Generalized Anxiety Disorder- I’ve been on antidepressants for over 20 years due to severe anxiety

One possibility is Wellbutrin (bupropion). It acts more on the dopamine and norepinephrine systems as opposed to the serotonin system that most antidepressants affect and it is through some of these serotonergic effects that sexual dysfunction arises. Since you mentioned you don’t feel the Lexapro is working anymore, and you have anxiety, I would be cautious about completely doing away with it. One strategy many psychiatrists use is to add bupropion to an SSRI as and adjunct or augmenting agent. The combination can improve different symptoms of both depression as well as anxiety due to the fact that they work on different neuronal targets. I have personal experience with this. I suffered both depression and anxiety and when taking Paxil (paroxetine) along with Wellbutrin (bupropion), I felt much better. The bupropion has a sort of activating effect (but it’s usually not like stimulants that can worsen anxiety). The paroxetine helped my anxiety more than the depression. The bupropion helped the symptoms paroxetine wasn’t helping, such as low motivation, apathy, etc. Bupropion improved those symptoms and I felt like I had more energy (without feeling “keyed up”), and was able to do more and my interest in things improved. Also, to your question, it seemed to at least partially mitigate some of the sexual dysfunction from the SSRI. It’s something to think about and discuss with your doctor. See what they think and if they have used this type of combination with good results. Hope that helps.