Let’s Talk About (Depressed) Sex

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What to do when you have trouble maintaining a healthy romantic life while dealing with depression

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For people who have depression, even the most basic activities can seem daunting—and that includes sex. But because both depression and sexual problems are things that are difficult to talk about, even with intimate partners, the issues surrounding having sex while dealing with depression often wind up being ignored. As mental health advocate and writer JoEllen Notte puts it: “It’s the intersection of two taboo topics.” And it can lead to even more problems relating to a person’s mental and physical well-being.

Notte breaks the negative sex experience that comes with depression into two categories: loss of interest and side effects of medication. Notte says about the former: “I tend to reinterpret [it] as ‘everything seems incredibly hard and not worth doing’… Not wanting to be touched, and not wanting to deal with people.” While that applies to people who have depression and both are and aren’t on medication, the side effects specific to medication are a significant problem, too, and include, Notte says, “erectile dysfunction, vaginal dryness, genital numbness, delayed orgasm, and what’s usually referred to as ‘lost libido.'”

This loss of libido is symptomatic of a larger problem of depression: anhedonia, which Dr. Sheila Addison, a licensed marital and family therapist, tells me is “a loss of pleasure in ordinary things.” One of the things people with depression do to combat anhedonia is try to self-medicate and force pleasure, including through sex. Addison explains, “People with depression sometimes wind up chasing ‘peak’ experiences, little bursts of endorphins that seem to cut through the depression for a moment, but it’s a short-term fix for a long-term problem. And if it turns into having sex that they don’t really want, hoping to feel better, it can contribute to feelings of emptiness and self-loathing.”

The best thing to do when dealing with depression is to seek out a doctor, but even if you are comfortable seeking out help for depression, it can be difficult to broach the topic of sexual health, without feeling anxious. As Notte points out, “So many people have had bad experiences with doctors not wanting to deal with [sex] or prioritizing it as a topic.” My own doctor’s flippancy toward the subject was enough to shut me down for months, and it seems like this is all too common, leading to further stigmatization of this sensitive topic. Notte says, “All of the data that says these [sexual] side effects don’t happen is skewed, because people aren’t reporting them.”

Nevertheless, each person I talked to stressed that even though it’s difficult, if you are having issues with sex and experience depression, talk to a doctor first. Addison says that online forums can be the source of “a lot of unsolicited advice, pseudoscientific ‘cures,’ and supposed remedies that will lighten your wallet more than your mood.” And if you find the first doctor to be unsympathetic to your problems, then look for another one.

But how to find the right doctor? Notte recommends looking for keywords like “sex-positive” and “trauma-informed,” as it often means they’ll be more willing to discuss sexual issues or at least be able to point you in the right direction to someone who could. Addison herself is a member of LGBTQ Psychotherapy organization GAYLESTA and listed amongst kink-friendly professionals. These keywords tend to suggest the doctor has a more nuanced, whole-body approach to understanding and treating mental illness, but, of course, it may take a bit of searching to find someone whose methods you are comfortable with.

Once you find a doctor with whom you’re comfortable talking, you can also utilize them when you want to talk with your partner about any problems you might be having with regards to sex. “People often don’t know that you can bring anyone with you to your doctor visit if you want,” Addison points out. “Sometimes it’s easier to have the doctor talk directly to your partner because it’s not so personal.” Addison advises that the partner who isn’t experiencing depression seek care as well, saying, “Get support for yourself, from a therapist or from a group for partners of people with mental illness. Take good care of yourself, physically and emotionally

The main theme here, as with any taboo topics, is that talking about them is key, and the only way to remove the stigma. It’s particularly apt in this situation, though, as conversation, and communication in general, are also at the core of maintaining healthy romantic and sexual relationships no matter what your mental state.

But even though we know we should communicate openly, it can be difficult to get started. That’s why Allison Moon, sex educator and author of Girl Sex 101, recommends beginning conversations with “I statements” when breaching the topic of sexual issues. “It’s easy for people to catastrophize when partners bring up sexual issues, and they may be tempted to take responsibility for the issues of their partners,” Moon says. “It’s a good idea to use extra care when explaining one’s own experience, and be clear that the partner isn’t at fault or causing anything.” When considering the problem as a whole, Notte advises a team mentality for couples. She says, “What happens a lot is it gets treated as an issue of the healthy partner versus the other partner and their depression, and if we can be couples who are working on one team while the depression is on the other team, it’s a much healthier dynamic.”

Moon also recommends “speaking in concretes” when describing the ways depression affects your life and sexual experience to your partner. “Because mental health is so individuated, saying something like, ‘I have depression’ doesn’t always convey what one intends. Instead, I suggest discussing how something like depression manifests in a way the partner can understand. For instance, rather than saying ‘Depression makes me insecure,’ you could say, ‘Sometimes I need extra verbal validation from you. Can you tell me you find me sexy and wonderful? Can you remind me that I’m a good person?'”

Describing symptoms associated with depression can be difficult, though, and Notte often advises individuals to use what she refers to as “accessible” resources (“things that are not scary, that are not medical journals”) to work on coming to a mutual understanding of what you are going through. “Find things that are the language you and your partner speak,” she says; she sends her own partner comic strips and had them play Depression Quest, a role-playing game in which you navigate tasks as a person with depression.

We treat mental health very different than physical health,” Notte points out, adding, “If I were dating somebody and I had diabetes and wanted them to know I’d have to inject myself with insulin at some point, I wouldn’t have to be embarrassed to tell them that.” As with any disease, depression shouldn’t be treated as a liability in dating, and people who would treat it as such are not worth your time. Addison tells me, “Anybody who’s going to make you feel bad or weird about how your body works, does not deserve access to it. Disability rights folks have taught me, don’t apologize for how your body works or feel like you need to make someone else feel okay with you. If they can’t handle you, they can’t get with you.”

But that doesn’t mean it will always be easy—for either of you. So being present with your feelings and communicating them to your partner is vital. Moon says, “When you notice something coming up for you, whether it’s an emotion, a sensation, or a memory, practice giving it attention and letting it give you information.” Perhaps there is a “need attached to the emotion that you can turn into a request,” like needing more lube, or a moment to process your feelings before hooking up, etc. “If you notice that you’re going to cry, for instance, you can mention that so it doesn’t scare your partner,” Moon suggests. “Saying something like, ‘I’m having a great time, but I’m noticing some sadness come up. So if I start to cry, that’s okay, you’re not doing anything wrong. I’ll let you know if I want to stop, but I don’t want to right now.'”

Likewise, Addison recommends acknowledging the experience in the moment in a way that reassures your sexual partner that you don’t blame them for what’s happening. You can do this, she suggests, by saying something like: “This is just a thing my body does sometimes, and I”m not worried about it, so you shouldn’t worry about it either. Thanks for understanding. And I’m really enjoying [kissing you] so let’s do more of that.”

While the physical manifestations of depression in sexual relationships cannot be solved by medication, Notte recommends “workarounds” to address your specific sexual issue. Notte recommends using lubricants and not shying away from toys if experiencing anorgasmia, genital numbness, or erectile dysfunction. Exploring these types of options are especially great for people whose depression-related sexual problems manifest as specifically physical.

While all of this information is important for people with depression, it’s also essential for the partners who don’t have depression to understand how to respond in these situations. Addison tells me the best way is the simplest—nothing more than a “thanks for letting me know.” She explains, “Viewing someone as broken, or suffering, or in need of special treatment, is actually a poor way to approach sexual intimacy. If someone trusts you enough to let you know what’s going on with them, appreciate the gift that has been given to you, and treat it accordingly, with respect. [If your partner says,] ‘I don’t come through intercourse, and I might or might not finish myself off afterward,’ it is not an invitation for you to try to complete the Labors of Hercules to prove what an awesome lover you are. It’s information for you to let you know how this person’s body works, so be grateful that they trusted you enough to share something private with you, and act accordingly.”

And, she points out, “There’s nothing wrong with enjoying your climax when you’re with someone who’s said, ‘I probably won’t get off, but it’s still fun for me.'” Above all, Addison states, “Treat them like the expert on their own body, and you’ll be on the right track.”

Of course, finding people who will do that, especially at the beginning of a relationship or when dating around, can be difficult, but Addison advises to “decide what you’re looking for and what you’re willing to do or not do in order to get it… then screen your dates accordingly.” Finding someone who is comfortable with and respectful of your depression and sexual issues is a trait that can be filtered right in with your usual set of dating criteria. Addison says, “If you say, ‘Hey, I have medication that means I probably won’t come, and I’m looking for a partner who won’t be hung up about it—are you cool with that?’ and they try to inform you about how they’re going to be the one who makes you scream down the rafters, that’s a good reason to swipe left.” After all, she explains, “You can’t fuck somebody out of depression with your Magic Penis or Magic Vagina.”

If you or a loved one are seeking out further information about experiencing the sexual side effects of depression, seek out a psychologist or psychotherapist near you, and remember, as Addison says, “The only people who deserve to get close to you are people who can understand your needs and treat you with appropriate respect and care.”

Complete Article HERE!

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LGB people face higher risk of anxiety, depression, substance abuse

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By Chrissy Sexton

Researchers at Penn State are reporting that individuals who identify as gay, lesbian, or bisexual are at a higher risk for several different health problems. The experts found that sexual minorities were more prone to anxiety and depressive disorders, cardiovascular disease, and drug and alcohol abuse.

Study co-author Cara Rice explained that stress associated with discrimination and prejudice may contribute to these outcomes.

“It’s generally believed that sexual minorities experience increased levels of stress throughout their lives as a result of discrimination, microaggressions, stigma and prejudicial policies,” said Rice. “Those increased stress levels may then result in poor health in a variety of ways, like unhealthy eating or excessive alcohol use.”

Professor Stephanie Lanza said the findings shed light on health risks that have been understudied.

“Discussions about health disparities often focus on the differences between men and women, across racial and ethnic groups, or between people of different socioeconomic backgrounds,” said Professor Lanza. “However, sexual minority groups suffer substantially disproportionate health burdens across a range of outcomes including poor mental health and problematic substance use behaviors.”

It has been previously documented that sexual minorities have an increased risk of substance abuse or anxiety disorders, but Rice said that studies have not yet established whether these health risks remain constant across age.

“As we try to develop programs to prevent these disparities, it would be helpful to know which specific ages we should be targeting,” said Rice. “Are there ages where sexual minorities are more at risk for these health disparities, or are the disparities constant across adulthood?”

The investigation was focused on data from over 30,000 participants in the National Epidemiologic Survey of Alcohol and Related Conditions-III, who were between the ages of 18 and 65. The survey collected information about alcohol, tobacco, and drug use, as well as any history of depression, anxiety, sexually transmitted infections (STIs), or cardiovascular disease.

To analyze the data, the researchers used a method developed at Penn State called time-varying effect modeling.

“Using the time-varying effect model, we revealed specific age periods at which sexual minority adults in the U.S. were more likely to experience various poor health outcomes, even after accounting for one’s sex, race or ethnicity, education level, income, and region of the country in which they reside,” explained Professor Lanza.

Overall, sexual minorities were found to be more likely to experience all of the health outcomes. For example, these individuals had about twice the risk of anxiety, depression, and STIs in the previous year compared to heterosexuals.

The experts also determined that risks for some health problems were higher at different ages. An increased risk for anxiety and depression was highest among sexual minorities in their early twenties, while an increased risk for poor cardiovascular health was higher in their forties and fifties.

“We also observed that odds of substance use disorders remained constant across age for sexual minorities, while in the general population they tend to be concentrated in certain age groups,” said Rice. “We saw that sexual minorities were more likely to have these substance use disorders even in their forties and fifties when we see in the general population that drug use and alcohol use start to taper off.”

Rice said the results of the study could potentially be used to develop programs to help prevent these health problems before they start.

“A necessary first step was to understand how health disparities affecting sexual minorities vary across age,” said Rice. “These findings shed light on periods of adulthood during which intervention programs may have the largest public health impact. Additionally, future studies that examine possible drivers of these age-varying disparities, such as daily experiences of discrimination, will inform the development of intervention content that holds promise to promote health equity for all people.”

The study is published in the journal Annals of Epidemiology.

Complete Article HERE!

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Yes, Depression Can Disrupt Your Sex Life

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— But The Reason Is Not What You Think

By Kelly Gonsalves

When a couple finds themselves in a sexual rut, it can be hard to even pinpoint what got them there in the first place, let alone figure out a way to climb out. Oftentimes it’s a series of accumulated factors that have contributed to a slower or stagnant intimate life—a particularly time-consuming project at work, paired with the kids just entering a challenging new grade level, plus residual tension between the two partners after a recent argument, and then add in any health trouble that might be making physical touch difficult.

One other potentially major exacerbating factor? Mental health.

Depression can lower a person’s libido, both as a symptom of the chemical imbalances present in a depressed person’s brain and as a side effect of certain kinds of treatment. But additionally, a recent study published in the Journal of Social and Personal Relationships suggests there might be another explanation for how depression can disrupt a couple’s sex life: a phenomenon that researchers call interference, which refers to the small but consistent ways being in a relationship can affect someone’s daily life.

“Interference focuses on the ways partners can disrupt day-to-day routines and individual goals. It happens because our relationships have interdependence—our lives overlap with our partners’ lives,” Amy Delaney, Ph.D., a Millikin University assistant communication professor and lead author of the study, tells mbg. “The example I always give my students is my husband putting his socks on the floor instead of in the laundry basket (which is right there). Because our lives are interdependent, when he doesn’t get his laundry in the basket, he’s interfering with my goal of not having dirty socks on the floor.”

Past research has posited that relationship turbulence is triggered by two qualities: relational uncertainty (that is, the degree to which each party feels confident or uncertain about the status of the relationship and each person’s investment in it) and interference from a partner.

All this in mind, Dr. Delaney surveyed 106 different-sex couples where one or both people in the relationship had been diagnosed with depression, asking them about their depressive symptoms, their sexual intimacy challenges, their levels of relational uncertainty, and the ways each partner interfered with the other’s daily life. Her findings? People with more depressive symptoms also tended to report more relational uncertainty and increased perceptions of interference. But it was the latter—perceiving interference from a partner—that predicted sexual intimacy challenges.

In other words, even just one partner’s depression was associated with both partners feeling like their lives were being disrupted by the other person, and feeling this interference was associated with more stress on the couple’s sex life.

“For couples with depression, interference could really damage partners’ connection,” Dr. Delaney explains. “First of all, interference means that couples are having trouble coordinating routines and goals. If two partners aren’t working well together to accomplish their day-to-day goals, they probably won’t feel very connected in a way that allows them to connect sexually. Second, the relational turbulence model says that interference prompts negative emotions, like frustration. If, for example, one partner is dealing with a lot of interference because their spouse won’t take their medication, doesn’t clean up their dishes, and keeps bailing on plans for date night, that is likely to cause some frustration! And if frustration is added to the already negative emotional climate of depression, partners probably have lots of barriers to creating a positive emotionally and physically intimate connection.”

Interestingly, this effect was particularly significant for men with depression: Men with more depressive symptoms perceived more interference, as did their partners. Dr. Delaney’s theory posited in the paper: “Perhaps men notice goal blockages when they are cognitively and emotionally taxed by depression, whereas women perceive interference when their partners are limited by depressive symptoms.”

So why is this all important? Dr. Delaney believes these results highlight the relational effects of depression and the relational causes of intimacy challenges.

“Lots of existing research really dismisses sex problems as either a symptom of the depression or a side effect of treatment,” she says. These two things can definitely be true, but her findings suggest the qualities of the relationship itself can also be important contributing factors. “Sex problems aren’t just a lack of interest or difficulties with physical function; they’re more nuanced than that.”

If you and your partner are currently in a sexual slump and one or both of you struggle with mental health difficulties, it might be worth it for each of you to consider how your behaviors, habits, and lifestyle might be affecting the other’s day-to-day life and energy. The effects of mental health difficulties, particularly depression, will not be solved over the course of one conversation, but just opening up that dialogue can be a good way to begin working toward improving your life together and minimizing the feelings of tension, disruption, and discordance between you.

“Approach rather than avoid,” writes sex therapist Jessa Zimmerman at mbg. “I recommend that you come from a positive place, making it clear that you’re interested in creating your best possible relationship. Express how you’ve been feeling about the cycle you’re in and specifically acknowledge your own contribution, in thought and in deed, to keeping the two of you stuck.”

Difficulties in the bedroom can indeed be one step in a frustrating cycle—life’s struggles lead to less sexual energy and less sex, less sex can create turbulence in your relationship, and relationship turbulence just adds to more overall struggles, and then the cycle just spirals on and on. Having a healthy and satisfying sex life, on the other hand, can actually improve your mental health and your overall relationship well-being. That’s an equal and opposite kind of cycle, one with so many ongoing positive benefits that it’s certainly worth trying to set it in motion.

Complete Article HERE!

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Men, like women, can have post-sex blues

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By Cheryl Platzman Weinstock

After sex, men can sometimes experience a myriad of confusing negative feelings, a phenomenon called post-coital dysphoria (PCD), which can interfere with relationships, researchers say.

The research team analyzed responses from over 1,200 men to an anonymous international online survey that asked whether they had ever experienced symptoms of PCD, which can include tearfulness, sadness or irritability following otherwise satisfactory consensual sex.

The men, aged between 18 and 81 years, were primarily in Australia and the U.S., but the sample also included men in the UK, Russia, New Zealand, Germany and 72 other countries.

The study team, led by Joel Maczkowiack, a master’s student at Queensland University of Technology in Brisbane, Australia, found that 41 percent of the men reported having experienced PCD in their lifetime, with 20 percent saying they had experienced it in the previous four weeks. Between 3 percent and 4 percent of the men reported experiencing PCD on a regular basis.

“I would like to think that this study will help males (and females) reflect on their experience of sex, as well as encourage communication between partners about their experience,” Maczkowiack told Reuters Health by email.

“In addition, we hope that this type of research will help people whose experience of sex is dysphoric (or dysphoric at times) to know that they are not the only ones who feel this way. In this sense, we hope this study normalizes a variety of human experiences following sex,” he said.

Past research has found that PCD is common among women. This is the first time it has been documented in men, Maczkowiack said.

PCD can occur despite satisfying and enjoyable sex. One man in the study reported that PCD made him feel “self-loathing.” Another reported, “I feel a lot of shame.” One participant said, “I usually have crying fits and full on depressive episodes following coitus that leave my significant other worried . . . .”

The study, published in the Journal of Sex and Marital Therapy, found that PCD may be related to previous and current psychological distress and past abuse, including sexual, emotional and physical abuse in childhood and adulthood.

Emotional abuse was the most common form of abuse reported by the men both before and after age 16, researchers found. Sexual abuse in childhood was reported by 12.7 percent of the men and sexual abuse in adulthood was reported by 3.5 percent of the men. Their most common reported mental health concern was depression (36.9 percent), followed by anxiety (32.5 percent) and bipolar disorder (3 percent).

Current psychological distress was the strongest variable associated with lifetime and four-week PCD. Higher levels of psychological distress were more strongly associated with PCD.

The data for this study was collected from February to June 2017 and drawn from a larger questionnaire that examined the post-coital experience of men and women.

“While this research is interesting, the study of PCD needs psychometrically valid instruments, said Rory Reid, an assistant professor of psychiatry and research psychologist at the University of California, Los Angeles, who was not involved in the study.

The study used a few questions to measure PCD, but there is ambiguity in those items, Reid said in a phone interview. “They lack precision and there was no specificity about frequency in responses as to exactly how often was ‘a little’ or ‘some of the time’,” he noted.

“Future studies of PCD need to utilize qualitative approaches where participants are interviewed about their PCD experiences so we can further understand this phenomenon, why people might experience it, the extent to which it is causing individuals psychological distress, and whether it is negatively impacting their romantic relationship,” Reid added.

One of limitations of the study was that the men self-reported their emotional response to previous sexual experiences. “This information can be difficult for participants to recall,” Maczkowiack, said.

“The findings of this study could influence marital therapy by normalizing different responses. In addition, it may open up communication between partners,” he said.

Complete Article HERE!

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Do You Have Sexual Side Effects From Antidepressants You Stopped Taking?

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From low libido to erectile dysfunction, some people report suffering from enduring sexual problems.

From low libido to erectile dysfunction, some people report suffering from enduring sexual problems.

By Michael O. Schroeder

Antidepressants are widely prescribed, commonly used for depression and recommended to treat a range of other issues, from anxiety disorders to pain. But the medications aren’t without risk – and some potentially serious side effects start, or continue, after a person has stopped taking them.

These effects vary by the individual and the drug, but for the most commonly prescribed antidepressants – selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SSNIs – side effects, or adverse events reported by patients, range from headache, nausea and fatigue to paresthesia, or an abnormal sensation that can feel, to some, like electrical shocks, to insomnia to seizures. And though less widely recognized, some patients also report another enduring effect of SSRIs and SSNIs: sexual dysfunction.

To be sure, sexual side effects ranging from lower libido to erectile dysfunction are known and detailed in drug labeling information. But though online support groups have cropped up for people who experience persistent sexual dysfunction after going off antidepressants – post-SSRI sexual dysfunction, or PSSD – it’s not clear how common the concern is.

However, one recent paper co-authored by researchers linked with an independent drug safety website RxISK.org that collects reports of side effects – including after people stop medications – recently reported on 300 cases of enduring sexual dysfunction. These were reported by people from around the world who were taking SSRIs, SSNIs and tricyclic antidepressants, as well as drugs called 5α-reductase inhibitors and isotretinoin. which are used to treat male hair loss (baldness) and benign (non-cancerous) prostate enlargement, and acne respectively. Reports by patients who’d taken 5α-reductase inhibitors and isotretinoin to RxISK of enduring problems with sexual function after stopping these medications appeared to have similar characteristics to those related to antidepressants, notes co-author Dr. Dee Mangin, the David Braley and Nancy Gordon Chair in Family Medicine at McMaster University in Hamilton, Ontario, and chief medical officer for RxISK.org.

“We were really looking at sexual dysfunction both on and after taking medication, because some of the reports we were getting were suggesting that sexual dysfunction, which is a known side effect of a number of drugs, seemed to be persisting once the drugs were stopped,” Mangin says.

As noted in the paper published in the International Journal of Risk & Safety in Medicine, there have been limited references to the potential for such issues to occur after patients stopped antidepressants. In the U.S., the product information for Prozac (fluoxetine) – the oldest of the SSRIs – was updated in 2011 to warn, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.” What’s more, the authors noted, “The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, states that ‘In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.'”

But the authors go further in detailing reports of enduring sexual dysfunction such as the onset of premature ejaculation and persistent genital arousal disorder (whereby a person becomes aroused without any stimulation) as well as losing genital sensation, or genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. “Secondary consequences included relationship breakdown and impaired quality of life,” the authors note.

The individuals weren’t independently evaluated before, during or after taking the medication, and more study is needed. Still, Mangin asserts, “The study provides the strong signal that there is a group of people who seem to experience enduring side effects that affect their sexual function after they’ve stopped taking the drug.”

Experts say just as patients should never stop antidepressants abruptly, or without consulting with their provider – since doing so is known to increase side effect risk and worsen those effects – patient and provider should discuss any adverse effects that start or continue after stopping a medication.

Dr. Eliza Menninger, who directs a behavioral health program at McLean Hospital in Boston, says she hasn’t heard from patients voicing serious concerns about sexual side effects after stopping their medication. For the most part, sexual side effects seem to go away after patients stop taking the medication, Menninger says. “Some will indicate it’s still an issue, but they don’t seem as bothered by it – and I don’t know if it’s as bad an issue as when they were on the SSRI,” she says.

However, clinicians say, it would be helpful to have more clarity on the issue – including how likely it may be that patients could experience enduring sexual side effects. In part due to the sensitive nature of sexual complaints, experts point out, these effects often go unacknowledged in patient-provider conversations.

One problem is that sexual side effects aren’t tracked in a systematic way like other drug side effects – even though they can be severely damaging to intimate relationships and undermine a person’s overall quality of life and well-being. “There’s no requirement, for example, for drug companies to track sexual side effects. They’re not considered serious adverse events, although the potential for them to continue post-medication I would consider extremely serious – even a disability,” says Audrey Bahrick, staff psychologist at the University of Iowa’s counseling service.

Bahrick recently signed onto a petition, along with Mangin and others who’ve researched enduring sexual side effects, asking the U.S. Food and Drug Administration and other regulatory bodies to require makers of SSRIs and SSNIs to update drug labeling to warn that such legacy effects can occur and continue for years or even indefinitely.

Sandy Walsh, a spokesperson for the FDA, said it would review the petition and respond to the petitioner, but declined to comment further regarding the petition. Drugmakers who responded to a request for comment say they work closely with regulatory agencies to keep information updated.

Mads Kronborg, a spokesman for pharmaceutical firm Lundbeck, notes that summary production information for its SSRIs, citalopram (Celexa) and escitalopram (Lexapro), “already states that side effects can occur upon discontinuation, and that such side effects may be severe and prolonged.” Specifically, it’s stated that “generally these events are mild to moderate and are self-limiting, however, in some patients they may be severe and/or prolonged.” The side effects listed for citalopram and escitalopram “include sexual side effects,” he says, though he adds that sexual side effects are not among the most commonly reported reactions to discontinuation. “So information about potential enduring side effects is actually already included.”

But the petition asserts drug companies aren’t going far enough to acknowledge these concerns.

Bahrick says though the prevalence of enduring sexual side effects remains unknown, “My own impression clinically is that it’s not at all uncommon, and that it can range from subtle – not returning to sexual baseline – to really a complete sexual anesthesia, where a person who has been without any significant sexual problems prior to taking the medication might be rendered unable to experience sexual pleasure, unable to have sensation in the genitals, having orgasms that are not associated with pleasure,” she says. “These are clearly, I think, drug effects. [Issues] like genital anaesthesia and pleasureless orgasm – these are not symptoms that are associated with any sexual problems, say, that are commonly associated with depression. We can see these as legacy effects of the SSRIs.”

In the absence of prevalence data, clinicians continue to debate the potential extent of enduring sexual side effects for those who have stopped antidepressants. Some worry about unnecessarily scaring patients away from antidepressants who may benefit from taking the drugs.

“These medications are used to treat symptoms of illnesses that are potentially quite debilitating and can be lethal, so while I want to encourage a discussion of side effects, the intent is to use medications to help improve significant symptoms,” Menninger says. She points out, as the petition notes, that to date no prospective studies have been done assessing sexual dysfunction prior to SSRI and then during and after SSRI use. Though certainly side effects are real and concerning, she says, “there is clinical evidence the medications make a significant difference in helping [and/or] saving a life.” That’s something some clinicians emphasize shouldn’t get lost in the discussion.

But Bahrick says for patients, not having information that these effects may occur undermines their ability to make a fully informed decision when deciding to go on antidepressants, and deciding whether to try alternative treatment options first. “It’s so important to get this information out there on the front end. Because these injuries are very real and can be lifelong and seriously limit intimacy and create a lot of shame and isolation and despair,” she says. While for some the side effects go away on their own, for others they persist – and Bahrick says there’s no known cure for PSSD. “So this is in service of informed consent that is quite lacking at this time.”

Complete Article HERE!

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How to enjoy sex even when your mental ill-health is working against you

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Anxiety and low self-esteem can seriously impact your sex life

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[E]ver had one of those days when your brain seems to be dead set on working against you?

You’re planning a nice bit of sexy time – whether with a partner or simply some solo fun – but your head’s just not in it.

However much you might want to get jiggy with it, your brain is skipping around elsewhere and you just can’t concentrate, let alone roll around in orgasmic delight.

So what causes your head to seemingly separate from your body at just the moment you want to be able to focus on fun times?

All too often it boils down to lack of confidence in yourself and what you’re doing.

If you have problems with self esteem, it can trickle into all areas of your life – and that includes the bedroom.

The saying ‘first you have to love yourself’ is bit of a cliche – but like most cliches, it’s actually true. Many things can sap your confidence, both mental and physical.

For my friend Amy, the problem is a lack of confidence caused by physical issues.

The problem has grown over the years, to the stage where it’s such a big issue that she’s unsure how to even start working through it.

‘I was born with cerebral palsy and I also have ME and fibromyalgia,’ Amy says.

‘I’ve gone from being moderately active and social to spending most of my time at home and sleeping a lot.

‘I was never particularly confident with guys because I have always been overweight.

‘I’ve had four sexual partners so far, three men and a woman. All were basically one night stands that were pretty unsatisfactory for me (and probably them too).

‘I’ve not had sex in years now and have never really dated anyone.

‘I’m pretty fed up of that to be honest but I feel quite isolated socially and wary of anyone who might take an interest because I feel so unattractive.’

You need to learn to love yourself

My personal suggestion in any situation like this always boils down to that same cliche – you have to learn to love yourself first.

Mirrors, masturbation and practice is the key.

Look at yourself so that you’re used to what your own body looks like and learn what really turns you on.

If you practice this alone then you’ll have all the more confidence when it comes to getting down to it with someone else in the room.

Amy’s story is just one of many I hear all the time from people whose sex lives have become unsatisfactory through no fault of their own.

I spoke to relationship and sexuality counsellor Jennifer Deacon and asked for her general advice on separating sex from anxiety.

‘When you’re anxious it’s often hard to feel turned on – or even have any desire at all.

‘That in turn can feed the anxiety more, particularly if you’re in a relationship where you might feel you’re letting your partner down, bringing up a whole heap more anxiety.

‘As with any anxiety the first thing is to try and find that tricky balance between reflecting on what’s going on with your thoughts and over-analysing.

‘What’s stopping you – is it the thought of being naked with someone else? The physical acrobatics that you might feel you ought to be performing?

‘Or is your sexual desire being suppressed because of meds that you’re taking?

‘Try to reflect on what’s going on, and then work through the ‘what ifs’ and ‘shoulds’ that often make up a huge part of anxious thoughts.

‘If you have a partner, try to communicate with them what you need – for example if you’re missing intimacy but are scared of initiating hugs or cuddles because you’re not sure you want full sex, then try to find a way to talk about this with them.

‘If your anxiety has roots in a trauma that you’ve experienced then communication becomes even more important – both communicating with yourself as to what you need and want, and communicating with your partner so that they can support you.

‘Lack of libido can be a common side effect from medication so if you notice that your sexual desire has waned since you started a new medication or changed your dose, consider discussing this with your GP or specialist.’

Many prescription drugs do indeed have side effects that affect the libido – and doctors aren’t always up front about explaining the risks.

Okay, so ‘losing interest in sex’ might be a long way down the list of worrying potential side effects, but given that antidepressants often cause this issue, I’m always amazed that it isn’t discussed more.

Sex is a healthy part of life and if you still want it but struggle to get any joy out of it, that’s going to affect your happiness levels.

After literally decades of living with chronic anxiety, I’ve been through endless different drugs in the hope of finding one that will help without ruining the rest of my life.

The problem is that drugs affect everyone differently – what works brilliantly for one person can potentially have drastically negative effects on another.

The first antidepressant I was given was Prozac.

Back then it was the big name in drug therapy and widely considered to be suitable for everyone.

And yes, it helped my depression – but it also completely removed my ability to orgasm.

I still wanted to – my sex drive itself wasn’t affected in any way – but I simply couldn’t ‘get there’.

I still regale people about ‘that time I gave myself RSI through too much w*nking’ – it’s a funny story now, but at the time it was utterly true and completely miserable.

I went back to the doctor and had my meds changed.

At the last count, I think I’ve tried about thirteen different anxiety meds and I still haven’t found one that I can cope with.

Ironically, if I was happy to lose my libido then several of them would have been perfect – but why should we be expected to go without one of the most enjoyable life experiences?

Personally, that makes me just as miserable as being anxious or depressed, so it invalidates the positives anyway.

Currently I’m med-free – and not very happy about it – but at least I still have my sex life.

For some people, finding the right medication without it affecting their libido will be easy.

But everyone has to find their own balance – some might prefer to take the meds and sacrifice their physical enjoyment.

But it’s okay to want both.

Complete Article HERE!

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4 things we really need to stop saying (and believing) about depression and sex

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It’s time to change your mind

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I always say that sex and depression is the intersection of two taboo topics.

It’s especially hard to talk about the two together because, frankly, it can be hard to talk about either topic separately.

Today, we’re going to look at some commonly held (and oft-repeated) beliefs that really need to be retired in the name of destroying the stigma around these important topics.

Also, they are just not true.

Depression is hard enough to cope with on its own. Don’t make it worse by piling on unfair, untrue cliches. Know the truth about sex and depression and help end the stigma.

Depressed people don’t want to have sex anyway

In 2014, I launched a survey on the impact of depression and its treatment on sexual function and relationships.

A total of 1,100 people took that survey.

In 2015, I started interviewing participants and only then did I spot the massive flaw in my survey: it only allowed for people to give responses about decreased libido.

When I conducted a second round of interviews in 2016 I asked, ‘Did depression impact your sex life? If so, how?’ and more than 29% of the respondents reported increased sexual activity during depressive episodes.

Don’t stick it in the crazy

Stop with this. It’s ableist and frankly it’s ridiculous.

Depression is not an STI and we don’t need to quarantine all the people with depression so they don’t sexually infect you.

Certainly you get to choose who you do and do not engage in sexual activity with, but reciting a (not at all clever) catchphrase, that is based in nothing, about dismissing an entire group of people just helps further stigma and makes people feel like they need to hide their own mental illness struggles.

Sex isn’t important enough to worry about when you’re fighting depression

A scenario that came up over and over in my research was patients being dismissed by doctors or the other people in their lives when they objected to sexual side effects because sex isn’t important enough to worry about ‘at a time like this’.

In some cases, the respondents believed it – ‘I didn’t worry about sex because there were more important things to worry about!’

Listen, yes, sometimes depression treatment is a fight to stay alive and we do whatever it takes, other times, it’s about maintenance and we are allowed to want more than just survival.

People with depression are allowed to want to actually live, and for a lot of people that includes sex.

You have to love yourself first before you can love anyone else

A lot of people will never love themselves.

When we tell people they are ineligible for love until they have hit this self-love goal (I know no one who has done this), what we are really doing is telling them that they have to be a better person in order to be loved.

Another variation on this is, ‘you have to get yourself together first’.

These are all nonsense, and the domain of people who want others to believe that relationships shouldn’t involve any baggage.

Everyone’s got baggage. You don’t need to pretend yours isn’t there to be loveable.

Complete Article HERE!

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Men, Depression and Sex

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As anyone who has been depressed will tell you, depression isn’t just about feeling blue.

Man and woman with pensive expression --- Image by © Ocean/Corbis

It is an incredibly complex condition which brings with it a whole slew of emotional, mental and physical symptoms with it. For men and women both, part of the problem can revolve around their sexuality – and this in turn can cause problems in a relationship at the time when the depressed person most needs the support.  Fortunately, there are ways to help treat this particular problem and restore intimacy and pleasure to a relationship.

Depression and Male Sexuality

It is common for both men and women to experience sexual problems as part of their depression – but the ways in which this presents itself can be different.  Healthline notes that in men, depression will often express itself as feelings of low-esteem, anxiety and guilt and this, in turn, can cause problems with erectile dysfunction, delayed orgasm, premature ejaculation or just a loss of interest in sex itself.

There is still a lot we just don’t know about exactly how depression affects the brain. But according to Net Doctor, researchers have learned that the chemical changes which take place when someone has this condition can lead to an increase in emotional withdrawal and low energy levels so that activities like sex, which require a connection to your partner as well as physical energy to perform, can become a challenge.  This can be hurtful for the person’s partner and make them feel unwanted or unloved, putting a strain on the relationship that can, in itself, be difficult to deal with.

To make matters worse, many antidepressants are notorious for their side effect of causing sexual dysfunction or loss of interest.  Included in this group are MAOI inhibitors, SSRI’s and SSNRI’s and both tetracyclic and tricyclic antidepressants. 

What to Do

So the long and short of it is, both depression itself and some of the treatments for depression can both put a damper on a guy’s sex life. So what are some solutions to the problem?

Get the Treatment You Need

Depression is not a choice that people make – and it is usually not a problem that goes away by itself. If you have not yet been diagnosed, talk to your doctor about the symptoms you are having and get started on a plan of care that involves the combination of medications, therapy and lifestyle changes that are right for you.

If you are already being treated for depression and suspect that your anti-depressants might be putting the kybosh on your sex life, find out if you can switch medications. While it might take a little time to take effect, there are some drugs which do not seem to effect one’s libido, including Wellbutrin and Remeron.

Exercise

Both Healthline and Everyday Health recommend regular exercise – preferably with your partner – as part of a program to help reconnect sexually. First, it gives you and your partner time together doing something enjoyable and this alone can be good for a relationship. It also helps to release feel-good chemicals like endorphins that help fight depression naturally and keeps you in good shape so that you feel good about yourself and the way you look. All this can go a long way to enhancing your sex life.

Take Your Time

According to Everyday Health, sex therapist Dr. Sandra Caron also has a few tips for couples who are struggling to overcome the barrier that depression has placed on their sives.  She recommends, first of all, that couples engage in more foreplay and other physical expressions of intimacy – hand holding, caressing, massage – before engaging in intercourse itself.  Depression tends to slow down all responses, so taking this extra time to achieve arousal can help enhance the pleasure for both partners.  She also recommends the use, if needed, of estrogen creams or lubricants and even erotica (like lingerie or sexy movies) to help sparthe mood.

Open Up

Probably the most important advice for men who are trying to reconnect with their partner sexually is to open up and communicate with your partner. This can be more difficult for men to do in general, but is even more of a challenge when it comes to talking about intimate issues like sexuality, desire and arousal. But being honest about how you are feeling and letting your partner know that it is the depression that is a problem and not a loss of interest or a loss of love can be an incredibly powerful way to overcome this challenges and get support from your loved one at a time when you need it the most.  Also, partners can be more understanding and supportive if they understand more about what is going on – otherwise, it is easy to interpret a low mood or lack of responsiveness as being hostile or unloving.

In short, depression is a difficult condition with a whole slew of symptoms that go far beyond just feelings of sadness or being blue.  And when depression begins to affect a person’s sexuality, this in turn can lead to a strain on intimate partner relationships.  However, while there are no quick solutions to this problem, getting on a treatment program that is tailored to someone’s individual needs as well as exercising regularly, spending time with a partner to engage in more foreplay and simply opening up and talking about the problem can all help to reignite the sexual spark in a relationship – and hopefully make the battle against depression that much easier.

Complete Article HERE!

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