Sex, depression and antidepressants

Let’s talk about sex, baby. Let’s talk about you and me, let’s talk about – all the ways in which you don’t want to have sex when you’re depressed and/or taking medication, because that ain’t something doctors wanna chat about. 

Ok, so I might be exaggerating. I’m sure some doctors do mention sex when prescribing antidepressants, but let me tell you a story. I was diagnosed with chronic depression when I was sixteen. At that time, I could not have cared less whether the illness was effecting my libido, and I’m pretty certain no one mentioned that to me. Sixteen year old girls are not supposed to be having sex, anyway. And if someone said the word ‘libido’ to me I probably would have cracked up from awkwardness because who the hell says that.

To be honest, I thought for years that “libido” only applied to men.

This post is exclusively about depression and antidepressants and people with female genitalia.

I had/have a complicated relationship to sex, but suffice to say sixteen-year-old me had been facing undiagnosed depression and severe anxiety for several years by that point, and while I had plenty of boyfriends, I hit a wall every time they wanted more.

The first time I heard a doctor mention anything about depression effecting libido (titter) I was eighteen and arguing over whether or not to go on antidepressants.

I didn’t want to. To me, taking ADs meant admitting I had a problem, which I had been steadily ignoring, and more than that, a problem I couldn’t deal with on my own.

Let’s be honest, at eighteen I was fucked. I had finally got to the point where I was ready to try something to help me. When they reeled off the list of side effects of the AD they were considering (I think it was Fluoxetine), and they said something about libido, again as at sixteen, I couldn’t have cared less, because I didn’t have one anyway.

Well, I thought I didn’t. But looking back, I did – and Fluox killed any last vestiges of that.

Full, important disclaimer, which I probably should have put earlier. Depression effects everyone differently. Medication effects everyone differently. 

But this is a blog about how low mood + high anxiety can minus your libido – which women have, because women – wow! – have sexual desires that are completely separate from men’s sexual desires. And this is a blog about how sometimes medication can help this issue, and sometimes it can make it a whole lot worse.

When I am in a depressive episode, the last thing I want to do is have someone else look at or touch my body. It’s not just a lack of physical urges. It’s an actual repulsion, to the point where I can recoil even from something like a non-sexual hug.

When I’m highly anxious, I cannot switch off that part of my brain that’s like a rat on a treadmill. There’s no point even trying to have sex when your brain is like “I need to do this this and this and if I don’t do this, this person is going to hate me and you know what they probably do already anyway, and also I need to do this which I should have done yesterday and oh right I’m supposed to be focused on kissing someone right now.”

When these two things are combined, you know what happens to the body? Let’s just call it the opposite of open.

So, say you’ve got all these things or some of these things going on in your brain, which is why your doctor has talked to you about medication.

My personal stance is this: Doctors don’t tell you shit about what antidepressants (and withdrawal from them) might do to your brain and your life, and they certainly don’t explain to you what they might do to your sexy times.

I’ve been on… five antidepressants now. Most of my friends are or have been on them. Most of them have told me that their desire for sex pretty much curled up and died.

And this is not just a brain chemistry thing going on. This is a literal “I do not get wet” thing. If a woman doesn’t get wet, her brain and her body are not engaged in sex. Her muscles won’t be in their relaxed and ready-to-receive state, to be graphic. And to have sex under those conditions can start a really bad cycle.

One of the main reasons I wanted to write this post is because “loss of libido” on its own might be not considered a huge threat. Especially if, like I’ve said, you’re at the end of it and you need something to help you and you really don’t care if it means you don’t want sex.

But, two things. One: let’s compare the issue of “loss of libido” in women to “erectile dysfunction” in men, because it is essentially comparable. And hey, ok, women can have loss of libido, whatever. But what, erectile dysfuction?!!! warning lights warning lights sirens alarms holy hell!! unacceptable!! make medications to counteract it and make them freely available!! We cannot have the sex lives of men suffering!! See what I mean? This is way more important than it’s made out to be. Women are allowed to want sex. It can and should be considered a medical priority.

Two: let’s look at the mental and emotional consequences for women who lose their libidos. For me, I thought I was broken. In a society that assures me my worth is based on how sexy I am, I had no worth. I didn’t understand why I didn’t want to have sex with men I thought I loved, or even men I just thought were hella cute.

I had several relationships end because of it. And yes, sex is not the be-all and end-all of a relationship and plenty of relationships can be perfectly happy with low levels of or no sex, or can set up other arrangements so everyone’s needs are met. But it is an act that creates intimacy, and intimacy is needed to deepen and progress a relationship. When your partner constantly rejects you, that doesn’t happen. Especially because she doesn’t really know why and thinks she’s probably just fucked in the head.

It’s ten years since I started taking antidepressants and I feel like I have seen the worst that they can possibly do. I have tried a bunch of different types and I have suffered. I have never really found anything that does much beyond keeping me alive (which is why talk therapy is hugely important). However, I have recently started on venlafaxine, and I think it might finally be the one for me.

Again, everyone has different reactions. Low libido is listed as a “common” side effect of venlafaxine. In terms of ADs, it’s kind of a last-ditch effort one because it can be brutal to go on and come off. It has a short half-life and the withdrawal symptoms are brutal. But I was willing to give it a try.

Going onto it was fine. Going up in dose recently was not, so major warning signs around that. And missing a dose? Not something you want to do.

However, I can report that I… am actually interested in sex again. And while that’s not something I feel hugely comfortable sharing with all and sundry, I think it’s important that people who need antidepressants know that this is possible. As with everything, it’s a case of finding the right drug for you.

And knowing that, if you do have low libido – or even more than that, repulsion from sex or fear of etcetera – that it may well be improvable by a medical change (and, again, as I will keep saying – talk therapy. Cannot express this enough).

I hope this has been in some way helpful and information.

I will now go back to awkwardly giggling over the word libido.