I have been on escitalopram (Lexapro) 10mg for two years for generalized anxiety and depression. It has been genuinely life-changing for my mental health, but the sexual side effects have been brutal — almost complete loss of libido and significant difficulty reaching orgasm. My psychiatrist and I discussed switching medications, but escitalopram works so well for my anxiety that I was reluctant.
My psychiatrist mentioned that there was some clinical trial evidence for maca improving SSRI-induced sexual dysfunction and suggested trying it before switching medications. He specifically mentioned a dose-finding study showing that 3g/day was effective while 1.5g/day was not.
I started at 3g/day using capsules (6 x 500mg capsules with meals) because I did not want to deal with the taste of powder. The brand was standardized to 0.6% macamides.
Weeks 1-3: No change in libido. Mild stomach upset during the first week that resolved. I nearly gave up.
Week 4: The first sign was noticing an attractive stranger on the train and having an actual physiological response — something that had been completely absent for over a year. It was such a foreign sensation that I almost did not recognize what was happening.
Weeks 5-8: Libido continued to improve steadily. By week 6, I would describe my sexual desire as having recovered to about 60-70% of pre-SSRI levels. Not back to normal, but the difference between 5% and 65% is the difference between feeling like a fundamental part of your humanity has been deleted and feeling like a person again. Orgasm difficulty also improved, though not as dramatically — still takes longer than pre-SSRI but is at least consistently achievable.
Week 12 and beyond: Effects have stabilized. I would estimate my libido is at about 70% of pre-SSRI levels, which I can absolutely live with given that my anxiety and depression are well-controlled. My psychiatrist was genuinely pleased with the result and has started recommending maca to other patients with SSRI-induced sexual dysfunction.
This combination of escitalopram + maca has given me the best of both worlds — effective anxiety treatment without the devastating sexual side effects. I consider maca essential to my medication regimen at this point.