Does CBD Affect Sex Drive like SSRI Antidepressant Do (down)?
July 01, 2021
It usually doesn't come up in the 10-minute discussion with your doctor before getting the RX for an SSRI like Prozac, Lexapro, Effexor, and others.
Pretty brutal sex drive side effects.
There's a great number of teens and younger adults who will probably not know what a full sex drive is as a result.
This is occurring during the peak of steroidal hormone production and sex drive which generally hits the highest level between age 18-20.
We'll dive into what drives that drop in sex drive and satisfaction with SSRIs and then we'll look at CBD.
F
Does it do the same thing?
It's important to understand how both affect the key pathway of serotonin.
We'll cover all of this in the following sections:
- SSRI effect on sex drive
- How serotonin governs sex drive
- How CBD affects serotonin
- Does CBD affect sex drive
- It's not just about sex drive
Let's get started!
SSRI's effect on sex drive
Our founder was originally put on Lexapro due to a brutal perimenopause. That story is here.
Within about 1 week, she noticed she had zero sex drive. She felt NOTHING!
Just flat. It wasn't just sex but about everything (food, sleep, etc).
What's sad is the number of teenagers, especially after lockdown, who are being put on SSRIs.
The brain is literally being molded up till about age 25 and this is thrown in the works.
The net effect:
In addition to reducing interest in sex, SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. Some people taking SSRIs aren't able to have an orgasm at all.
https://www.health.harvard.edu/womens-health/when-an-ssri-medication-impacts-your-sex-life
It's even worse harder women:
The most commonly reported adverse sexual effects in women taking antidepressants are problems with sexual desire (72%) and sexual arousal (83%).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711470/
That's a ridiculously high number.
Understanding why it happens really sheds a light on what's going on with SSRIs.
How serotonin governs sex drive
Serotonin is so fascinating.
It's literally the master of all human behavior.
We have a whole review of serotonin here.
Among its many roles, serotonin governs sexual arousal and interest:
Generally speaking, high levels of serotonin (either administered directly into the brain, or as the result of genetic absence of the transporter), inhibit sexual behavior.
- Serotonin is our most powerful neurotransmitter and needs to stay within a range.
- Too high and sex drive/interest/feeling goes down
- Too low and sex drive goes too strong (see CBD and premature ejaculation)
What can we tease out from the effects of SSRIs above?
It mirrors what we already know about SSRIs...most people already have sufficient serotonin!
In fact, it's estimated that SSRIs work for about 30% of the population until it stops working due to tolerance.
We did a giant review of CBD versus SSRIs.
A doctor can't tell you how much serotonin you have in your brain...they guess based on symptoms.
The better estimate is the 30% that they work on.
We also did a deep dive on how SSRIs actually work (hello BDNF) which is critical to read since we can boost that pathway in other ways.
Including CBD.
So...if increasing serotonin like SSRIs reduce sex drive (and just about any other drive), what about CBD?
How CBD affects serotonin
SSRIs push serotonin in one direction...up!
As a result, the body builds tolerance and your natural serotonin function actually goes down.
In fact, the body will start reducing serotonin receptor numbers and sensitivity.
That's the process of tolerance (you need more and more to get the same result).
CBD works in an entirely different way!
It works like a feedback mechanism in general and specifically, with serotonin.
This is the most crucial difference between CBD and SSRIs.
A perfect example of this following injury:
repeated treatment with low-dose CBD induces analgesia predominantly through TRPV1 activation, reduces anxiety through 5-HT1A receptor activation, and rescues impaired 5-HT neurotransmission under neuropathic pain conditions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319597/
We'll walk you through it because it's too interesting.
Basically, after an injury, serotonin gets depleted (it governs pain sensitivity as well).
As a result of this exhaustion, anxiety, pain, and other issues result.
The nervous system doesn't distinguish between physical and psychological pain by the way!
What happens with CBD in this situation?
- Pain goes down
- Anxiety goes down
- Serotonin (5HT) is "rescued"
The most important word there is "rescue". Not boosted indefinitely.
It's still range bound and we see this effect in every pathway we research on CBD.
As a result of this, you don't see a lack of sexual desire or pleasure resulting from CBD use.
Keep in mind that if serotonin goes too high, you can get serotonin syndrome (see CBD and serotonin syndrome).
It's actually very dangerous and occurs in a small percentage of SSRI users.
No recorded cases with CBD at doses up to 1.5 grams (1500 mg) and none of the precursor symptoms (agitation, muscle movement, etc) that signal an issue with elevated serotonin.
What CBD does appear to do is support serotonin when low but not beyond the normal range.
That's the beauty of the endocannabinoid system which CBD works in...it's tasked with balancing other key systems:
- Nervous system - serotonin and other neurotransmitters
- Endocrine system - hormones (estrogen drives serotonin - see estrogen and mental health)
- Immune system - inflammation and cellular birth/death cycles
So..let's cut to the chase.
Does CBD affect sex drive?
There is no research showing an effect of CBD on sex drive in a negative sense.
It does not reduce sex drive, pleasure, or interest in any research.
That's the just start of it.
Let's dig deeper as we like to do here in terms of research.
CBD also has a supportive feedback effect on another critical pathway...anandamide.
Anandamide is one of the two key players in our endocannabinoid system.
It's named after Ananda, the Hindu goddess of bliss.
Okay...that's interesting to our discussion.
Why does this matter?
Results revealed a significant relationship between endocannabinoid concentrations and female sexual arousal,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856894/
That mirrors studies on cannabis itself:
Most women reported increases in sex drive, improvement in orgasm, decrease in pain, but no change in lubrication.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522945/
Why is that?
THC mimics anandamide but too strongly. With regular use, it builds tolerance and the endocannabinoid receptors actually decrease in numbers and sensitivity.
CBD does not build tolerance.
It does, however, support anandamide when low!
Cannabidiol treatment was accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316151/
Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316151/
That's an extreme example of anandamide's effect but here's the kicker for sexual function.
The feeling of orgasm itself is directly tied to our endocannabinoid system:
masturbation to orgasm significantly increased plasma levels of the endocannabinoid 2-AG
https://pubmed.ncbi.nlm.nih.gov/29110806/
2-AG is the other big player alongside anandamide.
We have a massive review of research on CBD and sex drive, orgasm, and more here.
We also looked specifically at CBD and performance anxiety or lasting longer.
We've spent a lot of time looking at sexual function and the role of serotonin.
The decrease in libido and sexual pleasure from too much serotonin with SSRIs is just the tip of the iceberg.
It's not just about sex drive
We mentioned above that serotonin is the master regulator of all human behavior.
There's wild research (we look at some of it here) where serotonin levels lead to very fascinating results.
For example, as serotonin levels go up, a person is less likely to accept a bad offer!
We dovetailed with that into our serotonin and self-esteem review.
Serotonin is directly tied to our social status and how we perceive the "group" to perceive us.
In fact, when primates are elevated to the top, their serotonin levels rise.
Here's why the drop in libido from SSRIs is so concerning.
What else are we tinkering with?
It's really important for serotonin to remain in a given range and if normal sexual function is dropping from SSRIs, it's too high by default.
Here are the symptoms (just some of them) from serotonin syndrome (too much):
- Agitation or restlessness.
- Confusion.
- Rapid heart rate and high blood pressure.
- Dilated pupils.
- Loss of muscle coordination or twitching muscles.
- Muscle rigidity.
- Heavy sweating.
- Diarrhea.
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
Let's focus on the cognitive pieces: agitation and confusion.
It's a feeling of being unsettled...coming out of your skin.
If this gets extreme, it's tied to homicidal and suicidal thoughts (see SSRIs and suicidal thoughts).
The confusion piece is equally interesting.
Essentially, serotonin is a master controller for other neurotransmitters like dopamine.
In effect, it's the maestro for brain function!
SSRIs only push serotonin in one direction (up) and if you're low, that may work until tolerance builds.
We can estimate that's the 30% of patients that have a positive effect initially.
We learned about serotonin syndrome the hard way.
Many other drugs also boost serotonin such as anti-nausea medications.
Lexapro combined with a nausea drug sent our founder reeling (the story is here) leading to a psychotic break.
Leading up to that, she had zero interest in sex, food, or much of anything. Just flat.
In fact, she lost 16 pounds in 1 month. Serotonin is very powerful but it needs to be in a tight range.
CBD supports it when low but doesn't push it up beyond the bounds. There are none of the symptoms in research for elevated serotonin.
Always work with a doctor or naturopath with any supplement!
The information provided here is not intended to treat an illness or substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.