Anti-Depressants, libido, and the pursuit of balance

Recently, a Facebook memory from five years ago popped up on my feed.

“Who called it ‘taking antidepressants’ and not ‘livin’ libido low low’?”

A niche joke, catering to people who sit in the Venn diagram of consumers of mood stabilisers and Ricky Martin fans, but it resonated.

Seeing this memory reminded me that this medically-caused low sex drive is something I’ve lived with - and made bad jokes about - for a while.

During my 20s, I expected to be ticking off all the usual milestones: “finding myself”, progressing in a career, attending weddings, forming meaningful social connections, getting a dumb tattoo.

Instead, I was hit square in the face with depression and now, at 31, can only confidently tick “dumb tattoo” off my list (a crudely-drawn peace symbol).

Technically, I can tick it off twice if you include the solid outline of a Jack Russell on my forearm, but I digress.

Depression impacts every area of life. At a stage I expected to be getting to know myself, I instead got to know various doctors, psychiatrists, and psychologists.

I became well-acquainted with a list of therapeutic acronyms: CBT, ACT, DBT, TMS, as well as a host of medications: SSRIs, SNRIs, benzodiazepines.

The effects of medication on my personal life

I became one of the roughly 4.3 million Australians accessing prescriptions for mental health medication.

Medication has affected my romantic relationships and sex life just as much as my depression has.

It’s a surprisingly significant change to abruptly have little desire, or ability, to experience physical pleasure. Physical intimacy is one of life’s very few pure joys.

If you struggle with an overly-anxious brain, activities that move you into your body - in a consensual, respectful way of course - are so freeing.

Like exercise, it can help centre the mind and provide a brief moment of respite from the intrusive thoughts or sinking feelings.

It’s important to note that people who don’t have sex - for a variety of reasons - are completely valid and no less human in any way.

But for me, pleasure and intimacy make me feel momentarily alive. Delicate language aside, it’s not revolutionary to declare that sex feels good and is fun.

“Who called it ‘taking antidepressants’ and not ‘livin’ libido low low’?”

I’ve spent so much of my life feeling numbed by depression that it’s frustrating to have this element of me numbed by medication.

Despite my years of therapy, lifestyle changes, and a variety of health-promoting behaviours, depression is always around me.

While I’ve reached a level of acceptance about this, a significant relapse in low mood has caused me to reconsider taking antidepressants once again.

Regardless of your views on prescription drugs, the facts are stark in terms of treatment: I can get a prescription immediately, or wait several months for counselling.

Many people cannot afford therapy at all, even with Medicare rebates. There is also increasing evidence that these medications do in fact work.

There should be no shame in taking medication as part of a treatment plan for depression and anxiety.

Additionally, there should be no shame to discuss the side effects (dry mouth, dizziness, headaches, and of course, changes in sex drive) with your treatment team.

But when I’ve mentioned the loss of libido to my doctors in the past, the most common response is “are you sure it isn’t your low mood causing it?”

While I understand this is true for some, I’ve been managing this illness for over a decade, which means I am very attuned to the subtle changes in my body: mood, appetite, energy, libido.

It is embarrassing enough to bring up this issue with a doctor, and then doubly so to be dismissed.

It leaves me feeling, as I already do most of the time, like an alien. Is it foolish to be unhappy with a side effect if a medication helps improve my life in other ways?

Is it a "beggars can’t be choosers" situation? After all, the promise of a moderately improved mental state is surely worth taking a dint in the sex drive.

Am I just a sex-crazed maniac? And will I ever stop asking myself these questions? (No, no, no, and yes, respectively.)

I spoke to a psychologist, Josh Muller, about these very issues. Josh always discusses medication with their clients, including side effects, or barriers to taking medication.

“My overall views are that psych medication can help for some issues for some people,” they told me.

“Sometimes the usefulness of them is about getting someone stable enough to be able to engage in therapy... sometimes it is about helping their minds, sleep, or concentration work differently, like ADHD. Doctors sometimes forget or avoid talking about the full range of side effects, which is poor informed consent, especially about effects on sex life.”

Although Josh says that traditionally, psychology “overlooks or pathologises sexuality”, they have an interest and passion in this area.

“It’s up to the treatment team to a) bring it up sensitively, and b) create a safe enough environment for the client to talk about it. That's their responsibility as good health practitioners [but] many aren't trained well.”

Finding a therapist that suits you can be a struggle, but they are out there. It’s heartening to be reminded that there are non-judgemental, knowledgeable clinicians who are willing to discuss these issues.

“I talk with clients about focusing on pleasure and sensation, rather than necessarily on orgasms or erections,” Josh says. “Shifting your mindset and expectations on your body (or your partner's) can really change how pleasurable sex is.”

Josh reminded me that there is a difference between desire, attraction and arousal, and I’m left realising I might be putting too much pressure on myself. Intimacy just looks different sometimes, and that’s okay.

Crucially, if you’re planning to adjust your medication in any way - see your doctor. For anyone wanting to discuss side effects, know that you can, and try not to let past negative experiences get in the way (this is a note to self).

“Sometimes it can be easier to raise things via email than face to face,” Josh says. “I'd recommend people advocate for themselves, and believe that they have a right to good health, including sexual wellbeing.”