Sexual side effects on Lexapro are extremely common, affecting somewhere between 30% and 80% of people who take it depending on the study. The wide range exists partly because many people don’t bring it up unless directly asked. In one study of 344 patients on SSRIs, 58% reported sexual dysfunction when their doctor asked about it directly, compared to far fewer who mentioned it on their own. The good news: there are several well-studied strategies that can help restore your sex drive without giving up the mental health benefits of your medication.
Why Lexapro Lowers Libido
Lexapro works by increasing serotonin levels in the brain, which helps with depression and anxiety. But that same serotonin boost has a side effect: it dials down activity in dopamine pathways that play a central role in desire, arousal, and pleasure. Essentially, the system responsible for making you feel motivated and rewarded gets quieter. Serotonin also dampens norepinephrine signaling, which contributes to difficulties with arousal and orgasm. This isn’t a flaw in how you’re responding to the medication. It’s a predictable consequence of how the drug changes brain chemistry.
Talk to Your Prescriber About Adding Bupropion
The most well-supported strategy is adding bupropion (brand name Wellbutrin) to your Lexapro. Unlike Lexapro, bupropion works on dopamine and norepinephrine, the exact neurotransmitters that get suppressed. Harvard Health notes that it can counter SSRI-induced sexual dysfunction, boost sexual drive and arousal, and increase the intensity or duration of orgasm. Both men and women can benefit. Many prescribers are already familiar with this combination, so it’s worth raising directly at your next appointment.
Other Medication Add-Ons
Bupropion isn’t the only option. Buspirone, an anti-anxiety medication, can also help reverse sexual side effects from SSRIs at higher doses. It works partly by acting on serotonin receptors differently than Lexapro does, and partly through its effects on norepinephrine. This can be a good fit if you also deal with residual anxiety.
For arousal and orgasm difficulties specifically, medications like sildenafil (Viagra) have shown benefits for both men and women on SSRIs. In a randomized controlled trial of 98 premenopausal women taking SSRIs, 72% of those given sildenafil reported improvement in sexual side effects, compared to only 27% on placebo. The most common side effects were headache, flushing, and nasal congestion. While sildenafil is FDA-approved for erectile dysfunction in men, it’s used off-label for women in this context.
Adjusting Your Lexapro Dose
Sexual side effects are often dose-dependent, meaning a lower dose may cause fewer problems. If your depression or anxiety is well-controlled, your prescriber might try reducing your dose slightly to see if sexual function improves without symptoms returning. This is a balancing act and needs to be done gradually with medical guidance.
Some research has explored “drug holidays,” where patients skip their medication from Thursday evening through Saturday, then resume on Sunday. A small study in the New England Journal of Medicine found this improved sexual function for some SSRI users. However, this approach carries real risks: skipping doses can trigger withdrawal symptoms or a return of depression, and it doesn’t work safely with all SSRIs. Lexapro has a relatively long half-life, which makes brief interruptions less likely to cause withdrawal, but this is not something to try on your own.
Switching to a Different Antidepressant
If add-on strategies don’t work, switching medications is another path. Not all antidepressants carry the same sexual side effect burden. Bupropion on its own (rather than as an add-on) has the lowest rates of sexual dysfunction among antidepressants. Newer antidepressants like vortioxetine (Trintellix) and vilazodone (Viibryd) were designed in part to cause fewer sexual side effects than older SSRIs. The tradeoff is that switching medications means a transition period where your mood symptoms might temporarily fluctuate, so this decision involves weighing how well Lexapro is working for your mental health against the severity of sexual side effects.
Timing and Lifestyle Adjustments
While medication changes tend to have the biggest impact, a few practical habits can help at the margins. If you take Lexapro in the morning, scheduling sexual activity for the evening or before your next dose means you’re at the lowest drug concentration of the day. This won’t be dramatic, but some people notice a difference.
Regular cardiovascular exercise increases blood flow and temporarily boosts dopamine and norepinephrine, the same neurotransmitters that Lexapro suppresses in the context of sexual function. Some people find that exercising a few hours before sex makes arousal come more easily. Stress reduction matters too: cortisol (your stress hormone) independently suppresses libido, and if your anxiety or stress is still high despite Lexapro, addressing that through therapy, sleep, or lifestyle changes can free up some of the desire that stress is blocking.
What Doesn’t Have Strong Evidence
You’ll find plenty of supplement recommendations online, particularly maca root, ginseng, and various herbal blends marketed for sexual health. The clinical evidence for these in the specific context of SSRI-induced sexual dysfunction is thin. A clinical trial studying maca root for antidepressant-related sexual dysfunction was terminated after enrolling only 8 participants due to funding issues, producing no useful data. That doesn’t mean supplements can’t help individual people, but the evidence base is nowhere near what exists for medication-based strategies.
Having the Conversation
The biggest barrier for most people is simply bringing this up with their prescriber. Keep in mind that your doctor has heard this concern many times before, and there are concrete, well-studied solutions. It helps to be specific: mention whether the issue is primarily low desire, difficulty with arousal, trouble reaching orgasm, or some combination. Each pattern points toward slightly different solutions. You don’t need to tolerate sexual side effects as the price of treating your mental health. For most people, there’s a combination that addresses both.