From: Nicky Molloy 
Subject: SNET:  Antidepressants at the price of their libido
Date: 6 Aug 2000 06:43:13 -0400
To: SNET 

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ANTIDEPRESSANTS HELP MANY PEOPLE RECOVER
THEIR ENTHUSIASM FOR LIFE --
SOMETIMES AT THE PRICE OF THEIR LIBIDO.
http://www.salon.com/july97/sex970717.html

BY LORI LEIBOVICH | melissa Stern* started taking Prozac when she was 18,
after two emergency surgeries left her feeling depressed, fearful and
generally "freaked out." She was also in love at the time, with a man she
had met a year before the onset of her depression. "When I first met my
boyfriend, we were having sex like five times a day," Stern recalls. But
after taking antidepressants, Melissa lost interest in sex. Not only was she
unable to reach orgasm, it was difficult for her to become aroused at all.
After three months, she stopped taking Prozac. "My boyfriend knew me as this
hypersexual nympho girl," says Melissa, now 21 and a graduate student in the
Bay Area. "And I couldn't stand not being sexual."

It is a bitter irony -- and a dirty psychopharmacological trick -- that the
very pills that offer millions of people relief from despair can also
suppress their desire for sex.

"One of my patients said it really well," says Derek Polansky, an associate
in psychiatry at Harvard Medical School and author of the book "Talking
About Sex" (American Psychiatric Association Press). "She said, 'I feel like
I have a velvet glove around my clitoris. My responses, my whole sexual self
is muted.'"

Last year doctors wrote 51 million prescriptions for serotonin reuptake
inhibitors (SSRIs), the most common antidepressant family, which includes
Prozac, Zoloft and Paxil. Sales of the top six SSRIs topped $3.6 billion,
according to IMS America, an organization that tracks the pharmaceutical
industry. SSRIs are a godsend for the estimated 17.6 million people who
suffer from debilitating re-occurring depression in the United States each
year. They alleviate many of depression's most common symptoms -- feelings
of worthlessness, inability to work or conduct relationships, sleeplessness,
weight gain or loss, suicidal tendencies -- without the serious side effects
(blurred vision, sedation, nervousness and weight gain) associated with the
older family of antidepressants, known as tricyclics.

Researchers do not yet understand exactly why SSRIs cause the libido to shut
down. Studies conducted in the early '90s found that sexual dysfunction
affected about 20 percent of Americans taking SSRIs. Now, experts suspect
the numbers are actually quite higher.

"For some people, antidepressants simply 'knock out libido,'" says Andrew
Brotman, chief of psychiatry at Beth Israel-Deaconess Medical Center in
Boston. "I would guess that the incidence of sexual dysfunction is in the
neighborhood of 50 percent if you include decreased desire, decreased
sensuality, etc., and don't just count the inability to have an orgasm."

The sexual side effects of the SSRI users interviewed for this story had
many gradations. Some described feeling generally numb, not only indifferent
to the physical act of sex but also to other sensual acts, such as soaking
in a hot tub, getting or giving a massage or watching a sexy film. Some men
found they simply couldn't get it up -- and if they could, their orgasms
didn't feel as great. Some women said they could get aroused but felt
physically unable to climax.

"During the roughly four months that I took Prozac in 1994, I was
anorgasmic," says Julia, 29, an editor at an academic press near Washington,
D.C. "I didn't lose interest in sex, and I was able to become aroused, but
the floodgates just wouldn't open, even with the most expert masturbation."

One of the most common symptoms of depression is a loss of interest in sex,
according to the National Institute of Mental Health, so the numbing effects
of the SSRIs can, for some people, feel like more of the same. Once the
SSRIs kick in, people are often so grateful to feel like themselves again,
they don't care that their sex drive is diminished.

"There's this great scene in William Styron's memoir 'Darkness Visible'
where his psychiatrist warns him that the medication to treat his severe
depression might decrease his sexual interest," recalls Peter Kramer, author
of the bestselling book "Listening to Prozac." "And Styron thinks to
himself, what a fool. Sex is the farthest thing from my mind."

The loss of libido affects men and women equally, says Adam Keller Ashton, a
clinical sexologist and an assistant clinical professor of psychiatry at
SUNY-Buffalo. In a study to be published this fall in the Journal of Sex and
Marital Therapy, Ashton reveals that while men and women are equally
affected by sexual dysfunction, men complain more. "Women tended to explain
away the problem with excuses," Ashton said, usually blaming it on stress
and other emotional factors.

For some men, SSRIs can have the very desirable side effect of delaying
ejaculation. "When I first went on Prozac, my father, who is a psychiatrist,
told me that me and my partner might actually enjoy the side effects because
I'd be able to last longer," says John, a 30-year-old journalist from
Oakland.

"Antidepressants can make men and woman who are hypersexual feel much more
in control," Kramer says. Indeed, John says his sex drive used to get him
into trouble. He describes himself as an "oversexed youth" and a "chronic
masturbator." But with Prozac, his libido died down, which had good and bad
ramifications.

"Before I took the Prozac, when I would meet a woman I would automatically
think about going to bed with her," he says. "But when I was on the
medication, that was no longer the first thing that came to mind, so that
was good." John stopped taking the medication after four months because he
was feeling better -- and his sex drive had diminished to the point of
interfering with his relationship. "My doctor suggested some other
medications that I could take to counteract the side effects, but I didn't
want my body to turn into chemical soup."

There are several medications -- Wellbutrin (a non SSRI antidepressant),
antihistamines, Yohimbine (made from the bark of an African tree) -- that
can counteract sexual sluggishness. But a person has to be willing to
experiment. Some counteractive medications must be taken several times a
day, others within an hour of sexual activity. "It is very rare that we
can't find an antidote," says Ashton. "It just might take some time to find
it." With so much trial and error, many patients simply give up. Out of 200
SSRI users Ashton surveyed, 15 percent stopped taking the medication solely
because of the sexual side effects.

But since each person brings a range of emotional and psychological baggage
to bed, some SSRI users say it's difficult to discern whether their sexual
appetites waned as a result of medication or other complex factors.

"I don't know if taking medication affected me," says Jarmila, 30, a
freelance journalist in New York City who has been on various
antidepressants for the last four years. "On all of the meds I could orgasm
and usually it didn't even take longer. But then the love of my life had to
move to Eastern Europe and I wasn't sure whether we would be able to be
together and things were uncertain in the relationship, so I didn't want to
have sex with him. I'm not sure that had anything to do with the pills. It
seems like there are complicated reasons -- especially for women --
regarding sex because orgasming for women is so psychological," Jarmila
continues. "Maybe you're not depressed anymore, you're seeing things more
clearly and you realize you don't want to be sleeping with the person you're
sleeping with."

"When I was taking Paxil it was very hard for me to come," says Wyn, 26, a
jewelry saleswoman in New Jersey. "I don't know if this difficulty was
exacerbated by reading about the side effects and knowing that not being
able to come was one of them. Orgasm is so much more mental than physical."

Tina, 30, a new media designer from Knoxville, Tenn., began taking Paxil two
years ago for panic attacks. Though the medication makes her drowsy and she
feels less sexual, it has cured her intense fear of driving and crowds. "I
see taking medication as a compromise," she says. "Sometimes I think about
chasing the next miracle drug -- one that won't diminish my sex drive. But
then I remember that everything doesn't freak me out anymore. This is what
normal people feel all the time."

* All names have been changed for this article.
July 17, 1997

Have antidepressants -- or any other medications -- driven your sex life
into the ground? Join the discussion in Table Talk.

SALON OFFERS A
WEEK'S WORTH OF
SPECIAL FEATURES
ON LEGAL DRUGS.
HERE'S THE LINEUP:
MONDAY, JULY 14, 1997:


IN DRUGS WE TRUST
By Scott Rosenberg
Why do Americans make war on some drugs and build fortunes on others?

TAKE THE PILLS, GUYS
By Andrew Ross
Why do men kill themselves rather than seek help for depression?

TUESDAY, JULY 15, 1997:

FIGHTING THE BIG MONSTER
WITH A LITTLE KNIFE
By Cintra Wilson
Or, adventures with anti-depressants.

GEN RX
A member of the Prozac generation looks back.
By Jenn Shreve

MELATONIN MANIA
By Morris Dye
It helps jet lag -- and more? (In Wanderlust)

WEDNESDAY, JULY 16, 1997:

READIN', RITIN' AND RITALIN
By Arthur Allen
Do psychoactive drugs really help children? (In Mothers)

MEDITATION VS. MEDICATION
By Joan Smith
Some psychological suffering can only be alleviated with chemicals.

THURSDAY, JULY 17, 1997:

>NO SEX PLEASE, WE'RE MEDICATED
By Lori Leibovich
Antidepressants help many people recover their enthusiasm for life --
sometimes at the price of their libido.

FRIDAY, JULY 18, 1997:

THE COFFEE CONNECTION
By Josh Kornbluth
Why take a trip when you can sip?








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