We’ve all seen those ads for prescription drugs—you know, the ones featuring attractive people relaxing in bathtubs and playing on boats, followed by a rapid-fire list of side effects ranging from dry mouth to, you know, death. There are even commercials for drugs that curb the side effects of other drugs. Just because our world doesn’t feel enough like a weird hall of mirrors already.
And these ads certainly seem to be doing the job; people definitely seem to be asking their doctor if drugs are right for them. The Mayo Clinic estimates that, in the United States, 70 percent of the population is on at least one prescription drug. Many of those are for conditions like diabetes, high blood pressure, or yes, erectile dysfunction.
However, close to 20 percent of folks take a drug for psychiatric reasons. Despite advances in research, psychiatric drugs still operate in somewhat mysterious ways. For many people, the key to finding a pharmaceutical solution to a mood disorder is trial and error. You pretty much have to experiment with different combinations and dosages to determine which drug can offer you the most relief while causing the least intrusive side effects.
It’s an imperfect system and one that can be (read: totally is) very frustrating, and this can be especially true for drugs that manage depression: If you do find the right drug, one of the ways it works is to adjust the brain’s use of serotonin and norepinephrine, two of the neurotransmitters that control feelings of alertness and arousal. Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. Locher C, Koechlin H, Zion SR. JAMA psychiatry, 2017, Oct.;74(10):2168-6238. Changing the flow of these hormones in the brain can help regulate mood and thought, as well as reduce overall feelings of exhaustion, frustration, and other negative feelings. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review. Lee Y, Rosenblat JD, Lee J. Journal of affective disorders, 2017, Nov.;227():1573-2517.
Unfortunately, they can also reduce (or completely obliterate) your sex drive and ability to finish the job. And while drug side effects are often viewed as par for the course, when it comes to seeking help for mental health issues, they can feel like making a deal with the devil. In order to get relief from internal chaos, you sometimes end up swapping out a part of life that makes you feel, you know, alive.
Fixing Depression (but Freezing Your Libido)
A 2010 study found that sexual side effects were pretty common and that they had a "significant impact on the person’s quality of life, relationships, mental health, and recovery." Well, sure. When you’re experiencing stuff like a lack of arousal, decreased sensation, decreased pleasure, and absence of orgasm, that probably negatively impacts your quality of life. And around 70 percent of folks taking SSRIs like Prozac and Paxil report some sexual dysfunction.
What, exactly, does that mean?
"Sexual side effects can range from mild to marked," says Dan Goodman, M.D., of The Midtown Practice for Psychotherapy and Psychiatry. On the more mild end, that might look like "a slight decrease in libido, a decrease in arousal, or a delay to orgasm." On the more dramatic side, "this might include more significant and potentially complete loss of interest in sex, an inability to get an erection, or absence of orgasm."
Which means that if you’re on an antidepressant, you can also expect that you may experience at least a mild downturn in your sex drive. This can be frustrating for everybody involved, but what’s even more frustrating is the feeling that there’s nothing to be done about it.
What You Can Do
Sometimes it seems like we have to brush off a low libido as the cost of doing business when on SSRIs. In fact, many people (including doctors) assume it’s what they have to live with, and many psychiatrists don’t think to bring it up until the patient does.
But when a lowered libido is the reason that a person goes off the drugs that are otherwise helping them immensely, this can be a serious issue. As many as 30 percent of patients stop taking their meds, and the "minimization of antidepressant-associated sexual dysfunction could be an important factor in successful treatment and health outcomes." Which basically means that if taking a drug means someone can’t get it on, they probably won’t stay on it. Which... sounds about right.
To avoid patients abandoning treatment altogether, a lot of psychiatrists are willing to work with patients to find, if not a solution, then at least a compromise.
"Sometimes a dose reduction (or brief one or two-day ‘holiday’ from medication) improves the problem, but for other patients, sexual side effects don't remit until the medication is stopped," Goodman says. "Some people with side effects may choose to continue medication anyway, as benefits are sometimes very meaningful and may outweigh the side effects. But weighing the importance of therapeutic benefits against side effects is always a highly personal and individualized decision."
That can be a tall order, though; often, trying numerous doses or different drugs means a lot of office visits, a lot of drug costs, and really good insurance. Many folks don’t have that kind of privilege, and as a result, have to live with the crummy side effects just to limit their overall time and cost commitment. But if you do have the opportunity to change this up, it’s worth getting past the embarrassment and talking to your doctor about trying something new.
Nicole Prause, Ph.D., a sexual psychophysiologist who studies these exact side effects, says the most important thing is to be very frank with your healthcare provider—after all, they’re medical professionals.
"Be straight, be clear," she says. "They know exactly why you are asking, and are used to adjusting for it."
These side effects shouldn’t surprise your doctor, Prause says, and they should be willing to work with you—especially if it means not going off your medication. But there are also cases when doctors may not immediately weigh these consequences.
"There are antidepressants that are specifically designed not to have those effects, but patients may need to make clear that they want those," she says. "For example, bias may cause a doctor to assume an older adult is not concerned with orgasms."
Prause recommends asking your doctor in a straightforward manner what side effects you can expect, and asking candid questions, like "Would you prescribe something that is not going to make it difficult for me to orgasm?"
And Talk With Your Partner Too
Additionally, this is a conversation that people in relationships should consider having with their partners—ideally before going on a new medication. Prause advises that folks "might warn their partner that this is a common effect... and is not an indicator of their skill."
Removing the focus from orgasm can be useful, she says, because for many couples, sex is still enjoyable even without the grand finale.
"It is not unreasonable to ‘practice’ not having an orgasm intentionally before going on antidepressants, as this might help the couple remember that they have been able to make that choice and still enjoy other activities."
The unfortunate reality of sexual health is that often, both in the medical community and among those who are going through treatment, it’s viewed as a nice bonus and not a necessity of life. But if you’re willing and able to fight for your right to orgasm, it can be worth your while.
Hanna Brooks Olsen is a writer and political consultant who also has an exercise habit. She enjoys plant-based proteins and working out in t-shirts with snarky phrases on them. You can follow her on Twitter @mshannabrooks.