Sexual Health Q&A

Female Sexual Health HSDD
Is flibanserin (Addyi) safe for women who take antidepressants?

Research suggests that yes, flibanserin is safe for women on antidepressants.

Flibanserin, sometimes known by the brand name Addyi, is a drug used to treat hypoactive sexual desire disorder (HSDD). HSDD is a chronic lack of sexual interest, accompanied by distress, that can’t be easily explained by another medical condition.

Depression is often associated with sexual dysfunction, including HSDD. Sometimes, depression and HSDD influence each other. A woman who feels depressed may lack an interest in sex. At the same time, a woman whose libido is diminished may feel depressed, especially if she enjoyed intimacy with her partner before.

Flibanserin works by adjusting the levels of three neurotransmitters in the brain: dopamine, norepinephrine, and serotonin. Dopamine and norepinephrine are important for maintaining sex drive, but serotonin can lessen it. HSDD is thought to occur when levels of dopamine and norepinephrine are lower than they should be, and serotonin levels are higher. Flibanserin brings these chemicals back into balance to restore sex drive.

Certain drugs for depression, such as selective serotonin reuptake inhibitors (SSRIs – e.g., citalopram, sertraline, and fluoxetine) and serotonin and norepinephrine reuptake inhibitors (SNRIs – e.g., duloxetine and venlafaxine) also work on brain neurotransmitters. Because of these mechanisms, scientists have been studying the interactions of flibanserin, SSRIs, and SNRIs.

In January 2018, the Journal of Sexual Medicine published the results of one such trial. Scientists worked with 111 pre-menopausal women who took either SSRIs or SNRIs. Two thirds of the women were randomly assigned to take flibanserin, and the rest took a placebo. Most women took their prescribed regimen for at least 8 weeks.

Overall, rates of side effects were low. Some were more frequent in the flibanserin group than the placebo group. The most common was dry mouth, which affected 5.5% of the women taking flibanserin and 2.6% of the women on placebo. Other side effects included insomnia, back pain, and dizziness. Side effects were considered mild to moderate. No serious adverse events were reported and none of the women had thoughts of suicide.

In general, women in the flibanserin group were more likely to see improvements in their depression and anxiety symptoms, and women in the placebo group were more likely to have worsening symptoms.

Women who find themselves less interested in sex may consider seeing their doctor. A number of factors can contribute to low sex drive, including illnesses, medications, pregnancy, breastfeeding, menopause, marital discord, and stress. It is helpful to have a complete checkup to try to pinpoint the causes. Some women benefit from seeing a sex therapist to manage HSDD.

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