Globus, Mirtazapine and Libido

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I'm a 49 year old male. 18 months ago my doctor suggested I try anti -depressants to control symptons of anxiety. At the time I was feeling quite low and dissillusioned, although I wouldn't say I was depressed. I have had panic attacks over the years since my early teens so I guess I am prone to being at the mercy of my mind despite my best efforts to control it. Panic attacks were not frequent - they seemed to arrive about every 7 years and effect me on and off for a couple of weeks - the first one on each occasion being the worst, which would build gradually and then completely floor me for twenty excruciating minutes before lifting. In recent years though more constant anxiety symptons seemed to have taken the place of the panic attacks. These were numerous - classic and extreme vertigo, nausea, sharp (but not agonising) chest pains, fatigue, heart burn ( for which I have been taking 20 mg of Omeprazole daily for the last 6 years), indigestion and feelings of suffocation. Shortly after a family bereavement I started to suffer from Globus Sensation (the feeling of something trapped or lodged in the throat), and it was only with this that a doctor I was seeing at the time felt that everything I was experiencing was down to anxiety. I was offered councelling - which I accepted - and it helped to a certain degree, but the numerous symptons would always come back. I should say that I am also asthmatic so Globus Sensation and the associated suffocation feeling can make it hard to know exactly what is happening and what is the best remedy. Just the act of breathing becomes the all consuming thought. Also I fully accept that a combination of ashtma and globus can lead to a lot of worry which in itself spirals and the anxiety of that only makes globus worse. Sometimes for up to an hour my mind gets the worst of me and it's only afterward when the globus sensation has lessened that I can look at things more realistically. Because of the globus I decided to try an anti-depressant after my new doctor suggested it. I reinterate that I was not feeling depressed but wanted to get on top of the physical symptoms of anxiety - which increasingly felt like they were ruling my life, making me withdrawn and also rather self possessed. I suppose that was enough to make me feel low - being less connected with friends etc, but I really didn't ever feel like harming myself or anything like that. The first anti-depressant I tried was Sertraline. I had some fairly severe side effects in the first couple of weeks - disorientation, nausea, nightmares, sweats, but it did settle. However after just a few days it created a sexual disfunction in that I could not reach orgasm. I stayed on the drug for about 3 months though. In all that time the sexual disfunction remained. Friends however, did appear to notice an improvement in my mood and my ability to engage with them again. Unfortunately I could not live with the side effect and my doctor said there were other options that were less likely to effect sexual function. After tapering off of Sertraline and a short period without any antidepressant I started Mirtazapine. First at 15mg, moving up to 30 mg after a few weeks. There were no evident side efects. When asked if I felt any positive effects after 3 months I could not honestly say I felt any different. My doctor pointed out though, that I might notice the difference If I stopped. Unsure of this I said I was willing to carry on seeing as I didn't feel that there were any negative effects. I have now been on Mirtazapine for close to a year, I still get globus, the odd chest pain and heart burn (if I neglect the Omeprazole). The problem is, that very gradually I have reallised I have had a loss of libido. With Sertraline the effect was so immediate and frustrating (failing to reach orgasm) that it was very obvious. With Mirtazapine the ability to achieve orgasm is still there, but a slow decline in interest has become increasingly evident. I had wondered if this was just a natural state of affairs for a man approaching 50, so I did see my doctor about this. She assured me that there was no reason that my age should play much if any part in a lack of libido and she suggested a blood test to check on my level of testosterone. The result came back at '9' - low testosterone is considered 1 to 8, normal is considered 9 to 18. So my testosterone is at the low end of normal. I am now being referred to a specialist in male sexual health who will consider whether the Mirtazapine is the cause of my lack of libido. I have never been tested for testosterone before this so I don't know what my level might have been previously, but I'm guessing that as it is something I myself noticed and brought to the attention of my doctor, that my testosterone was higher before. It's not just libido, it's my passion for everything in life feeling less acute. 

I am giving serious consideration to stopping the Mirtazapine for, as stated above, many of the anxiety symptoms remained anyway. My doctor is concerned that coming off of anti-depressants might put me into a more depressed state, or that my anxiety might get the better of me to a far more crippling degree than before. I will wait for the specialists opinion but I am hoping that I can taper off of Mirtazapine without major withdrawal problems - I live alone so I'm a bit worried that if I do have a depressive reaction to coming off of the drug there's nobody around to talk me around or reassure me. If I can come off it without too many problems I think I will still have benefitted from the fact that it may have helped me look at the wider view around the things that cause my anxiety - even if many of the symptoms remained. I have to say though that I have never really found it easy to work out what does cause me anxiety - I always thought I was quite laid back and not up-tight at all and often it's only months after that I can look back and see that things I felt I was coping with were in fact knawing away at me little by little - giving me this now almost constant globus sensation in place of the infrequent but dramatic panic attacks.

I have agreed to try Cognative Behavioural Therapy as an alternative option - although my lack of passion and enthusiasm, and natural cynicism might be a big stumbling block there.

If anyone has experience of lack of libido or a decrease in testosterone through taking Mirtazapine I would be grateful for any further insights. Ie, do you put lack of sexual drive down to depression/anxiety or the antidepressant drug?

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8 Replies

  • Posted

    Hi Daryl,

    I can't speak to the libido issue with mirt,

    I've only been on it for 3 months (and already trying to get off as safe as possible)

    What I do want to pass along though is this:

    A.Your "Total " Tetosterone  levels are only one part

    of the picture.

    B.Did your Dr.take your " Free T" labs as well?

    and  E2 levels?

    These play a huge role in how you feel,your libido,

    and yes,anxiety and depression is a well known symptom

    Of "low"T,and low normal T.

    Also, bear in mind they don't take age into account on Tetosterone levels,they use the same ranges for a 60 year old man as a 20 year old.It's ridiculous.

    That 60 yr. man needs a higher level of Total and free T

    to just to feel normal,and vibrant.

    Your "low normal T" could explain many of your symptoms.

    This is a big discussion in the US now,as men in their

    fifties and beyond with symptoms of Low T are being told they are in "the zone" by their Dr.s claim of them having" low normal T",

    when in fact the patient feels like crap,no libido,

    crying spells,depression and on and on.

    Ask your Dr.about the free T,and E2 levels.

    Research these things,and if your Dr. doesn't know

    ( or care like so many of these docs) get yourself another

    Dr. who is well informed on tye subject.

    Good health to you.

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    • Posted

      Thanks for the prompt reply. I will look into the things you have suggested before my next appointment. The doctor I'm due to see is a specialist in male sexual health (lectures on the subject too) so I'm guessing he should be sympathetic to all the issues that might surround the lack of libido. I do think that Mirtazapine might be the major cause, as it's something I've noticed over the past few months - a time period in which I would say my instances of anxiety have lessened. It probably won't be a simple fix, it seems you need a lot of the same chemicals in your brain for sexual matters as you have with anxiety, so it's either a case of striking a balance or living with, or without, one or the other. Right now, i'm thinking (hoping) that having been on anti-depressants I have a clearer picture of all the aspects of anxiety that can get at me, and that if I can get off of Mirtazapine fairly easily perhaps I can manage without any anti depressants (the last option I have left is Venlafaxine but that seems to have more instances of sexual dysfunction assciated with it than Mirtazapine). I'd certainly rather have a sex life, and generally a passion for life back, even if I have to trade it for the return of vertigo, occasional panic attacks etc. I think that now that I have a better knowledge of how anxiety hits and what it can do to you, I *might* be able to cope with it without drugs. 
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  • Posted

    It's been 3 years since you posted this comment re mertazipine and libido. I am 72 and have been taking mirt for about a year. Starting at 15 mg. Early on I found an improvement in my sex life. My libido was high and orgazmic response fantastic. I was still experiencing major anxiety usually upon waking so asked for a change in dose. Doc uped it to 30 mg and after 3 months at this level I am feeling what can be described as low libido and erectile disfunction. I think I see the connection and would like to know how this worked out for you. 

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  • Posted

    Hi there, I'm a 42 year old male, professional, UK. Broadly similar problems to your own. Was on combination of mirtazapine 15mg and sertraline 150mg for around 18 months. Prior to that, had been on sertraline for 20 years with I would say 50% sexual function affected ie I could manage but never ideal.

    I found adding mirtazapine wiped it out completely. I had zero sexual desire. I just concentrated on my job but my relationship suffered badly. So I came off mirtazapine, stayed on sertraline and randomly got tested for testosterone by GP. It was lowish, about 7. Tested again, about 6.5. Privately got put on testosterone gel and have gradually over 2 years increased to 21 although my endocrinologist now wants to reduce and potentially stop the testosterone gel. In the last week I've gone back on mirtazapine to help with sleep and hey ho, sudden and dramatic plunge to zero sex drive.

    So in my view, it's the mirtazapine which is the culprit.

    Before I write more, can you maybe reply to say how you're getting on?


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    • Posted


      I broke up with my long term girlfriend and life pretty much went into a downward spiral. Depression, couldn't sleep due to over thinking, anxiety due to overthinking and lack of sleep (and for fear of bumping into her in the street etc).

      Tried all the herbal teas I could drink, read all the self help books.  Went to a shrink. Didn't help much, so after a few months I went to the doctors who perscribed me Escitalopramum 10mg and some sleeping tablets three weeks ago.

      Ironically, I met a new girl two weeks after I'd been on the Escit...and despite being able to get an erection no problem, I couldn't orgasm. Of course, I haven't told her I'm on medication, so each time we get down to having sex, then I have increased anxiety because I am worried I can't orgasm!  This in turn is pretty depressing itself! Thinking back, the libido with Escit wasn't too bad, I still felt horny, but maybe not as much sex drive as I had before.

      I went back to my doctor and explained the situation, and she suggested mirt. Said that it wouldn't affect my sex drive or ability to orgasm. She did tell me however that it will increase my appetite for food, so I could put on weight if I didn't control the hunger pangs.

      When I researched mirt (google, Mirt libido), it led me to some conflicting views. Some people say it doesn't affect sex drive or orgasm, and some people (like you) say it does.

      So now I am wondering what do do. I actually stopped taking the Escit for two weeks, because I wanted it to get out of my system, because I wanted to be able to orgasm. Finally I could cum, but at the back of my head is that the depression is still there (despite having a new girl, she's not THE one, and I'm still desperately sad about my previous break up), so I would like to take meds to prop me up.  But I certainly don't want to lose libido and I certainly want to be able to full satisfy whoever I'm sleeping with.

      I'm in a dilemma smile

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    • Posted

      I've taken it for years.  Only depression medication that didn't affect my sex life.  Now it's stopped working for insomnia.  Weaning myself off to try it again in a few weeks but this insomnia is something else.  


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  • Posted


    I have been reading al your information as my husband suffers with anxiety and I need to try and find some answers.  He started off on Amitriptyline 7 years ago, which made him quite aggressive, so went back to the he GP and his meds were changed to Sertraline.  He took these for a number of years and was fine.  He is not a good sleeper and has problems with his teeth and this also sets his anxiety off really bad and he had an infection in one of his teeth which was really bad for his anxiety.  He returned to the doctors and they changed his tablets as they said Sertraline could affect his teeth and he was put on 30mg of Mirtazapine as this would also help him sleep.  He has been on Mirtazapine for about 2 years now and I have noticed his mood has changed dramatically.  He is libido has decreased dramatically, he does not really show and interest in me or us that much, he seems to have closed himself off.  His appetite has increased and he can't seem to control it and still has bad anxiety attacks that make him shake.

    Last week he decided to stop taking his tablets, but did this with immediate effect instead of weaning himself off.  Initially he said he felt stronger as his muscles seem to have gone a lot less, his sexual desire increased and he did not feel as anxious.  This weekend, he said he felt like he had a knot in his stomach and felt very nervous and has now gone back on his tablets.  He says he feels crap all the time, whether he is taking his tablets or not and now he is taking them again his stomach feels bloated.

    From what I have read from you all I think Mirtazapine is having a significant effect on libido and I will definitely mention this to him and get him to ask the GP to do a testosterone test on him.

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  • Posted

    Definitely get you some TRT 600 mgs a week your doctor will only give you 250 not enough 
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