Lexapro and Sex Drive: What Prescribers Try When Libido Drops

Lexapro is working. The dread has eased, you’re sleeping, and you feel more like yourself. But desire has gone quiet, and you’re not sure whether to bring it up or just accept it as the price of feeling better. You don’t have to choose between your mood and your sex life without a conversation first.

Your sexual response has several parts, including desire, arousal, and orgasm, and SSRIs can affect each of them. Lexapro, the brand name for escitalopram, raises serotonin activity between nerve cells, which is thought to be how it eases depression and anxiety. The same effect can dampen desire in some people, and addressing it well takes precision about which part of the response has changed and why.

The standard advice starts with the label. The Lexapro prescribing information tells prescribers to ask about sexual function before treatment and to ask specifically about changes during treatment, because people often don’t report them on their own. It also advises discussing management strategies so patients can make informed decisions. The guidance is sound, and the reasoning behind it is well established.

But “discuss management strategies” leaves the strategies undefined, and at Siggy we think you should know which options have evidence behind them before you walk into that conversation. Some common tips, like shifting your dose to bedtime or skipping pills on weekends, have little or no research supporting them. Others, like adjusting the dose, switching medications, or adding a targeted treatment, have been studied. The difference between those options comes down to evidence, and knowing it can shorten the path back to feeling like yourself in every sense.

What This Page Covers

• The Short Answer
• How Often Lexapro Affects Sex Drive
• Is It the Medication or the Depression
• Does Timing Your Dose Help
• Lowering the Dose
• Switching to a Different Antidepressant
• Adding a Medication or Behavioral Strategy
• Lexapro Libido Options Compared

The Short Answer

Lexapro can lower sex drive, and it’s more common than the label numbers suggest. The first step is figuring out whether the medication, the depression, or both are behind it. From there, prescribers usually consider three evidence-based moves: lowering the dose, switching to an antidepressant with fewer sexual side effects, or adding a treatment that targets the problem.

Two popular workarounds have much weaker support. There’s no evidence that taking Lexapro at a different time of day helps, and weekend drug holidays rest on a few small, short trials. Never stop or skip doses on your own.

How Often Lexapro Affects Sex Drive

In the label’s placebo-controlled trials, decreased libido affected 6% of men on Lexapro versus 2% on placebo, and 3% of women versus 1%. Ejaculation problems, mostly delay, affected 12% of men versus 1%, and difficulty reaching orgasm affected 3% of women versus less than 1%.

Those numbers are almost certainly low. The label itself states that estimates in product labeling are likely to underestimate the actual incidence, partly because patients and doctors are reluctant to discuss sex. When researchers ask directly, rates climb. A 2009 direct-inquiry meta-analysis found escitalopram among the antidepressants with significantly more sexual dysfunction than placebo, with rates across the drugs studied ranging from about 26% to 80%.

Is It the Medication or the Depression

Depression lowers desire on its own. A 2022 clinical review of sexual dysfunction in depression reported that sexual problems are a symptom in roughly 70% of people presenting with major depression, and that treating depression to remission can reduce them.

That’s why timing is the most useful clue. The Lexapro label advises taking a detailed history, including when symptoms started, because sexual changes can come from the underlying condition. If desire faded months before you started Lexapro, depression is a likely contributor. If it dropped soon after starting or after a dose increase, the medication moves higher on the list.

It also helps to name which part of your sexual response changed. Low desire, trouble with arousal or erections, and delayed orgasm can have different causes and different fixes. Other medications, alcohol, hormone changes, and relationship stress can play a part too, and they’re worth mentioning.

Does Timing Your Dose Help

A common tip is to take Lexapro at night or to plan sex around your dose. There’s no research showing that this restores libido. Escitalopram has a half-life of about 27 to 33 hours and reaches steady levels within 7 to 10 days, according to an escitalopram pharmacokinetic review, so blood levels stay fairly steady from one hour to the next. That makes timing tricks unlikely to change much.

Drug holidays are a riskier version of the same idea. In a 1995 drug holiday study of 30 people, stopping an SSRI from Thursday morning to Sunday noon improved sexual function for those taking sertraline or paroxetine but not fluoxetine, the SSRI that lingers longest in the body. Escitalopram wasn’t included, and a 2013 Cochrane review found no randomized trials of drug holidays at the time.

Newer trials add a little more. In a 2024 open-label trial of 50 men taking SSRIs other than fluoxetine, about a third of them on escitalopram, skipping doses two days a week for 8 weeks improved erection and satisfaction scores, though some reported nausea, headache, or restlessness. A 2023 trial in women with the same 8-week design reported gains in desire, arousal, and orgasm. Both trials were small, short, and unblinded, and they pooled several SSRIs, so they don’t show whether a drug holiday is safe or effective for you.

Skipping doses also has a cost. Guidance from the Royal College of Psychiatrists warns that missing medication on some days makes drug levels fluctuate and withdrawal symptoms more likely.

Lowering the Dose

If you take 20 mg, a lower dose may be worth discussing. The Lexapro label reports that a fixed-dose trial showed both 10 mg and 20 mg worked for depression but failed to show a greater benefit of 20 mg. Side effects overall were more common at 20 mg in the label’s fixed-dose trials, and the 2022 review lists dose reduction as one of the main management strategies.

The tradeoff is symptom protection. A lower dose may not hold your mood or anxiety as well, so any reduction should be gradual and monitored. Our guide to adjusting your Lexapro dose explains the patterns prescribers watch for when they make a change.

Switching to a Different Antidepressant

Some antidepressants cause fewer sexual side effects than SSRIs. The CANMAT 2023 guidelines list desvenlafaxine, bupropion, mirtazapine, vilazodone, and vortioxetine among options with lower rates when sexual function is measured systematically. The direct-inquiry meta-analysis found no significant difference from placebo for bupropion and mirtazapine.

One trial tested a switch head to head. In a manufacturer-funded switch trial, adults with sexual side effects on citalopram, paroxetine, or sertraline were switched to vortioxetine or escitalopram for 8 weeks. Sexual function improved in both groups, more with vortioxetine, and both groups kept their antidepressant response. Our comparison of Trintellix vs Lexapro covers that option in more depth.

Switching isn’t risk-free. The new medication may not work as well for you, and the change needs a planned transition to avoid withdrawal. That’s why prescribers often try a simpler adjustment first when Lexapro is otherwise working well.

Adding a Medication or Behavioral Strategy

Adding a treatment lets you keep the benefit of Lexapro while targeting the side effect. The Cochrane review of 23 trials found:

• Bupropion 150 mg twice daily improved sexual function scores compared with placebo, while 150 mg once daily didn’t produce a clear difference in response.
• For men with erectile problems, sildenafil and tadalafil improved erections more than placebo.
• For women, it was uncertain whether sildenafil helped.

A PDE5 inhibitor such as sildenafil helps with erections but doesn’t directly raise desire, so it fits best when arousal is the main issue. Bupropion’s effect is broader but adds a second daily medication. Our comparison of Lexapro vs Wellbutrin explains how bupropion differs.

Behavioral steps have some support too. In a randomized crossover trial of 52 women with antidepressant sexual side effects, exercising right before sexual activity improved desire, and scheduling regular sexual activity improved orgasm function. It was a small study, but the approach is low-risk.

Lexapro Libido Options Compared

The table below summarizes the options discussed above, based on the Lexapro label, the CANMAT guidelines, the Cochrane review, and the trials cited in each section.

Option	What It Targets	Evidence	Main Tradeoff
Lower the dose	Overall drug effect	20 mg no better than 10 mg for depression	Less symptom protection
Switch medication	Drug-specific side effects	Lower rates with several alternatives	Risk of losing response
Add bupropion	Overall sexual function	Benefit at 150 mg twice daily	Adds a second medication
Add sildenafil or tadalafil	Erections in men	Better than placebo	Doesn’t target desire
Exercise before sex	Desire in women	One small crossover trial	Limited evidence
Weekend drug holiday	Brief drug break	Small, short open-label trials	Withdrawal and relapse risk

For more strategies across all SSRIs, see our guide to SSRI sexual side effects.

Sexual side effects are one of the hardest things to bring up, and many people never mention them at all.

Low libido on Lexapro is common, underreported, and often manageable. The most useful first step is naming it, then sorting out whether depression, the medication, or both are driving it. From there, lowering the dose, switching, or adding a targeted treatment all have evidence behind them, while timing tricks have no support and weekend drug holidays rest on small, short trials.

Ready to take control of your mental health? Start your anonymous intake with Siggy and get your plan reviewed by a licensed prescriber.

This article is for education only and isn’t a substitute for personal medical advice. Talk with your own clinician before starting, changing, or stopping any medication. If you have thoughts of harming yourself, call or text 988. If you’re in immediate danger, call 911.