Sex, Love, and SSRIs

Megan and Neil had always been passionate about each other. Shy and unaccustomed to dating, they met on a group outing in high school where they spent the evening flirting. Megan still remembers the feeling of excitement that washed over her the first time they held hands. From that moment on, they "spent as much time together as two kids without driver's licenses can."

As they entered college, they were determined to stay together. But the move away from home was hard on Megan. Painfully homesick, she spent the beginning of her freshman year feeling uprooted, anxious, and disoriented. As the semester wore on, she fell into a deep depression.

Megan went on antidepressants and almost immediately felt steadier and more able to cope. But her relationship with Neil took a turn for the worse. After a few months, her ability to reach orgasm disappeared. Even though she knew that this was likely a side effect of her medication, Megan still couldn't shake the feeling that this was a sign of problems in the relationship. Frustrated, she began to retreat from Neil. Four years of intimacy quickly dissolved, and the couple parted ways.

Megan's experience isn't unusual. Doctors have been grappling with sexual dysfunction since SSRIs (selective serotonin reuptake inhibitors) were introduced in the 1980s. Approximately 70 percent of people taking SSRIs suffer from sexual side effects. But these drugs may also compromise the ability to feel love.

Rutgers University anthropologist Helen Fisher, for one, believes SSRIs are wreaking havoc on human courtship. SSRIs alleviate depression by upping the levels of serotonin in the brain and curbing the production of the neurotransmitter dopamine. Unfortunately, dopamine is also responsible for the feelings of elation and ecstasy that accompany falling in love. By suppressing dopamine, Fisher argues, drugs like Prozac block your ability to have these feelings, thus making it harder to fall in love and stay in love.

This dopamine deficit affects people in a variety of ways, according to Fisher and her research partner, Virginia-based psychiatrist J. Andrew Thomson, Jr. Singles using antidepressants may have a harder time meeting people, because their natural sexual response is dampened. Some researchers believe desire was designed to help people select mates who are genetically suited to them. The spark that ignites on meeting someone new is telling you something: This might be your match. When you miss those signals, your odds of finding an appropriate mate decrease.

Even if you're one of the lucky ones who manage to find love while taking SSRIs, you still have some obstacles to overcome, says Fisher. Like Megan, you may lose the ability to orgasm, and this could cause long-term relationship issues. Orgasms trigger the release of the hormone oxytocin—one that has been linked with pair bonding. Indeed, those who fail to orgasm, thanks to SSRIs, may be at a distinct disadvantage when it comes to mating and bonding.

According to Fisher, the female orgasm is an important survival mechanism—it evolved to help women choose appropriate mates. The theory: If a man is patient and attentive enough to bring a woman to orgasm he's more likely to be a good partner and father. When women can't climax, they lose one of the most reliable means of filtering out unsuitable partners.

Not everyone agrees. Biologist Elisabeth Lloyd, author of The Case of the Female Orgasm, counters that orgasms aren't a survival mechanism at all; they're simply a happy accident. "The evidence goes against the idea that [women use] orgasms to assess the reliability of mates," says Lloyd. But Fisher thinks it's just a matter of time before the evolutionary purpose of female orgasms is confirmed. "Orgasm is an extremely powerful experience that people go out of their way to achieve. If it was entirely incidental, it would probably be selected out [by evolution]," she says.

While Fisher recognizes that SSRIs have helped millions of people overcome debilitating depression, she believes that the drugs' benefits must be weighed against their risks. Once viewed as the last resort for people in acute emotional distress, Fisher believes that SSRIs are now being widely over-prescribed. "There are all kinds of people who need these drugs for very good reasons and they should take them," Fisher says. "But that doesn't mean they shouldn't be made aware of the risks." Fisher plans to launch a study examining the long-term impact of SSRIs on mating behavior.

So what about the people who must remain on SSRIs? For some patients, regaining desire is simply a matter of switching antidepressants. For others, lowering the drug's dosage may help. Also, drug holidays—physician-directed medication hiatuses—have proven effective. Thomson urges patients to be proactive and ask their doctors to work with them to find the right combination of drugs.

Megan worked closely with her psychiatrist to find a drug regimen that restored her desire and feelings of connection. She has since met and married a new man. However, her problems have not disappeared entirely. Megan still has moments when she mistakes a lack of sexual desire as an issue in her relationship. She's not alone, says Thomson. "Patients need to know that the sexual side effects can be subtle, or they may blame themselves or their relationship."