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“I had no desire for sex, but I knew he did and that made me feel terrible,” says 25-year-old Nina*, one of the many people to suffer sexual dysfunction as a side effect of antidepressants.
During her first months on antidepressants, Nina was in a relationship. Her boyfriend was understanding of her low sex drive, but it still put a strain on the couple, and it started to take a toll on her.
“I started worrying about how it made my boyfriend feel. I didn’t want him to feel unwanted or undesired, but I really had no attraction to him anymore,” says Nina. “He would do things to try and get me in the mood like massages, nice dinners, extra foreplay, but it didn’t do much.”
Nina admits sometimes she would force herself to initiate sex with her boyfriend, so he didn’t feel like he was the only one doing so. When they broke up, Nina describes it as “almost a relief”.
Last year there were 20.2 million antidepressant drugs prescribed in the UK, according to the NHS. Up to 70 per cent of patients treated with antidepressants experience sexual dysfunction as a side effect, so it’s safe to say Nina is not alone in her experience. When your partner’s not in the same boat, however, navigating this in a relationship can be complicated. So when your desire for intimacy has dwindled, how can you tell your partner it’s not them, it’s antidepressants?
Typically used to treat clinical depression, antidepressants can also be prescribed for anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Selective serotonin reuptake inhibitors (SSRIs) are the most widely prescribed antidepressant. Causing fewer side-effects, they’re usually the preferred option for treatment, but they are one of the types of antidepressants best known for causing sexual dysfunction.
After two years, Nina has decided to slowly come off escitalopram, her current medication and a type of SSRI, and switch to bupropion – a different type of antidepressant, which has the lowest rate of sexual side-effects in antidepressants – in the hope of getting her libido back.
Lowered libido caused by antidepressants is often more than just lack of desire to have sex. It can mean inability to reach orgasm, erectile dysfunction, vaginal dryness, and difficulty ejaculating. These physical side effects can result in psychological ones, too, such as feeling an overwhelming sense of guilt for not being able to perform sexually for your partner, as Nina experienced.
Sex and relationships expert Jessica Staniforth says that guilt surrounding having, or not having, sex is “perspective-based”. “We all feel it in different ways, for different things,” says Staniforth. “However, when it comes to sex, I’ve found that in the majority of cases it comes from the ‘should’ – what, how, when we ‘should’ be having sex. This is a dangerous path, and stems from the cultural and social messages that are inter-dispersed in our modern world without us even being aware of it.”
Thirty-one-year-old Jennifer* is familiar with the feeling of guilt: when it comes to her two-year marriage, she’s experiencing an antidepressant-induced lack of sexual desire. “We have talked a lot about it, and he knows that it’s not him, but rather a result of medication and anxiety,” Jennifer says.
“I feel extremely guilty. I feel like I am a bad partner and that I am constantly letting him down, though he has never said anything to make me feel that way – it all comes from inside my head.”
Although it may be difficult to remember at times, relationships where SSRIs present problems aren’t always destined for the graveyard. After all, relationships revolve around more than just sex, and sex is about willing consent. It’s these key reminders that keep Jennifer and her husband Nick’s* marriage going strong.
“There’s no blame or regret or any kind of animosity towards [Jennifer]. I understand that the diminished libido is a chemical reaction, and not due to a loss of attraction on either of our parts,” says Nick.
From her own experience, pretending to be “in the mood” for the sake of your partner is something Jennifer advises against. “I’ve tried that, and my husband obviously saw right through it. It’s a hard thing to fake,” she says.
Reassurance of sexual attraction in ways other than sex is important for the married couple when it comes to navigating the problems created by low libido. “One thing I’ve always said is that we still have our intimacy in other ways – like cuddling on the couch. We still have touch and that’s important,” says Nick. “As long as we still have that and our communication, I know everything will be okay.”
Communication is also the advice 47-year-old Damon* gives. He began to see the impact on his sex life shortly after being prescribed sertraline, another type of SSRI, to treat PTSD and major depressive disorder (MDD).
“I was worried things would sour in our relationships for sure, but I felt that communication was key,” he says about his long-term marriage to his wife.
Staniforth backs this up, and recommends communicating and planning with your partner when it comes to issues with sex drive. “Plan a sex date,” she says. “Yes, actually sit down with your partner and plan it all out. It can build up tension and excitement.”
The sexual repercussions of sertraline have encouraged Damon and his wife to implement Staniforth’s advice and prioritise their sex life. “I would absolutely recommend making more time in planning sex, giving you more time to explore yourselves and try things you’ve not tried before,” says Damon.
“We introduced toys, which have been amazing. I would tell people that quality is better than quantity. If you normally take one hour for a sensual session, plan for two … Maybe it will take two sessions back to back, two days in a row to reach orgasm. We tried that and [it] worked very well.”
For Damon and his wife, his experience with sexual dysfunction resulting from antidepressants definitely wasn’t the be-all and end-all of their marriage. In fact, it ultimately had a positive effect. “[It] made us just put more effort in our sexual health and relationship,” says Damon. “I would say it changed our relationship for the better overall.”
*Some names in this article have been changed.
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Illustration by Ella Sando