How to treat sexual dysfunction caused by SSRIs?

Hello doctor,

I am a 36-year-old male who has been dealing with anxiety and depression since my teenage years. I have been on three different SSRIs for the past eight years. Over the past five years, I have been experiencing moderate to severe sexual dysfunction, including issues with libido and orgasm. While Prozac 20 mg helps control my anxiety symptoms, switching medications is challenging due to side effects and insomnia. I have tried Sildenafil and Tadalafil to manage the sexual dysfunction, but they have not improved my libido or orgasms. I also attempted Buspirone in combination with Prozac, but it did not provide long-term relief. My primary concern is finding ways to reduce sexual dysfunction caused by either anxiety or SSRIs. I am currently stable on Prozac 20 mg and occasionally take Klonopin 0.5 mg.

I recently tried adding Buspirone 10 mg twice daily to see if it would help with sexual dysfunction, but it made me very dizzy. Sexual dysfunction has worsened over the past few years to the point where I have minimal sexual desire and difficulty reaching orgasm in my relationship. Sildenafil helps with achieving an erection, but I lack desire and have difficulty orgasming. I initially started Prozac 20 mg more than 15 years ago. At one point, I switched to Venlafaxine 75 mg and later returned to Prozac 20 mg. My sexual dysfunction did not begin when I first started Prozac; it emerged over the past 5-8 years and has been deteriorating. I often avoid intimacy due to the fear of not being able to perform, and my libido is significantly low. My testosterone levels, thyroid levels, blood sugar levels, and blood pressure are all within the normal range. Please help.

Thank you.

Hello doctor,

Thank you for your response.

As I mentioned earlier, tapering off Prozac is quite challenging for me. Within two weeks, I experience withdrawal symptoms that significantly reduce my quality of life. These symptoms make it difficult for me to go to work, and I also suffer from severe insomnia. I am highly sensitive to making any changes to my SSRI medication. Is there a possibility of combining Bupropion with Prozac, or are there any other medications that influence dopamine that can be taken in conjunction with Prozac? I have heard that dopamine may be a potential solution to my situation. Please clarify.

Thank you.