido or a sexual side effect on the drug, and sex drive and your menstrual cycle covers the cycle side. For the wider picture on depression and desire, see depression and low libido, stress killing your sex drive, and our guide to SSRIs and the libido drop.

How often fluoxetine does this, by the numbers

Montejo and colleagues (2001) ran the biggest study. Their prospective open-label study in Spain followed 1,022 adults, 610 women and 412 men with a mean age of 39.8, who had normal sexual function before the drug. Across all the antidepressants, 59.1% reported a sexual problem. For fluoxetine alone it was 57.7%, or 161 of 279 people, the biggest single group in the study. About 40% of everyone affected said they tolerated it poorly. With no placebo group and direct questions, treat these as high-end figures.

How you ask changes the count. In an earlier study, Montejo-Gonzalez and colleagues (1997) followed 344 people on fluoxetine, paroxetine, sertraline or fluvoxamine. When doctors asked direct questions, 58% reported a sexual problem. When people were left to bring it up themselves, 14% did. Landen and colleagues (2005) found the same gap in 119 people on citalopram or paroxetine: 41% when asked directly, 6% unprompted.

The placebo-controlled picture comes from Coleman and colleagues (2001). They randomized people with recurrent depression to bupropion SR 150 to 400 milligrams a day (150 people), fluoxetine 20 to 60 milligrams a day (154) or placebo (152) for up to 8 weeks. From week 2 onward, significantly more people on fluoxetine had trouble finishing than on bupropion or placebo (P < 0.001), and at various points low desire and dissatisfaction were also more frequent on fluoxetine. It was one 8-week trial, and the report does not print the desire percentages.

Clayton and colleagues (2002) surveyed 4,534 women and 1,763 men on a single antidepressant across 1,101 U.S. primary care clinics. The SSRIs, mirtazapine and venlafaxine XR ran at 36% to 43%. Bupropion IR sat at 22% and bupropion SR at 25%. In people with no other obvious reason for a sexual problem, the odds were 4 to 6 times higher with SSRIs than with bupropion SR. It was a cross-sectional survey with no separate fluoxetine rate.

Fluoxetine against the other antidepressants

Per-drug rates for reporting any sexual problem were citalopram 72.7% (48 of 66), paroxetine 70.7% (147 of 208), venlafaxine 67.3% (37 of 55), sertraline 62.9% (100 of 159), fluvoxamine 62.3% (48 of 77), fluoxetine 57.7% (161 of 279), mirtazapine 24.4% (12 of 49), nefazodone 8% (4 of 50), amineptine 6.9% (2 of 29) and moclobemide 3.9% (1 of 26). Fluoxetine is the lowest of the six high-rate drugs and still far above the bottom four. Open-label, direct questions, no placebo: every bar leans high.

Serretti and Chiesa (2009) pooled studies that asked about sex directly, in people with no problem beforehand. Ten drugs raised the rate significantly above placebo. In order of impact: sertraline, venlafaxine, citalopram, paroxetine, fluoxetine, imipramine, phenelzine, duloxetine, escitalopram and fluvoxamine. So fluoxetine landed fifth. The 25.8% to 80.3% range in that paper spans all ten drugs. Bupropion and mirtazapine were among six that did not differ significantly from placebo. The authors warn that including open-label studies and mixing different scales could weaken the ranking.

Reichenpfader and colleagues (2014) ran a larger network meta-analysis: 63 studies, more than 26,000 people on second-generation antidepressants. Most head-to-head comparisons showed a similar risk, with credible intervals wide enough to hide real differences. Bupropion came out significantly lower than some drugs, and escitalopram and paroxetine significantly higher than some. The authors rated the strength of that evidence as low. So the ranking is loose, with fluoxetine in the pack. Compare what the sertraline trials show and what the escitalopram trials show.

Why it does not fade with time

The advice to give it a few months has thin data behind it. In the 344-person Spanish study, only 5.8% saw the problem disappear completely within 6 months, and 81.4% showed no improvement at all by then. It improved when the dose was lowered or the drug stopped. That study covered four SSRIs together, fluoxetine among them, and had no placebo group, so it cannot give a fluoxetine-only answer.

Landen and colleagues (2005) looked at it from another angle. In 119 people with depression who had not responded to citalopram or paroxetine, the sexual side effect correlated with how long the depressive episode had lasted. It did not correlate with age, dose, blood level, time on the drug, or any depression score. The authors took the missing link to time on the drug as support for the idea that SSRI sexual side effects do not abate. The two studies disagree on dose.

Fluoxetine has one quirk that matters here. It is long-acting. Rothschild (1995) asked 30 people with SSRI-linked sexual problems to skip their pills from Thursday morning to Sunday noon, for four weekends. People on sertraline and paroxetine reported significant improvement. People on fluoxetine did not. When Alipour-Kivi and colleagues (2024) tested weekend breaks in 63 men, they left fluoxetine out on purpose, writing that its long half-life makes drug holidays ineffective. Neither paper tells you how long fluoxetine takes to clear, so we will not guess. Do not try a break without your prescriber.

Switching can carry the problem along with you. In the STAR*D trial, Katz and colleagues (2012) followed 727 adults who moved to a second antidepressant after citalopram failed. People who had a sexual side effect on the first drug were 2.75 times as likely to report one on the second (95% CI 2.29 to 3.29). That was a secondary analysis with no fluoxetine arm. If your labs look normal and you still feel nothing, numbers fine, still flat covers that ground.

What the switch and add-on trials found

Taylor and colleagues (2013) wrote the Cochrane review of fixes for antidepressant-linked sexual problems: 23 trials, 1,886 people. In men, sildenafil (three studies, 255 people) and tadalafil (one study, 54 people) improved erection scores over placebo. For women, sildenafil stayed uncertain. Bupropion 150 milligrams twice daily beat placebo on rating scales (SMD 1.60, 95% CI 1.40 to 1.81), while 150 milligrams once daily showed no significant difference (RR 0.62, 95% CI 0.09 to 4.41). The other add-ons failed to show a significant improvement. There were no randomized trials of switching to a current lower-risk drug, of talk-based approaches, or of drug holidays. The authors called the evidence rather limited.

One trial looked only at fluoxetine. Michelson and colleagues (2000) took women who had done well on fluoxetine for at least 8 weeks and then noticed a sexual decline. They got buspirone (19 women), amantadine (18) or placebo (20) for 8 weeks. Every group improved, placebo included, and the three did not differ significantly. The authors said that general improvement is why these add-ons need a placebo arm. It was small, but it is the closest match to a woman on Prozac today.

Clayton and colleagues (2004) tested bupropion SR 150 milligrams twice daily against placebo in 42 people whose depression had responded to an SSRI. After 4 weeks the total score did not differ significantly, but desire, measured by feelings of desire and how often people had sex, improved more on bupropion (p = .024). Nurnberg and colleagues (2008) gave sildenafil or placebo to 98 premenopausal women whose depression was in remission on a serotonin reuptake drug. Sildenafil scored better by 0.8 (95% CI 0.6 to 1.0), and by 0.6 when the 22% who dropped out were counted at baseline. Neither trial reports a desire-only result for fluoxetine.

On switching, the Spanish study reported 12 of 15 people fully improving after a move to moclobemide, without a control group. A larger randomized trial by Jacobsen and colleagues (2015) switched people off citalopram, paroxetine or sertraline to vortioxetine (225) or escitalopram (222); vortioxetine improved the total score more (8.8 versus 6.6, P = 0.013). Fluoxetine was not one of the starting drugs. See what the bupropion trials show and libido after stopping antidepressants.

What each study can and cannot tell you

The sources split into two piles. The surveys and rankings ask how often fluoxetine lowers desire, and most asked people directly with no placebo group, so their numbers run high. The add-on and switch trials ask what to do once it has happened. Most are small and short, and only one was built around fluoxetine.

Add-on and switch options for a fluoxetine (Prozac) libido drop: what the evidence says.

Strategy	Best evidence	Result	Grade
Bupropion 150 milligrams twice daily	Cochrane, three studies, men and women	SMD 1.60, 95% CI 1.40 to 1.81	Limited but the strongest
Bupropion SR twice daily, 4 weeks	One trial, 42 people on SSRIs	Desire and frequency better (p = .024); total score no different	Small, short
Bupropion 150 milligrams once daily	Cochrane, two studies	RR 0.62, 95% CI 0.09 to 4.41	No signal at that dose
Sildenafil, men	Cochrane, three studies, 255 men	Better erection scores	Men only
Sildenafil, women	One trial, 98 women; Cochrane	Difference 0.8, 95% CI 0.6 to 1.0; Cochrane still uncertain	Uncertain
Buspirone or amantadine, women on fluoxetine	One trial; 19, 18 and 20 women per arm	No better than placebo	Small, null
Weekend drug holiday	One study, 30 people	No improvement on fluoxetine	Uncontrolled
Switching antidepressants	No randomized trial of current lower-risk drugs	Untested	Untested

What to bring to your prescriber

Take this list with you, in this order.

1. Which question you are asking. Do you want to know if it is the drug or the depression, or do you want something done about it? The answers differ.
2. Your timeline. When you started Prozac, every dose change since, and when you first noticed the change in desire. Worsening months in has been tied to the depression returning.
3. Ask to be asked directly. In one study, 58% reported a sexual problem when asked straight out, against 14% who raised it on their own. Say it plainly, even if nobody asks.
4. The waiting question. In the 344-person study, only 5.8% saw it disappear within 6 months, and weekend breaks did nothing for the fluoxetine group in a small study. Ask what the plan is if nothing changes.
5. The options with a signal. Bupropion 150 milligrams twice daily, and for men the erection drugs, have trial results behind them. No randomized trial has tested switching to a current lower-risk drug.
6. The supplement question, bottle in hand. NUUD does nothing for depression or for medication side effects, and no one has studied it alongside fluoxetine. Bring the label and ask.

"I've tried everything"

The honest count is short. Bupropion at 150 milligrams twice daily did. For men, the erection drugs did. The once-daily bupropion dose did not, and the other add-ons in the Cochrane review failed to show a significant improvement. The one trial built around women on fluoxetine found buspirone and amantadine no better than placebo, while every group improved a little just from being in the study. So "tried everything" often means you tried things that never cleared the bar. Sleep, your load and how things feel with your partner have never been in a trial, and they are fair places to look. When desire has been low for a long time on its own terms, what HSDD means explains the term, and libido after stopping antidepressants covers what is known about the other side.

The everyday levers, and where a botanical fits

Start with who this section is not for. Blood-pressure medication, heart conditions, and kidney and lung problems are exactly what NUUD's own label warns about: 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 many readers of this article, that sentence is the answer. Talk to your prescriber first and bring the label.

A few ordinary things move desire in most people, and the free ones do more work than the internet admits.

• Sleep, in quantity and quality, since a tired body rarely wants much. Sleep, libido and testosterone covers that.
• Movement you can keep up. Exercise and libido covers the wider picture.
• Getting the depression or anxiety properly under control, since the illness carries part of the drop and your prescriber can adjust that directly.
• Time and safety, with a partner or on your own, with nothing expected at the end.
• A botanical supplement, if you want one, as the smallest lever on the list.

NUUD is a botanical supplement built around desire in general; it does nothing for depression, anxiety, OCD, PMDD, or the side effects of Prozac or any antidepressant, and it has no role in managing any medical condition. The formula is built on the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, with onset in roughly 30 to 60 minutes. If you take blood-pressure medication or have a heart, kidney or lung condition, the label says no, and your prescriber decides the rest. If your prescriber has read that label and has no objection, that is what our women's libido gummies are for. There is a men's version.

Nothing is wrong with you

Your prescriber chose fluoxetine knowing it can do this. In the Spanish study, 57.7% of people on it reported a sexual change when asked directly. In the 2009 ranking it came fifth of ten. That is a known cost of the medicine, weighed against what it does for your mood. It says nothing bad about you. Depression and a heavy stretch of life flatten wanting on their own. In the 501-person fluoxetine study, more people said sex got better on the drug than worse. If yours went the other way, you are in a well-documented group. You want to want it again. You just want to feel normal again. Both are fair things to ask for.

Keep reading

• SSRIs and the libido drop: what helps
• Does Zoloft affect sex drive?
• Does Lexapro affect sex drive?
• Does Wellbutrin affect sex drive?
• Antidepressants and low libido
• Libido after stopping antidepressants

Frequently asked questions

Does Prozac lower sex drive?
It can, and for a large share of people it does. In a 1,022-person Spanish study, 57.7% of the 279 people on fluoxetine reported a sexual problem when asked directly, and a 2009 meta-analysis ranked fluoxetine fifth of ten antidepressants that raised the rate above placebo. That study was open-label, so the figure leans high. Depression lowers desire too: in a 501-person fluoxetine study, more people said their sex life improved over 13 weeks than said it got worse.

Does Prozac affect sex drive in women differently than men?
Slightly, in the one fluoxetine study that split by sex. After 13 weeks of fluoxetine 20 milligrams daily, 13.4% of women and 17.4% of men said their overall sexual function got worse, while 51.6% of women and 40.6% of men said it got better. That first phase had no placebo group. Across all the antidepressants in the Spanish study, men reported a problem more often (62.4% against 56.9%) and women reported greater severity, though that split was not given for fluoxetine alone.

Will my sex drive come back if I stop Prozac?
Nobody can promise that for one person, and no study in our sources timed desire after stopping fluoxetine. In a 344-person study of four SSRIs, fluoxetine among them, sexual function improved substantially when the dose was lowered or the drug was withdrawn. Fluoxetine is long-acting, and weekend breaks did nothing for the fluoxetine group in a small study. Never stop on your own; plan any change with your prescriber, and read our guide to libido after stopping antidepressants.

Is Prozac worse than Zoloft or Lexapro for sex drive?
Not by most measures, though the gaps are small and the evidence is loose. In the 2009 ranking, sertraline came first, fluoxetine fifth and escitalopram ninth. In the Spanish study, fluoxetine ran at 57.7% against sertraline at 62.9%; escitalopram was not included. A network meta-analysis of 63 studies and more than 26,000 people found most drugs at a similar risk, with escitalopram and paroxetine significantly higher than some, and rated that evidence low.

Can I take a botanical supplement with Prozac?
Ask your prescriber first, and bring the label. The caution reads: 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. NUUD does nothing for depression, anxiety, OCD, PMDD, or the side effects of Prozac, and no one has studied the formula alongside fluoxetine. So the decision belongs to you and your prescriber, with that label on the table.

References

1. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The Journal of clinical psychiatry. 2001;62 Suppl 3:10-21. https://pubmed.ncbi.nlm.nih.gov/11229449/
2. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. Journal of clinical psychopharmacology. 2009;29(3):259-66. https://pubmed.ncbi.nlm.nih.gov/19440080/
3. Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, et al. Prevalence of sexual dysfunction among newer antidepressants. The Journal of clinical psychiatry. 2002;63(4):357-66. https://pubmed.ncbi.nlm.nih.gov/12000211/
4. Coleman CC, King BR, Bolden-Watson C, Book MJ, Segraves RT, Richard N, et al. A placebo-controlled comparison of the effects on sexual functioning of bupropion sustained release and fluoxetine. Clinical therapeutics. 2001;23(7):1040-58. https://pubmed.ncbi.nlm.nih.gov/11519769/
5. Michelson D, Schmidt M, Lee J, Tepner R. Changes in sexual function during acute and six-month fluoxetine therapy: a prospective assessment. Journal of sex & marital therapy. 2001;27(3):289-302. https://pubmed.ncbi.nlm.nih.gov/11354934/
6. Madeo B, Bettica P, Milleri S, Balestrieri A, Granata AR, Carani C, et al. The effects of citalopram and fluoxetine on sexual behavior in healthy men: evidence of delayed ejaculation and unaffected sexual desire. A randomized, placebo-controlled, double-blind, double-dummy, parallel group study. The journal of sexual medicine. 2008;5(10):2431-41. https://pubmed.ncbi.nlm.nih.gov/18410297/
7. Reichenpfader U, Gartlehner G, Morgan LC, Greenblatt A, Nussbaumer B, Hansen RA, et al. Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis. Drug safety. 2014;37(1):19-31. https://pubmed.ncbi.nlm.nih.gov/24338044/
8. Montejo-González AL, Llorca G, Izquierdo JA, Ledesma A, Bousoño M, Calcedo A, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. Journal of sex & marital therapy. 1997;23(3):176-94. https://pubmed.ncbi.nlm.nih.gov/9292833/
9. Landén M, Högberg P, Thase ME. Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine. The Journal of clinical psychiatry. 2005;66(1):100-6. https://pubmed.ncbi.nlm.nih.gov/15669895/
10. Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. The American journal of psychiatry. 1995;152(10):1514-6. https://pubmed.ncbi.nlm.nih.gov/7573593/
11. Alipour-Kivi A, Eissazade N, Shariat SV, Salehian R, Soraya S, Askari S, et al. The effect of drug holidays on sexual dysfunction in men treated with selective serotonin reuptake inhibitors (SSRIs) other than fluoxetine: an 8-week open-label randomized clinical trial. BMC psychiatry. 2024;24(1):67. https://pubmed.ncbi.nlm.nih.gov/38263040/
12. Katz AJ, Dusetzina SB, Farley JF, Ellis AR, Gaynes BN, Castillo WC, et al. Distressing adverse events after antidepressant switch in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial: influence of adverse events during initial treatment with citalopram on development of subsequent adverse events with an alternative antidepressant. Pharmacotherapy. 2012;32(3):234-43. https://pubmed.ncbi.nlm.nih.gov/22392456/
13. Jespersen C, Lauritsen MP, Frokjaer VG, Schroll JB. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. The Cochrane database of systematic reviews. 2024;8(8):CD001396. https://pubmed.ncbi.nlm.nih.gov/39140320/
14. Taylor MJ, Rudkin L, Bullemor-Day P, Lubin J, Chukwujekwu C, Hawton K. Strategies for managing sexual dysfunction induced by antidepressant medication. The Cochrane database of systematic reviews. 2013;2013(5):CD003382. https://pubmed.ncbi.nlm.nih.gov/23728643/
15. Clayton AH, Warnock JK, Kornstein SG, Pinkerton R, Sheldon-Keller A, McGarvey EL. A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction. The Journal of clinical psychiatry. 2004;65(1):62-7. https://pubmed.ncbi.nlm.nih.gov/14744170/
16. Nurnberg HG, Hensley PL, Heiman JR, Croft HA, Debattista C, Paine S. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA. 2008;300(4):395-404. https://pubmed.ncbi.nlm.nih.gov/18647982/
17. Michelson D, Bancroft J, Targum S, Kim Y, Tepner R. Female sexual dysfunction associated with antidepressant administration: a randomized, placebo-controlled study of pharmacologic intervention. The American journal of psychiatry. 2000;157(2):239-43. https://pubmed.ncbi.nlm.nih.gov/10671393/
18. Jacobsen PL, Mahableshwarkar AR, Chen Y, Chrones L, Clayton AH. Effect of Vortioxetine vs. Escitalopram on Sexual Functioning in Adults with Well-Treated Major Depressive Disorder Experiencing SSRI-Induced Sexual Dysfunction. The journal of sexual medicine. 2015;12(10):2036-48. https://pubmed.ncbi.nlm.nih.gov/26331383/
19. Jacobsen PL, Nomikos GG, Zhong W, Cutler AJ, Affinito J, Clayton A. Clinical implications of directly switching antidepressants in well-treated depressed patients with treatment-emergent sexual dysfunction: a comparison between vortioxetine and escitalopram. CNS spectrums. 2020;25(1):50-63. https://pubmed.ncbi.nlm.nih.gov/31010445/

This article is for general education and is not medical advice. Depression, anxiety, OCD and PMDD are medical conditions that only a licensed clinician can diagnose and manage, and Prozac (fluoxetine) is a prescription medicine. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing depression, anxiety, OCD, PMDD, the side effects of any medication, 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, and do not stop or change your medication without your doctor.