Sex, Love, and SSRIs

From Psychology Today:


Sex, Love, and SSRIs

Can Prozac keep you from falling—and staying—in love? How SSRIs are wreaking havoc on courtship.

By: Orli Van Mourik

Megan and Neil had always been passionate about each other. Shy and unaccustomed to dating, they met on a group outing in high school where they spent the evening flirting. Megan still remembers the feeling of excitement that washed over her the first time they held hands. From that moment on, they "spent as much time together as two kids without driver's licenses can."

As they entered college, they were determined to stay together. But the move away from home was hard on Megan. Painfully homesick, she spent the beginning of her freshman year feeling uprooted, anxious, and disoriented. As the semester wore on, she fell into a deep depression.

Megan went on antidepressants and almost immediately felt steadier and more able to cope. But her relationship with Neil took a turn for the worse. After a few months, her ability to reach orgasm disappeared. Even though she knew that this was likely a side effect of her medication, Megan still couldn't shake the feeling that this was a sign of problems in the relationship. Frustrated, she began to retreat from Neil. Four years of intimacy quickly dissolved, and the couple parted ways.

Megan's experience isn't unusual. Doctors have been grappling with sexual dysfunction since SSRIs (selective serotonin reuptake inhibitors) were introduced in the 1980s. Approximately 70 percent of people taking SSRIs suffer from sexual side effects. But these drugs may also compromise the ability to feel love.

Rutgers University anthropologist Helen Fisher, for one, believes SSRIs are wreaking havoc on human courtship. SSRIs alleviate depression by upping the levels of serotonin in the brain and curbing the production of the neurotransmitter dopamine. Unfortunately, dopamine is also responsible for the feelings of elation and ecstasy that accompany falling in love. By suppressing dopamine, Fisher argues, drugs like Prozac block your ability to have these feelings, thus making it harder to fall in love and stay in love.

This dopamine deficit affects people in a variety of ways, according to Fisher and her research partner, Virginia-based psychiatrist J. Andrew Thomson, Jr. Singles using antidepressants may have a harder time meeting people, because their natural sexual response is dampened. Some researchers believe desire was designed to help people select mates who are genetically suited to them. The spark that ignites on meeting someone new is telling you something: This might be your match. When you miss those signals, your odds of finding an appropriate mate decrease.

Even if you're one of the lucky ones who manage to find love while taking SSRIs, you still have some obstacles to overcome, says Fisher. Like Megan, you may lose the ability to orgasm, and this could cause long-term relationship issues. Orgasms trigger the release of the hormone oxytocin—one that has been linked with pair bonding. Indeed, those who fail to orgasm, thanks to SSRIs, may be at a distinct disadvantage when it comes to mating and bonding.

According to Fisher, the female orgasm is an important survival mechanism—it evolved to help women choose appropriate mates. The theory: If a man is patient and attentive enough to bring a woman to orgasm he's more likely to be a good partner and father. When women can't climax, they lose one of the most reliable means of filtering out unsuitable partners. 

Quote: Brother! One would hope that before "experimenting" to see if he could help her climax a woman would determine a man's suitability, patience, attentiveness, and likelihood of being a good partner and father and would -- through frank conversation, intense observation, and watching how he treats other women in his life -- judge his general concern for her contentment and happiness, his ability to listen, his general attitude toward women, his attitudes toward sex and the body, etc. Jeezaloo, every kindergartner knows that first comes love, then comes marriage, then comes (sex and) the need for a baby carriage.
Not everyone agrees. Biologist Elisabeth Lloyd, author of The Case of the Female Orgasm, counters that orgasms aren't a survival mechanism at all; they're simply a happy accident. "The evidence goes against the idea that [women use] orgasms to assess the reliability of mates," says Lloyd. But Fisher thinks it's just a matter of time before the evolutionary purpose of female orgasms is confirmed. "Orgasm is an extremely powerful experience that people go out of their way to achieve. If it was entirely incidental, it would probably be selected out [by evolution]," she says. 

Quote:I obviously don't buy the evolutionary arguments, and think that God formed women with the ability to orgasm for obvious reasons: sexual desire causes her to long for her husband, and sexual fulfilment causes her to long for him again and to be happy with him. That's how babies get made, that's how couples feel close to one another, and content. And it's why I believe that non-coy, straight-up discussion of sexual matters -- age-appropriate and Catholic -- and an immedicate cessation of the all-too prevalent neo-Gnosticism and this he-boy "rad-trad" nonsense about women as sexless creatures are necessary.
While Fisher recognizes that SSRIs have helped millions of people overcome debilitating depression, she believes that the drugs' benefits must be weighed against their risks. Once viewed as the last resort for people in acute emotional distress, Fisher believes that SSRIs are now being widely over-prescribed. "There are all kinds of people who need these drugs for very good reasons and they should take them," Fisher says. "But that doesn't mean they shouldn't be made aware of the risks." Fisher plans to launch a study examining the long-term impact of SSRIs on mating behavior.


Quote:SSRI's are definitely over-prescribed, but they can be God-sends for those who truly have need. I hope no one feels ashamed for truly needing such a medication. I now take Paxil (again) -- a very low dose at the moment -- and have taken it before. If I were non-Catholic and the type to seriously ponder suicide, I'd be able to say that SSRI's may well have saved my life. But, as this article notes, they have side effects, some quite serious, and should be used only when needed, and with full knowledge. The use of the will in dealing with the side effects is necessary for the patient (and, if such is the case, the patient's spouse).
So what about the people who must remain on SSRIs? For some patients, regaining desire is simply a matter of switching antidepressants. For others, lowering the drug's dosage may help. Also, drug holidays—physician-directed medication hiatuses—have proven effective. Thomson urges patients to be proactive and ask their doctors to work with them to find the right combination of drugs. 
Quote:This is very true about SSRI's! Prozac makes me crazy; Paxil is extremely helpful. But that's just me; everyone is different. Those in true need of such a medication might have to work with their doctors to find the right medicine and the right dose, and might have to adjust those doses over time and such. Sounds like a pain, and it is, but for those who feel like blowing their brains out, it can be well worth the effort.
Megan worked closely with her psychiatrist to find a drug regimen that restored her desire and feelings of connection. She has since met and married a new man. However, her problems have not disappeared entirely. Megan still has moments when she mistakes a lack of sexual desire as an issue in her relationship. She's not alone, says Thomson. "Patients need to know that the sexual side effects can be subtle, or they may blame themselves or their relationship."
Quote:It is here that knowing that love is, ultimately, an act of the will -- which is NOT at all to downplay, as some do, the great importance of the emotional life. We weren't given an emotional nature to simply ignore it all; the feeling of falling and being "in love" is a beautiful thing; it happens to us for good reason, and such intense emotions are used to describe the relationship between Christ and His Church (see the Canticle of Canticles). When a couple have run their situation through their heads and know, intellectually, they are meant for each other and will marry, those feelings should be protected and nurtured. Long live romance!

Yeah, I've been on Paxil for years.  Paxil CR (Controlled Release) seems to have less side-effects.  The original Paxil was bad with side-effects.  And withdrawal from any kind of Paxil is a nightmare.

These are powerful drugs, no doubt about it.  If one needs them, they need them.  But they shouldn't be prescribed like Pez.

For people who never had to take these things (Deo gratias), I'll try to explain.

They're emotional anesthetics in a way.  They take sharp emotions and kind of smooth off the edges.  I've been on the lowest to highest dose at different times.  At the highest does, the house could have caught on fire, and I would be like, "Oh, the house is on fire.  We should get out."

So, at least for me, they don't affect my intellectual response, but they definitely affect the emotional response.  And that's actually what they're supposed to do.  But it isn't selective.  It affects all emotional responses:  fear as well as love.  Depression as well as joy.

In my case, some of my emotional response has been taken over by intellectual response.  Like in the fire example, instead of panicking and fleeing for my life like a normal person, I would have seen the house is on fire and known to get out in order not to die.

I don't doubt that SSRIs can affect relationships, on the other hand, suicide would affect them more.  One has to make tradeoffs in life.

We have emotions (and orgasms) for a reason.  God made us that way.  They are part of being human.  Sometimes we have to suspend those things for the good of us as a whole (like when we have an arm in a sling so it can heal), but any time we suspend something that is integral to us as humans, it affects us throughout our lives, and sometimes in surprising ways.

My $0.02 anyhow.

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