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Last updated: Jun 21, 2022
5 min read

Viagra and antidepressants: can you mix the two?

 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

If you’ve recently been prescribed an antidepressant and are experiencing side effects like erectile dysfunction (ED), you may be wondering, “Can I take Viagra with antidepressants?”

The short answer is: Yes, you can. While antidepressant medications can be effective in treating mental health conditions like depression and anxiety, some may cause sexual side effects, such as erectile dysfunction. And Viagra may be able to help manage antidepressant-induced ED (Sooriyamoorthy, 2022; Higgins, 2010).

Keep reading to learn more about combining antidepressants with Viagra and why some antidepressants may cause erectile dysfunction.

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Can you take Viagra with antidepressants?

Yes, it is generally safe to take Viagra (generic name sildenafil; see Important Safety Information) with an antidepressant. No major drug interactions are known to occur between them (FDA, 2017).

In fact, in clinical trials, sildenafil—the active ingredient in Viagra—was effective for improving ED, arousal, ejaculation, orgasm, and overall satisfaction in men with sexual dysfunction associated with SSRI antidepressants. Viagra was well-tolerated in this trial’s participants, with no reports of serious side effects (Nurnberg, 2003).

Sildenafil belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors. Similar drugs that a healthcare provider may prescribe to treat antidepressant-induced sexual dysfunction may include tadalafil (brand name Cialis; see Important Safety Information) or vardenafil (brand name Levitra) (Chokka, 2018). 

Viagra, low blood pressure, and tricyclic antidepressants

While Viagra typically doesn’t interact with antidepressants, one precaution is that one of Viagra’s side effects may overlap with one specific side effect of certain antidepressants. 

Certain antidepressants may cause orthostatic hypotension (OH), which is a drop in blood pressure that occurs when you get up after lying down. Symptoms of OH, such as dizziness and blurred vision, usually go away within a few moments. But, OH can sometimes be more severe, causing people to faint or lose consciousness (Rivasi, 2020). 

Taking Viagra may cause a temporary decrease in blood pressure (FDA, 2017). Antidepressants known to cause OH include tricyclic antidepressants (TCAs), such as amitriptyline and clomipramine (Rivasi, 2020). So, if you take both Viagra and a TCA, your risk for this side effect may be somewhat higher. 

If your healthcare provider prescribes these drugs together, they’ll likely recommend that you take certain precautions. For example, you shouldn’t jump out of bed. Instead, sit on the edge of the bed for a couple of minutes before standing.

Viagra comes with other precautions and interaction risks as well, so be sure to tell your provider and pharmacist about all of your current medications so that they can help prevent harmful interactions.

Which antidepressants cause erectile dysfunction?

Several types of antidepressants may cause ED or other sexual problems like reduced libido, which healthcare providers often summarize as sexual dysfunction. Individual results, however, vary. Not everyone who takes these medications develops sexual side effects. Some people have sexual side effects from one antidepressant but not from another.

The following lists include antidepressants that have been reported to cause erectile dysfunction (Chokka, 2018; Higgins, 2010; Jing, 2016; Wang, 2018):

Selective serotonin reuptake inhibitors (SSRIs), such as:

Serotonin-norepinephrine reuptake inhibitors (SNRIs), including:

Tricyclic antidepressants (TCAs), such as:

Monoamine oxidase inhibitors (MAOIs), like:

  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Selegiline (Eldepryl, Zelapar)

How do antidepressants cause ED?

Antidepressants are thought to work by increasing the availability of certain chemicals in your brain that affect mood, like serotonin and norepinephrine. We don’t know exactly why antidepressants may cause ED and other sexual side effects, but one theory is that an increase in serotonin may affect other hormones and neurotransmitters, like dopamine and the sex hormone testosterone. This may lead to symptoms of sexual dysfunction, like decreased libido, and ED (Jing, 2016).

Other ways to treat antidepressant-induced ED

Your healthcare provider may recommend various strategies to improve antidepressant-induced ED. Some examples include (Chokka, 2018; Jing, 2016; Santarsieri, 2015; Sooriyamoorthy, 2022):

  • Adjusting your dosage: Your healthcare provider may change the dosage of your antidepressants over time. It may take some trial-and-error to find the lowest effective dose for managing symptoms of depression or anxiety disorder that also doesn’t cause bothersome side effects. 
  • Switching to a different antidepressant: Individual results can vary with different antidepressant drugs. Some people have sexual side effects from one antidepressant but not with another, even if they belong to the same class of drugs. Examples of antidepressants that are associated with a lower chance of  ED include bupropion (Wellbutrin; see Important Safety Information) and mirtazapine (Remeron; see Important Safety Information).
  • Adding an additional medication: Providers may prescribe bupropion (Wellbutrin) in addition to your antidepressant. Bupropion is an antidepressant, but it doesn’t cause sexual side effects. It may also help people quit smoking.
  • Changing your lifestyle: Eating a balanced diet, exercising regularly, quitting smoking, and reducing alcohol intake have been shown to be beneficial for men with ED.
  • Considering natural remedies for ED: Limited evidence suggests that certain herbal supplements may help with ED. These include red ginseng, saffron, and yohimbine. However, it’s important to seek the advice of a healthcare provider before starting any herbal supplements, especially when taking antidepressants or other medications.  Supplements can have interactions with prescription medications. ​​

The bottom line: If you’re on an antidepressant and are experiencing ED or other sexual side effects, it’s probably safe to take Viagra that’s prescribed by a licensed healthcare provider. Ultimately, it’s best to consult your clinician for personalized medical advice on the sexual side effects of antidepressants, your sexual health, and treatment options.

References

  1. Chokka, P. R. & Hankey, J. R. (2018). Assessment and management of sexual dysfunction in the context of depression. Therapeutic Advances in Psychopharmacology, 8(1), 13–23. doi:10.1177/2045125317720642. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761906/ 
  2. Higgins, A., Nash, M., & Lynch, A. M. (2010). Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug, Healthcare and Patient Safety, 2, 141–150. doi:10.2147/DHPS.S7634. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/ 
  3. Jing, E. & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The Mental Health Clinician, 6(4), 191–196. doi:10.9740/mhc.2016.07.191. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29955469/ 
  4. Nurnberg, H. G., Hensley, P. L., Gelenberg, A. J., et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA, 289(1), 56–64. doi:10.1001/jama.289.1.56 Retrieved from https://jamanetwork.com/journals/jama/fullarticle/195700 
  5. Rivasi, G., Rafanelli, M., Mossello, E., et al. (2020). Drug-related orthostatic hypotension: beyond anti-hypertensive medications. Drugs & Aging, 37(10), 725–738. doi:10.1007/s40266-020-00796-5 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524811/ 
  6. Santarsieri, D. & Schwartz, T. L. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs in Context, 4, 212290. doi:10.7573/dic.212290. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630974/ 
  7. Sooriyamoorthy, T. & Leslie, S. W. (2022). Erectile dysfunction. StatPearls. Retrieved June 13, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/ 
  8. US Food and Drug Administration (FDA). (2017). Viagra (sildenafil citrate) tablets for oral use. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/020895s048lbl.pdf 
  9. Wang, S. M., Han, C., Bahk, W. M., et al. (2018). Addressing the side effects of contemporary antidepressant drugs: a comprehensive review. Chonnam Medical Journal, 54(2), 101–112. doi:10.4068/cmj.2018.54.2.101. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29854675/