7.04.2006

Sex, Love, and SSRIs

Previously posted on Annotate
March 2006

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. (Excerpt from Love)

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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