Does mirtazapine cause impotence? This antidepressant may impact sexual function, but less often than other drugs. See how it affects male sexuality and learn tips to protect sexual health.
Mirtazapine can cause impotence in some men, yet this side-effect is less common than with many other antidepressants because it does not disrupt serotonin and dopamine balance. Below you’ll find more details on drug-induced impotence.
What is mirtazapine and what is it used for?
Mirtazapine is an antidepressant prescribed to treat major depressive disorder in adults.
Unlike many agents in this class, mirtazapine is **not** an SSRI; it therefore does not raise serotonin levels.
Instead, this atypical antidepressant blocks 5-HT2 and 5-HT3 receptors, preventing serotonin from activating them. This mechanism helps avoid adverse effects such as reduced libido, erectile dysfunction, nausea and vomiting.
Does mirtazapine cause impotence? What do studies say?
Mirtazapine triggers impotence in some men, but studies—including this article—rank it among the antidepressants that least affect sexual function.
The lower impact on sexual function is attributed to its neutral effect on serotonin—excess serotonin often harms male sexuality.
Moreover, mirtazapine boosts noradrenaline and dopamine, neurotransmitters linked to arousal, motivation and reward.
Can mirtazapine worsen pre-existing erectile dysfunction?
Yes—although rare, mirtazapine may aggravate pre-existing ED depending on individual response.
How can mirtazapine affect male sexual health?
Even with a milder profile, mirtazapine can impact sexuality by causing:
- Weight gain—one of its main side-effects—hurting self-esteem and confidence;
- Excessive sedation, lowering energy and sex drive;
- Libido reduction related to weight gain;
- Erectile dysfunction due to sedation and increased weight.
Is antidepressant-related erectile dysfunction reversible?
Drug-induced impotence often subsides within 2–8 weeks of starting treatment.
If no improvement occurs, the prescriber may adjust the dose, switch medication, or refer the patient to a urologist.
Ways to preserve sexual function during treatment
Preventive management—especially in men with previous ED—may include:
- Increasing dosage (lower doses are more sedating and libido-lowering);
- Screening and controlling risk factors (diabetes, hypertension);
- Combination therapy with ED medications;
- Non-pharmacological strategies: psychotherapy and exercise.
The urologist’s role in diagnosing antidepressant-induced ED
A urologist may:
- Order hormone profiles plus blood tests for cholesterol, glucose and cardiac status;
- Work with the psychiatrist to adjust or change the drug and prescribe ED therapy if needed.
When should you see a urologist?
Seek specialist help if:
- ED persists after one month on the antidepressant;
- Pre-existing ED worsens after starting the drug;
- You have risk factors such as sedentary lifestyle, obesity, smoking, hypertension or diabetes.
ED linked to mirtazapine may be reversible, but individual evaluation is essential. Book a pre-consultation and take the first step toward restoring sexual quality of life.
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