Sex, pregnancy & antidepressants

Taking antidepressants can affect sexual activity. It is also important to know about potential risks of taking antidepressants whilst pregnant or breastfeeding.

Sex

Both depression and antidepressant medication can cause disorders of desire, arousal and orgasm.

Antidepressant drugs can cause sedation, hormonal changes, and sexual dysfunction. How much it affects you depends on you as an individual and also on each different drug. Among the more common problems you may experience are decreased libido, problems with erection, impaired ejaculation, being less able to achieve an orgasm and poor vaginal lubrication.

If you are experiencing problems you should consult your doctor and ask for either the dose to be reduced or to change to a different drug.

Pregnancy

Patients who are already receiving antidepressants and are at high risk of relapse are best maintained on depressants during and after pregnancy.

There is most experience with amitryptyline, imipramine (constipation and sedation can be a problems with both), and fluoxetine (increased chance of early delivery and low birth weight). Experience with other drugs is growing and a change in treatment may not be necessary, or wise.

Finally, newborn babies may experience withdrawal symptoms such as agitation and irritability. The risk is assumed to be particularly high with paroxetine and venlafaxine.
Pregnancy & mental illness

Breast-feeding

The benefits of breast-feeding to both the mother and the baby need to outweigh the potential risk of drug exposure to the child.

The Maudsley Prescribing Guidelines suggest as far as possible, the same medication should be continued during pregnancy and breastfeeding, the lowest effective dose should be used and as far as possible to avoid breast feeding when the medication is a peak. 

The antidepressants of choice for mothers who are breast-feeding are paroxetine or sertraline.