Sexual side effects and weight changes are real concerns on psychiatric medication, and both are worth raising and working on with your prescriber. How likely they are depends a lot on the specific medication. If either one is bothering you, tell your prescriber before making any change. Do not stop or lower your medication on your own.
Part of our guide: A Patient’s Guide to Psychiatric Medication
Your next step is simple: write down what changed and when it started, then raise it directly at your next visit, or sooner if it makes you want to stop treatment. The sertraline (Zoloft) label actually tells prescribers to ask, because patients may not bring it up themselves.
If you are thinking about suicide or self-harm, or are worried about someone else: call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.
This matters here because many of these medications carry safety warnings. Antidepressants have an FDA boxed warning about increased suicidal thoughts and behavior in pediatric and young adult patients in short-term studies, and the label says all treated patients should be closely monitored for worsening. Stopping medication suddenly because of a side effect can also cause problems of its own.
First, check whether it is the medication
Depression itself can cause these symptoms. NIMH lists problems with sexual desire and performance and changes in appetite or unplanned weight changes among common signs of depression. The sertraline label also notes that sexual symptoms may have other causes, including the underlying psychiatric disorder, and that a detailed history, including when symptoms began, is important.
That is why timing is so useful to your prescriber. Other medications, medical conditions, sleep, hormones, relationship stress and alcohol can all play a part as well. Your prescriber may suggest a medical check if the picture is unclear.
What to track before your visit
- When the change started, compared with any medication start or dose change
- What changed: interest, arousal, erection, orgasm or ejaculation, or menstrual changes
- Whether your appetite changed, what you crave and whether you feel hungrier at night
- Your weight, if you are comfortable tracking it, measured the same way each time
- How much this bothers you and whether it makes you want to stop treatment
- Any changes in sleep, activity, alcohol or other medications
Sexual side effects: what the labels and evidence say
The sertraline label says SSRI use may cause ejaculatory delay or failure, decreased libido and erectile dysfunction in men, and decreased libido and delayed or absent orgasm in women. Other medication groups can also be involved:
- Some antipsychotics. The olanzapine (Zyprexa) label says olanzapine raises prolactin levels and that galactorrhea, amenorrhea, gynecomastia and impotence have been reported with prolactin-elevating compounds. Antipsychotic labels also carry a boxed warning about increased risk of death in elderly patients with dementia-related psychosis.
- Lithium. The Lithobid label lists impotence and sexual dysfunction among adverse reactions.
Options your prescriber may discuss
A 2013 Cochrane review of 23 trials and 1,886 people looked at ways to manage sexual problems caused by antidepressants. It found that adding sildenafil or tadalafil appeared effective for men with antidepressant-related erectile problems, and that adding bupropion at higher doses looked most promising for women so far. It found no randomized trials of switching to antidepressants now available or of "drug holidays," and the authors describe the overall evidence as limited.
In practice, a conversation may cover:
- Waiting and watching, if the problem is mild and recent
- Adjusting the dose or the timing, under your prescriber's guidance
- Adding a medication aimed at the side effect
- Switching to a different medication. This article on how switching antidepressants works explains what is involved.
- Therapy, including couples therapy, if the change is affecting your relationship
None of these is right for everyone, and each has trade-offs. Skipping doses before sex on your own is not one to try, since stopping a serotonergic antidepressant abruptly can cause discontinuation reactions.
If symptoms continue after stopping
Some people report sexual problems that persist after an SSRI is stopped. A 2023 systematic review concluded that it was not possible to determine reliable estimates of how common this is, and that cause and effect could not be established, though continued symptoms could not be entirely ruled out. The evidence is limited and the question is still open. If this describes you, tell a clinician, since other causes should be checked and your experience deserves attention.
Weight changes: what the labels and evidence say
Medications differ, and the numbers below come from studies of groups, so your own response may be quite different.
| Medication | What the source reports |
|---|---|
| Olanzapine | Label warns of metabolic changes including high blood sugar, abnormal lipids and weight gain, with regular monitoring of weight and glucose. Mean weight increase in adolescents was greater than in adults. |
| Mirtazapine | In controlled trials, increased appetite was reported in 17% versus 2% on placebo, and weight gain of 7% or more of body weight in 7.5% versus 0% on placebo. |
| Valproate | Weight gain is listed. In migraine trials, not bipolar trials, it occurred in 8% versus 2% on placebo. |
| Lithium | Label lists excessive weight gain and also weight loss among adverse reactions. |
| Bupropion | In depression trials of the sustained-release form, weight loss of 5 pounds or more was more common than on placebo: 14% to 19% versus 6%. |
Differences between common antidepressants were small in one large study. A 2024 study of health records compared eight first-line antidepressants at 6 months and found small differences in average weight change. Compared with sertraline, escitalopram, paroxetine and duloxetine were linked with slightly more gain, about 0.3 to 0.4 kg, and bupropion with slightly less, about 0.2 kg. The risk of gaining 5% or more of body weight was 15% higher with escitalopram and 15% lower with bupropion. This was not a randomized trial and had no placebo group, so it compares drugs and does not show how much weight any one causes. The authors note low adherence and incomplete data, so these numbers are a rough guide.
Practical steps for weight concerns
- Raise it early. It is easier to address a small change than a large one.
- Ask whether baseline weight, blood sugar and lipids should be checked, especially on an antipsychotic. See which blood tests psychiatric medications need.
- Ask whether another medication would suit you better, and what you might give up by switching.
- Ask for help with sleep, food and movement. This article on lifestyle and medication covers how they fit together, and metabolic psychiatry is one related service to ask about.
- The olanzapine label warns about high blood sugar. Call your prescriber promptly about unusual thirst, frequent urination, increased hunger or weakness.
How to bring it up
If it feels awkward, you can say it plainly: "Since starting this medication, my sex drive has dropped and it is affecting my relationship," or "I have gained weight since the dose change and I am thinking of stopping. Can we talk about options?" Direct statements like these make the visit more useful. This article on how medication management helps reduce side effects and this one on talking to your provider about changing medications have more ideas. It also helps to say what matters most to you, such as how much symptom relief you would trade for fewer side effects. What feels tolerable differs from one person to the next, and the decision is yours to make together with your prescriber.
If you want help reviewing side effects with a prescriber, see medication management at Mind Body Seven. You can request a consultation, and the intake team confirms fit, scheduling and costs.
FAQs
Do these side effects go away on their own?
Sometimes. NIMH says antidepressant side effects are generally mild and tend to go away with time, though this varies, and sexual or weight changes may not fade for some people. If yours are not improving, it is worth raising.
Should I stop my medication if I gain weight?
Not on your own. Talk with your prescriber first, since stopping suddenly can cause withdrawal-type symptoms or a return of the condition. Together you can weigh the benefit you are getting against the side effect and review other options.
Are there antidepressants less likely to cause these problems?
Some differ. Bupropion has shown less weight gain than other first-line options in a large records study, and it has its own risks, including a dose-related seizure risk. The best choice depends on your history, so ask your prescriber.
Are these side effects hard to talk about with a therapist?
They do not have to be. A therapist can help you prepare for the conversation with your prescriber and work through the effect on your relationship, and some people bring a partner into that work. See couples therapy.
