Assisted Loving: Tackling depression is a matter of the heart

By Ginger Manley | Posted: Monday February 6, 2012

Dear Ginger,

Can you give me some suggestions about anti-depressant medications and sexuality? Almost everything I have tried seems to interfere with my sex life, but my doctor says I need to stay on the medicine. Having sexual side effects from my medicines is enough to make me depressed even if I weren’t already feeling that way.

George


Hi George,

This is a great question. While the focus in February is on heart health, it is almost impossible to experience heart-felt emotions if one is depressed, and if the treatment for the depression zaps your sex life, then that’s adding insult to injury. But choosing to stop taking prescribed medications is never in a person’s best interest either. So let’s look at the big picture.

Depression is the most common untreated chronic illness in the world, according to the World Health Organization. In the U.S. alone, depression affects more than 26 percent of the population, and about six percent – or one in 17 of us – has severe mental disorders. Many people with depression are “walking wounded” who either have never been diagnosed or treated or cannot afford medications and therapy or who have stopped following their doctor’s plan, against medical advice.

The term depression is commonly used to cover an array of mental health disorders, ranging from an occasional blue mood all the way to a disabling state of emotions. Most of the time when we talk about depression we are referring to the down side of mood, but there is also an opposite side to depression that medical folks call mania. When both ends of the range occur within the same individual, he is said to have bi-polar depression or disorder. Looking at depression through the lens of biology, we know that depression is a brain disorder, one that through modern technology we can document and measure.

Traditionally the symptoms of depressive disorders have been treated through (1) a combination of psychotherapy and counseling, and (2) the prescription of one or more medications. Modern technology is beginning to offer hope for curing some forms of depression. For example, deep brain stimulators are now being used in medical settings, including Vanderbilt Medical Center, to treat some cases of treatment-resistant depression. By pinpointing the exact area of the brain that is affected and applying a recurring burst of electric current, like with a cardiac pacemaker, doctors are now able to offer hope to people whose depression had seemed untreatable.

There are four major health systems involved in regulating our sexuality – the circulatory or blood flow system, the neurological or nervous system, the endocrine or hormone system and the psychological or mental state system. All four of these are closely linked, and a change in any one can cause big changes in any of the others. In the case of depression, one of the first symptoms of the disorder itself is often a change in sexuality (sexual dysfunction).

People who experience depression often have a loss of interest in sex, and additionally they may have difficulty getting aroused, decreased pleasure with sexual activity and sometimes they have changes in climax or orgasm. These same sexual dysfunctions can also develop as a side effect of taking antidepressant drugs, which is one of the main reasons people like you, George, consider stopping or decreasing their prescribed medications. This is a very serious problem, affected more than 50 percent of patients who are prescribed antidepressant medications.

Antidepressant drugs fall into several categories, depending on the way they affect the neurological system. Older drugs were mainly sedatives and hypnotics, while newer drugs target specific neurotransmitters, but they all affect the nervous system, one of the four systems that play a key role in sexuality. When a prescribed medicine, like an SSRI (specific serotonin reuptake inhibitor), interferes with transmission of nerve signals needed for sexual functioning, sexual dysfunction occurs. Some drugs cause more problems than others, and some affect one part of the sexual system, like causing decreased libido or making orgasm difficult or impossible, but not another part. In addition, a drug may play havoc with one person’s sexual functioning and not cause any problems with another person’s. Some of the newer, so-called second and third-generation antidepressant medicines seem to have fewer unwanted sexual side effects. Unfortunately, there have not been many very good alternatives available, although there are some new antidepressant drugs being developed that show promise of relieving the depression while sparing the sexual functioning. Some of these are already being used in other countries but have not yet been approved for use in this country.

The important take-away point to this answer is that each person who needs to be on antidepressant medications should be able to depend on their health-care provider to ask them regularly about any side effects, especially sexual side effects. A recent study of doctor’s visits showed that, unfortunately, only a very few doctors asked their patients such things. George – and everyone reading this who is in George’s shoes – please push this issue with whomever is treating your depression. Don’t stand back and wait for them to ask you – tell them at every visit and, if you are not satisfied with the answers you get, find someone else to treat you. Your sexuality is too important to do otherwise. And please don’t just arbitrarily stop taking your medicines. Your mental health needs appropriate treatment. It’s a matter of the heart.

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