Sex, Love, and SSRIs

Would you rather be miserable and smitten, or serene and passionless? If you're suffering from depression and your doctor has prescribed SSRIs (or serotonin selective reuptake inhibitors) these are your options, according to anthropologist Helen Fisher. Fisher, who has been called the "doyenne of desire," believes that Prozac and other SSRIs are robbing us of our ability to form satisfying romantic relationships.

It's no secret that SSRIs squelch the sex drive. Over the past decade, Prozac's libido-dampening effects have become such a part of the cultural conversation that the issue was even highlighted on Sex in the City. But Fisher's not just talking about sex, she's talking about love. According to her:

Serotonin-enhancing antidepressants (such as Prozac and many others) can jeopardize feelings of romantic love, feelings of attachment to a spouse or partner, one's fertility and one's genetic future.

(World Question Center)

Sound a little alarmist? Well, Fisher's says she's got biological evidence to support her claim.

SSRIs, like Prozac, work in two ways: they increase levels of serotonin, and they limit the activity of dopaminergic pathways--the pipelines that deliver dopamine to different regions of the brain. Scientists still aren't entirely sure why this alleviates depression. But they do know that upping serotonin and curbing dopamine helps to blunt extreme emotions, and prevent the obsessive thinking that is believed to trigger depression. This is the good news.

The bad news is that both of these actions contribute to the suppression of sexual desire. Some people seem to be immune to this effect. Most are not. According to recent reports, 73 percent of SSRI users are libidinally-challenged.

Doctors have been grappling with this problem since the introduction of SSRIs. But most concur that a lack of sexual desire is preferable to debilitating melancholy. If Fisher's right, that may change.

According to Fisher, passion is more than a pleasant byproduct of procreation. Without passion, a woman's ability to choose an appropriate partner is impaired. And long-term relationships are destined to fail. Why? It's all about the orgasm.

Fisher believes that orgasms evolved for two reasons. First, women use orgasms to filter out inappropriate mates.

A woman unconsciously uses orgasms as a way of deciding whether or not a man is good for her. If he's impatient and rough, and she doesn't have an orgasm, she may instinctively feel he's less likely to be a good husband and father.

(Excerpt from Love)

But sex becomes no less important once you've chosen a partner. The second reason the orgasm evolved, according to Fisher, is intensify the feelings of attachment that promote long-term bonding. When couples experience orgasms, they produce "a flood of oxytocin."

In recent years, scientists have become increasingly interested in oxytocin (not to be confused with the much-abused pain killer oxycontin). (DumbCrooks:OxyMorons) We've known for a while that dopamine is responsible for the elation and insanity that accompany falling in love. But the chemical components of long-term love remained somewhat mysterious. Researchers now think that oxytocin holds the key.

In long-term relationships that work . . . oxytocin is believed to be abundant in both partners. In long-term relationships that never get off the ground . . . or that crumble once the [dopamine] high is gone, chances are the couple has not found a way to stimulate or sustain oxytocin production.

(Excerpt from Love)

Orgasms aren't the only way to promote the production of oxytocin. Small amounts of the hormone are released when a mother nurses or "when we hug long-term spouses or children." But when it comes to pair bonding, the orgasm is the single most effective way to increase levels of the lasting-love hormone. And if you're not having satisfying sex with your partner, Fisher says, your chances of sustaining feelings of affection and kinship are severely compromised.

But wait--it gets even worse. According to Fisher, SSRIs also impact your ability to procreate, by increasing levels of serotonin.

Serotonin increases prolactin [and] prolactin can impair fertility by suppressing hypothalamic GnRH release, suppressing pituitary FSH and LH release, and/or suppressing ovarian hormone production. [And] strong serotonin-enhancing antidepressants adversely affect sperm volume and motility.

What does all this mean? If Fisher is correct, it means that if you're taking Prozac to treat your depression, you may end up lonely and childless. But don't despair just yet. Fisher's theory has yet to proven. And her doomsaying is contradicted by a preponderance of evidence. I've known plenty of people who've managed to maintain healthy relationships while taking SSRIs. That said, many of them look forward to a new generation of anti-depressants that don't impair the sex drive.

Be assured, scientists are on the case. Researchers are beginning to hone in on the mechanisms of depression.

Scientists have discovered a protein in the brain called P11 that may explain how drugs like Prozac fight depression . . . The finding, published in the current issue of Science, also could point the way to a new generation of drugs for depression.

(Study Sheds Light on How Depression Drugs Work)

The more we learn about how depression works, the better the chances become of developing a targeted drug with limited side effects.

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Hear Hear , Greek . I agree with what you said.After reading this article , i think i may try to get off Effexor , as my sex drive has disappeared and yes , it is adversely affecting my relationship.We still care for each other but there is that missing element.Also , my emotions are very flattened .I would like to feel stuff !
Thank-you Helen Fisher for researching this important area.Human civilisation is based on human love and if that love is jeopardised by SSRIs then we need to know.

By Annabel hartridge (not verified) on 04 Apr 2009 #permalink

my girlfriend started lexapro and suddenly after about 3 weeks she said she was "no longer in love" with me. we were together for over 7 years, we had problems in the past but our relationship grew stronger with the passing of my mother several months back. after just a few weeks on this drug, the woman that i loved who told me that she loved me every day suddenly grew agitated with things that she once admired. she grew weary of my talkative nature when she had always encouraged me to share with her. she planned her exodus so badly that she had to borrow money from me, get me to ship stuff to where she was going, and give her a ride to an airport that was an hour and a half away because the closer airport didn't have a sooner flight.
she knows that something is up because she messed up the planning to leave me so badly, but she claims that she enjoys the way the pills make her feel, and she says that the "little things built up". i had changed myself for the better because of her, but she said that just made her feel smothered. i could not believe when the woman who told me she loved me every day just weeks before had started to plan leaving me with no discussion, no compromise, and no chance to fix the little and insignificant things that she claims made her want to leave. she refused to see that in leaving, she was actually forcing me to make changes that would have actually fixed some of the problems that she claimed to suddenly have with the relationship. had to get it off my chest!

medication did more harm than good to me. After becoming a widow at 36 and a single mother of two I came to the point that I couldn't take my kids to the park. Taking medication was the only hope.However, the desire of being a woman,have an orgasm, the tremor, the extra sleep during the day, made me change medication again and again. I am not the exception. Speaking to members of a support group I realized I wasn't alone.
Bottom line, if taking medication made me sad but serene the benefit was far from what I wanted. I still depressed and I still a loner.Why not taking the medication? Because now I can have a movie and have an orgasm, I do more Yoga and more happy thinking (this I force on me like a healthy diet),and if I want to forget my depression by sleeping is something I do because I want to not because my pills make my sleepy.
My case shouldn't be taken as an example be any one. Each individual has to see his/her doctor and find the right way for him/her.
I prefer to be alert, have sexual desire and avoid heart problems or tremor similar to Parkinson in the future.Pills is a fix not a solution.