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Just The Tips: My Antidepressants are Killing My Sex Drive

Just The Tips: My Antidepressants are Killing My Sex Drive: © Ikon Images / Corbis

© Ikon Images / Corbis

Dear Katherine,

Here’s my issue. I have struggled with depression on and off throughout my life and recently I’ve started to go on antidepressants. My mood is definitely more stable and I don’t feel that dark pull as strongly. However, my sex drive has definitely taken a dip.

I’m less interested in sex with my partner, and when I do get into it, I’m just not as passionate and have trouble orgasming. It’s distressing and sometimes feels like it’s even worsening my depression. I feel isolated. What’s happening to me? Why does it happen and how do I manage it?

Thanks,

Sexless in Seattle

My Dear,

Once, when I was 21, I went on birth control pills and went nuts. I was with a partner at the time and the idea of physical touch was entirely revolting to me. I cried at the prospect of sex. The very thing that was supposed to help me enjoy sex was impeding it, and yet the medication also revealed an underlying problem, which predated the chemicals I was putting in my system: I hadn’t wanted to have sex with the person I was with for a while.

I recount this personal anecdote for you to illuminate that when it comes to brain chemistry and sexual behavior, boundaries blur.

In his tome The Noonday Demon: An Atlas of Depression, Andrew Solomon writes: “Depression, like sex, remains an unquenchable aura of mystery. It is new every time.” It is with that knowledge firmly in your mind that I endeavor to answer your questions and more.

Solomon wrote his book over the course of five years while struggling with his own depression. He describes the affliction in scientific and poetic detail, calling it, “the flaw in love,” and writing that “when [depression] comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection.” He also describes the often complex relationship between antidepressants and depression. “You can feel…how the medication seems to be poisoning the parasite so that bit by bit it withers away.” When it comes to the nuances of depression, Solomon’s your guy.

He chronicles his own struggle to balance sexual desire and treatment, noting the sexual side effects of his medications: a slightly decreased libido and the problem of much-delayed orgasm. I turn to his work in this area, along with a scientific explanation and my own experience, to help you understand your condition better. We all struggle with what to do when we don’t want to have sex in a way that feels “normal.” As you explore yourself, your depression and your medication, keep that in mind.


Understand What’s Happening

WITH THE CHEMISTRY
Let’s address the basic science behind what’s happening in your brain. As you probably know, when you take antidepressants, they affect your brain chemistry. Very simply put, you’ll have more of certain kinds of neurotransmitters hanging out in your synapses than you might otherwise. Some of these neurotransmitters are connected to your sexual functioning. Whether you’re on SSRIs or Tricyclic Antidepressants, sexual side effects have been connected to an increase in serotonin and decrease in dopamine. Read this excellent article for more information on how the particular antidepressant you’re on might be affecting your brain.

WITH THE SEX
Solomon explains by way of Dr. Anita Clayton of the University of Virginia the four phases of sexual functioning: desire, arousal, orgasm and resolution. He examines how antidepressants influence all four:

Desire: “Is compromised by decreased libido”
Arousal: “Is diminished by inhibited sexual excitement, diminished genital sensation, impotence, or lack of vaginal lubrication.”
Orgasm: Is delayed; some people become totally anorgasmic.
Resolution: “Is of course rather undermined when there has been no desire or arousal or orgasm”

Those are some of the specific symptoms you may be experiencing, and you can be assured that they are real. Understanding your sexuality in multiple phases may help you notice where, specifically, you get hung up.

Finding an Approach

Of course, understanding what’s happening to your body and brain is only half the battle. What else can you do and what else is there to know?

IT MIGHT JUST BE THE DEPRESSION
One of the side effects of depression itself is decreased libido, so you may be experiencing something that would be there, with or without your medication. In this case, gentle acceptance and patience are key.

GOING OFF MEDS
According to Solomon, “taking brief holidays—usually about three days—from drugs achieves occasional positive results.” There are major risks that accompany going on and off medication and it should always be attempted with medical supervision.

SENSUALITY AS ALTERNATIVE
Humans thrive from touch. “Depression is a bodily affliction, and the physical helps,” Solomon says. Sensuality and sexuality are deeply connected. Finding ways to explore one can unlock the other. Invite your partner into situations where you share touch. Keep both of your expectations low when it comes to transitioning into actual coitus—focus on the immediate physical sensation.

YOU ARE STILL YOURSELF
Your sexuality is not a sole result of your depression, nor is it unrelated to your depression. “In trying to separate the depression from the person and the treatment from the person, we deconstruct the person into nothingness,” Solomon writes. This paradox is one we all have to live with, but the more you endeavor to embrace it in your approach to your own sexuality, the less distressing it may feel.

You are more than your sex drive, just as you are more than your depression. I eventually decided to go off the pills that made me feel unsexy. My libido improved but the relationship still ended; I can’t say for sure why. It’s hard to identify causality when it comes to emotion, sex and brain chemistry.

Solomon ends his book with a chapter on hope. Much of it has to do with an understanding that depression—whether ameliorated by medication or not—can breed a kind of intimacy. “You cannot draw a depressed person out of his misery with love…You can sometimes manage to join someone in the place where he resides.” One the biggest mistakes I’ve made when it comes to love, sex and depression, is pretending to be somewhere I’m not. Invite your partner to love you where you reside, and if sex happens there, great. If not, so be it.

xK


Just the Tips is Playboy.com’s weekly advice column with professional matchmaker Katherine Cooper. Have a question for Katherine about sex, love or dating? Shoot her a note at justthetips@playboy.com or follow her @kathkathcoop.


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