Intimacy & Antidepressants
If you're reading this, you might be one of the 1 in 5 women who experiences depression or anxiety during pregnancy or postpartum. You might be taking an SSRI—or considering whether you should. And if you've noticed changes in your desire for intimacy, your ability to become aroused, or your experience of orgasm, I want you to know two things: you're not imagining it, and you're definitely not alone.
This is a topic that doesn't get talked about nearly enough. We discuss postpartum depression. We discuss the importance of treating mental health conditions during pregnancy. But we rarely have honest conversations about how both our medications AND the postpartum period itself can profoundly affect our intimate lives—and what to do about it.
Mental Health Matters
Let's start with the most important thing: treating your mental health is not optional. Perinatal mood and anxiety disorders affect approximately 15-20% of women, and mental health conditions remain one of the leading causes of maternal mortality in the United States.
If you're struggling with depression or anxiety during pregnancy or postpartum, you deserve treatment. Full stop. Untreated depression doesn't just affect you—it can impact your ability to bond with your baby, attend prenatal appointments, care for yourself, and be present in your relationships.
The American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and major medical organizations all support the use of SSRIs when indicated during pregnancy and postpartum. Robust evidence shows that SSRIs do not increase the risk of major birth defects, and the risks of untreated depression often outweigh the small potential risks of medication.
So if you need an SSRI to function, to care for yourself and your baby, to stay alive—take it. This blog isn't about convincing you to stop your medication. It's about having an honest conversation about side effects so we can work through them together.
The SSRI-Intimacy Connection
Here's the reality that your prescriber may not have explained in detail: SSRIs can significantly impact sexual function. Studies suggest that 40-65% of people taking SSRIs experience some form of sexual side effects. That's not a small number.
Common SSRI-related sexual side effects include:
• Decreased libido (loss of interest in sex)
• Difficulty becoming aroused
• Delayed or absent orgasm (anorgasmia)
• Genital numbness or decreased sensation
• Decreased lubrication
The mechanism involves serotonin's effect on sexual function. While increased serotonin helps regulate mood, it can also interfere with the signals involved in sexual desire, arousal, and orgasm. It's not your imagination. It's neurochemistry.
What makes this even more frustrating? Only about 14% of patients spontaneously report these side effects—but when asked directly, 58% acknowledge experiencing them. Many people suffer in silence, feeling embarrassed or thinking they should just be grateful the medication is helping their depression.
The Perfect PostpartumStorm
Here's where it gets complicated: postpartum bodies are already primed for decreased libido, entirely independent of any medications. You're experiencing a perfect storm of factors:
Hormonal Shifts
After birth, estrogen and progesterone plummet dramatically. If you're breastfeeding, these hormones stay low for months. This hormonal state—sometimes called a "pseudo-menopausal" state—directly impacts:
• Vaginal lubrication (low estrogen = vaginal dryness)
• Libido (testosterone is also lower while breastfeeding)
• Vaginal tissue health and sensitivity
The Prolactin Factor
Prolactin—the hormone that drives milk production—actively suppresses libido. It's high throughout breastfeeding, peaking during and after feeding sessions. Your body is essentially saying, "We just made a baby. Let's not do that again right now." From an evolutionary perspective, this makes sense. From an intimacy perspective, it can be challenging.
Physical Recovery and Touch Saturation
Your body has been through significant physical changes. Whether vaginal birth or cesarean, recovery takes time. Add to this the phenomenon of "touch saturation"—when you've had a baby on your body for hours each day, the last thing you might want is more physical contact. Your need for "intimate touch" may genuinely feel met by breastfeeding, leaving little desire for partner intimacy.
Sleep Deprivation and the Mental Load
Sleep deprivation raises cortisol (the stress hormone), which suppresses desire. The mental load of keeping a tiny human alive, managing household tasks, and possibly returning to work leaves little mental space for sex. Your brain is prioritizing survival, not seduction—and that's actually normal.
When you add SSRI side effects to all of this, it can feel like your sexuality has completely disappeared. But here's what I want you to understand: this is happening to your body, not because of something you're doing wrong.
What You Can Do
The good news is you have options—and you don't have to choose between your mental health and your intimate life. Here's what the research and clinical experience tell us works:
Have the Conversation
First and most importantly: talk to your prescriber. Tell them specifically what you're experiencing. Is it low desire? Difficulty with arousal? Problems reaching orgasm? Each symptom may have different solutions. Your provider can't help if they don't know what's happening.
Medication Adjustments
Several strategies can help reduce SSRI-related sexual side effects:
• Dose adjustment: Sexual side effects are often dose-dependent. A lower dose might preserve benefits while reducing side effects.
• Timing changes: Taking medication at a different time might create a window when side effects are less pronounced.
• Adding bupropion: Wellbutrin (bupropion) works on different neurotransmitters and has been shown to help counter SSRI-induced sexual dysfunction. It's often added as an augmentation strategy.
• Switching medications: Bupropion, mirtazapine, vortioxetine, and vilazodone have lower rates of sexual side effects. If your depression allows, your provider might suggest a switch.
Important note: Never adjust your medication without talking to your prescriber first. Stopping or changing antidepressants abruptly can cause withdrawal symptoms and depression relapse.
New Treatment Options
The landscape of postpartum depression treatment has expanded. Zuranolone (Zurzuvae) was FDA-approved in 2023 specifically for postpartum depression. It works on different receptors than SSRIs (GABA rather than serotonin), has a rapid onset, and a short treatment course of just 14 days. However, it's new, expensive, and breastfeeding must be suspended while taking it. Ask your provider if it might be appropriate for your situation.
Address the Postpartum Factors
Some intimacy challenges are postpartum-related rather than medication-related. These strategies help:
• Lubricant is not optional—it's essential: Low estrogen during breastfeeding causes vaginal dryness. Use a high-quality water-based or silicone-based lubricant liberally. This isn't about being "turned on enough"—it's biology.
• Consider vaginal estrogen: For significant vaginal dryness or discomfort, low-dose vaginal estrogen is safe during breastfeeding and can make a significant difference.
• Prioritize sleep: Sleep deprivation is a major libido killer. Work with your partner to ensure you're getting consolidated rest when possible.
• Pelvic floor physical therapy: If intercourse is painful, pelvic floor PT can address muscle tension, scar tissue, and other postpartum changes affecting comfort and pleasure.
Redefine Intimacy
This might be the most important shift: intimacy doesn't have to mean intercourse. During this season, consider:
• Non-sexual physical affection: cuddling, massage, holding hands
• Sensual but non-goal-oriented touch
• Emotional intimacy: talking, laughing, connecting
• Taking the pressure off orgasm—it's okay if it doesn't happen every time
• Scheduling intimacy (yes, really—it removes the pressure of spontaneous desire)
Research on postpartum sexuality suggests that couples who communicate openly and adjust expectations fare better than those who try to return to "normal" immediately. This is a season, not forever.
For Partners Reading This
If your partner is postpartum and on an SSRI, here's what you need to know:
• This isn't about you. The changes in your partner's desire are hormonal and neurochemical. It doesn't mean they don't love you or find you attractive.
• Don't add pressure. Feeling pressured to perform sexually can make things worse. Be patient and supportive.
• Focus on connection. Find ways to feel close that don't center on sex. Emotional intimacy during this time builds a foundation for physical intimacy to return.
• Be part of the solution. Support your partner's mental health treatment. Take on tasks that reduce their mental load. Help them rest.
• Seek your own support. This is hard for you too. Talk to a therapist or trusted friend—just not in a way that puts more pressure on your partner.
When to Seek Additional Help
Consider reaching out for additional support if:
1. Sexual dysfunction is causing significant distress in your relationship
2. You're considering stopping medication because of side effects
3. Pain during intercourse persists beyond initial healing
4. You're struggling to communicate with your partner about these changes
5. These issues are contributing to worsening mental health
Resources include: pelvic floor physical therapists, sex therapists, couples counselors, and reproductive psychiatrists who specialize in perinatal mental health. You don't have to figure this out alone.
The Bottom Line
If you're postpartum, on an SSRI, and struggling with intimacy—you're experiencing a well-documented, completely understandable combination of factors. The postpartum hormonal state already decreases libido. SSRIs can compound this effect. And the exhaustion, physical recovery, and mental load of new parenthood make it even more complex.
But here's what I want you to take away: you don't have to choose between your mental health and your intimate life. There are options—medication adjustments, additions, switches, and strategies. Talk to your provider. Communicate with your partner. Give yourself grace.
This season is temporary. Your needs matter—all of them. And with the right support, you can navigate both your mental health and your intimate connection.
You deserve to feel better. You deserve to feel connected. You deserve support on both fronts.
Resources
For Mental Health Support:
Postpartum Support International: postpartum.net (Helpline: 1-800-944-4773)
MGH Center for Women's Mental Health: womensmentalhealth.org
For Pelvic Health:
Find a pelvic floor PT: pelvicrehab.com
References
1. ACOG Clinical Practice Guideline No. 5: Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Obstet Gynecol. 2023.
2. Higgins A, et al. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Ther Adv Psychopharmacol. 2010.
3. Lorenz TK, et al. Lower sexual interest in postpartum women: relationship to amygdala activation and intranasal oxytocin. Horm Behav. 2013.
4. Montejo AL, et al. Sexual dysfunction in selective serotonin reuptake inhibitors and potential solutions. Ment Health Clin. 2018.
5. Society for Maternal-Fetal Medicine. Statement on SSRIs and Pregnancy. 2025.
6. La Leche League Canada. Sex, Hormones and Breastfeeding. 2020.
7. Higgins A, et al. Sexual function in breastfeeding women. Breastfeed Med. 2021.
