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the sexual downside to antidepressants

by – Kai, lead somatic sexologist

In this blog, I discuss the SEXUAL DOWNSIDE to antidepressants. How these drugs damage our emotional and neurological systems for attachment, bonding, sex drive, romantic love and even reproduction. The effects of these drugs can be dramatic such as relationship breakdown, failure to courtship – date and pair bond. I provide professional and educational information about how antidepressant drugs affect your sexual wellbeing. Discussing antidepressant use with my clients is often deeply personal, surrounded by a sense of shame and embarrassment. So, I have decided to openly discuss and share my personal antidepressant journey/experiences with you.

Antidepressants are used in a variety of medical and psychological situations. There wide use is often hotly debated. Conditions they might be prescribed for include – major depression, PTSD, anxiety and panic disorders, obsessive compulsive disorder, social phobias, eating disorders, Asperger’s, chronic pain situations, premature ejaculation, irritable bowel syndrome, neuropathic pain, snoring, migraine, ADHD, menstrual pain. The science to support antidepressant use for brain chemical imbalance is flawed (not proven) and widely believed amongst the medical and psychological profession (although this is changing see article from Psychology Today here).  The scientific evidence and justification for use of antidepressants in many of these conditions is often poor. Studies are of short duration. Professor Jon Jureidini from The University of Adelaide tells The Guardian that “it’s more reliably predictable that they’re going to get rid of sexual function than it is that they’re going to get rid of depression.” See article here.

Side effects of antidepressants are often under reported due to the short duration of studies and lack of long term follow up (years) post use. It is reported that most people who are prescribed antidepressants will experience one or more sexual side effects. Sexual side effects include emotional blunting,  lack of sexual desire, decreased sexual arousal, diminished or no genital sensation, decreased vaginal and penile lubrication, erectile difficulty, decreased ejaculatory fluid, difficulty achieving orgasm and blunted orgasm.

Dr. Kelly Brogan MD a Manhattan-based holistic psychiatrist highlights the non-sexual side effects/harms antidepressants can haver in her article here. Dr. Brogan particularly pays attention to the fact that these drugs can be habit forming. Coming off these drugs can produce and exacerbate the original physical and emotional components that you may have been experiencing. Stopping these drugs can become overwhelming for many people. They may not have the necessary support to help them through the physical and emotional manifestations. Some people may consider themselves relapsing. Instead the manifestations are most likely due to coming off the drug. In this situation, the person thinks going back on the drug will manage the manifestations, which is true because the drug will aid emotional blunting.  But then they are faced with the side effects again . It becomes a deleterious spiral – thus habit forming. See definition of habit here.

Antidepressants can be effective for some people.  However, its important to recognise the social and psychological side effects of antidepressants in  sexual relationships because these can have profound consequences. Antidepressants effect the ability to feel emotions. Blunting emotions during romantic love suppresses one to obsessively think about the other and limits partnered focussed attention. Yearning and sexual energy is also involved in the motivational drive to attachment with a partner. A decline in sexual energy in long term partners can alter feelings of attachment. Partnered attachment is characterised by things such as grooming, separation anxiety, nesting, being near of each other, sharing, comfort, security, emotional togetherness. Often feeling happy with each other.

“When two people are first together, their hearts are on fire and their passion is very great”. Shostak, 1981 in Fisher and Thompson

Orgasm increases our susceptibility for falling in love. When we stimulate our genitals, and become aroused we increase our levels of the neurotransmitter Dopamine and Noradrenaline. Taking antidepressants effects the ability to initiate sexual activity, feel aroused, and orgasm. When this occurs, you are essentially failing to activate the neurotransmitters in yourself and partner which are linked to romantic love. Orgasm is also essential in the selection of a partner. Those who are unable to take the time to pleasure a partner, become apathetic and impatient from antidepressants will jeopardise the ability for the partner to assess their commitment to/in a long-term relationship.

Antidepressants affect our genitals. If you have a clitoris it may feel dull. The nerves around the vaginal opening may not adequately feel your partner’s penis. The erection width of a penis causes muscles to distend and increases sexual excitement. The clitoris may not feel the subtle pleasure from foreplay. These contribute to the inability to have an orgasm and feel into the sexual experience. I also suspect the glans of the penis which are homologous to the clitoris for some can also feel dull. If you have a penis, your erection is a great indicator of good health (psychological and physical). If you are unable to achieve an erection due to antidepressants you can potentially “cripple courtship functions”. Erections also aid the ejaculation of seminal fluid that contains Dopamine, Noradrenaline, Testosterone, Estrogen, Follicle-Stimulating Hormone, Luteinizing Hormone effecting sexual desire and function. The penis contributes to feelings of romantic attraction and positive mood via these neurotransmitters when semen is deposited via penile-vaginal or penile-anal intercourse, in particular long term relationships.

Antidepressants contribute to low libido. Low libido and the ability to feel into sexual experiences with yourself or a partner increases disinterest. A person on antidepressants may also attribute this disinterest as personality deficits in the potential partner, poorly evaluating and judging the viability of a relationship. Some people on antidepressants can even fail to notice the potential or interested persons. Some people are completely unaware that these drugs are causing their current relationship problems. Our brains and bodies consist of many sexual intricacies that are responsible for pleasure, falling in love, relationships, and selection of partners. Taking antidepressants is likely to alter these complexities and affect an individual’s sexual being, partnerships and wellness.

As a health care professional and sex educator, it is my opinion, that antidepressants can play a short-term role in the acute stages of mental health emergencies. This enables a degree of emotional bluntness until such a time you can discuss your feelings with a mental health professional and are provided with the tools to manage your situation. Long term use of these drugs I feel are dangerous.

I have been personally prescribed antidepressants. I was going through a difficult period in my life where I did not have the personal tools to manage the stress and anxiety I was under. I would like to share with you my lived experience of taking antidepressants for stress and anxiety. Prior to taking these drugs I was somewhat mindful about the side effects. However never really thought they would affect me. Literature suggests that it takes up to a month for these drugs to become truly effective. I would disagree. Taking antidepressants for me led to emotional blunting (mind and body) within around two days. For a brief period, this was useful and helped me manage the emerging and continuing stress I was faced with.

The anti-sexual experiences and sexual side effects included my penis no longer feeling alive.  My genitals went from responsive to just numb, dormant like. The colour of my glans went from perfused pink/purple to white/pale. My glans were no longer sensitive.  Erections were not strong. Often, I could not achieve an erection. I no longer felt sexual within myself. When I did masturbate, it took me longer. I had to be more vigorous to achieve orgasm or I just gave up attempting. When I did achieve an orgasm, it felt like someone putting the brakes on. My orgasm was short, diminished/blunted. I no longer had the afterglow that I got from orgasm. My orgasms prior to antidepressants made me feel elated, and if I had a sexual partner provided me with sense of warmth/ and emotional closeness. I became sexually empathetic with myself. I experienced intense pain in my bone joints and extreme inner restlessness. I often found myself clenching my jaw. I also yawned excessively. Suffered from intense headaches, and was regularly constipated. These things I had never experienced before. These side effects didn’t change even when I tried different antidepressants or doses. Needless to say I don’t take these medications any more.

“My orgasms prior to antidepressants made me feel elated, and if I had a sexual partner provided me with sense of warmth/ and emotional closeness”.

Not only have I experienced these effects in my own body. But I have also had to develop and attempt to maintain relationship(s) where my partner has also been on them, or withdrawing from them. I have seen and experienced first-hand the destruction these drugs have during dating and in my own personal relationships. The long-term effects from these drugs persist with me today. Some days I can feel a sense of akathisia in my body which I feel is a result from these medications.

Not being able to orgasm, experience self-pleasure or partnered pleasure is in fact unhealthy and truly a distressing situation. The sexual side effects of antidepressants can contribute to increase stress, anxiety and further depressive symptoms. If this occurs they can cause further psychological damage, change the brains plasticity towards emotional love and effect relationship development. Sexual pleasure with yourself or partner is one of the most profound bodily experiences we humans can have. Sexual pleasure is the glue that binds our relationships and romantic love. Having an orgasm happens to be an amazing stress relieving tool. To negatively impact this has great consequences for individuals, relationships and society.

We seek pills and potions because we often believe we need a quick fix. When emotions and pain become so overwhelming is it a bad thing? Emotion in society is often frowned upon. Crying, joy, love, ecstasy, sad, upset, angry, overwhelmed are actually not bad for you. In fact, if you didn’t experience these emotions then you would not be human. Our mind and body learns from emotional experiences. Sometimes an emotional experience may require a different set of tools to manage the event that you don’t have. This is when emotions can become daunting, and spiral out of our control. Its important to work with these emotions and learn how to self regulate.

Our sexual experiences can also feel emotionally charged and challenging. Being emotionally erotic with your lover may feel overbearing and frightening. Especially if you have never felt the intensity of erotic connections/love  before. In these situations you may back off from your lover. Feel confused and pull away from a potential relationship. If you have been prescribed antidepressants you may suppress your erotic emotions to create erotic numbness without consciously realising it. Be mindful of antidepressant side effects on your sex life and in your relationships – if your experiencing side effects just know its not you. Be patient and gentle with yourself. Work through any erotic anxiety with someone like myself  and explain what’s happening to your lover.

“If your experiencing side effects just know its not you. Be patient with yourself and explain what’s happening to your lover”.

Did I need to be on these drugs? Or should I have experienced the full force of the emotions I was having? I can tell that I needed a shoulder, and someone to just listen to my experiences. If I feel anxious or distressed now I use mindfulness technique’s including breath work to work through these feelings and self regulate. My advice is –  if you are on or considering antidepressants feel into your body and assess whether you truly need to be on these drugs. If you need to be on antidepressants consider using them until such a time you have found alternatives to  help manage your condition for example bodywork for pain and anxiety, mindfulness and breath work techniques, cognitive behavioural therapy, acupuncture, aromatherapy, exercise – walking clubs, developing explicit communication tools, diet and eating healthy. There are many alternatives. Eventually you will need to confront your erotic being and awaken your body and genitals – you might want to consider talking to myself about this.

Please do not suddenly stop or change your dose of antidepressant medication unless you have discussed this with your medical practitioner. If you suddenly stop antidepressant medication you may feel unpleasant physical/emotional side effects known as discontinuation syndrome. This blog article is not a substitute for your medical practitioner’s advice. Please use the information in this blog article to support a positive and healthy discussion with your medical practitioner.

 

notes

Fisher and Thompson in Evolutionary Cognitive Science have written a comprehensive critique on “Lust, Romance, Attachment: Do the Side Effects of Serotonin-Enhancing Antidepressants Jeopardise Romantic Love, Marriage, and Fertility?” You can find the chapter here. If you are not interested in reading the whole chapter you will find this blog article summarises the main sections.