The Post-SSRI Orgasmic High
SSRIs are a form of antidepressants known to suppress libido, so what happens to your sex drive when you stop taking them?
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I have been on and off various forms of antidepressants since college. A class of antidepressants (Zoloft, Lexapro, and Prozac) called SSRIs (selective serotonin reuptake inhibitors) is often the first line of pharmaceutical treatment for depression and a safer and less addictive solution than benzodiazepines (Xanax, Ativan, and Klonopin) for anxiety and panic disorders. The problem is, as if trying to date while depressed or anxious isn't shitty enough, taking SSRIs, which work by blocking serotonin receptors in the brain so that levels of the chemical in the brain stay higher, can basically cause chemical castration.
"The current thinking is that serotonin and dopamine are something like the brakes and the gas when it comes to sex," explains Dr. Julie Holland, a psychiatrist and the author of Moody Bitches: The Truth About the Drugs You're Taking. "Too much serotonin seems to make it hard to flip the switch over to orgasm. When women are in a lower serotonergic state, as when they are closer to their periods (PMS) or if they've taken MDMA the day before and are temporarily depleted, it's easier to climax. When women take SSRIs, it's not only harder to climax, but for many women, it's harder to feel sexual pleasure or get horny. I have patients tell me they're less interested in sex, their pelvis feels numb, or it's nearly impossible to climax."
You get off the meds, and then you quite literally get off.
I knew that during high school I would masturbate an average of three times a day, and while I had to use my hand to rub my clit sometimes, I also knew I had gotten off during oral, vaginal, and anal sex without using a vibrator. (There's no shame in using a vibrator during sex; I think more women should. But what if you're up against the fence at Williamsburg Waterfront and just don't have it on you?) Yet when I was on Lexapro, a commonly prescribed SSRI, I did not know that girl. Sex became something I did because I knew I was supposed to, rather than because I felt my clit would explode if I didn't have that hot man in me right this second. "I guess when you're super depressed your sex life seems not that big of a deal, but when you're a functioning human being and part of society again you're like, 'No, this is actually a pretty key thing that I'm missing out on,'" says Claire, a 29-year-old living in Brooklyn who has also experienced the SSRI chastity belt via Prozac. "I would have sex with the men I was dating because I thought, This is what you should do in a relationship, but it wasn't really fulfilling. You kind of forget what sex is like. Then you go back [get off the meds] you're like, 'I remember!'"
You get off the meds, and then you quite literally get off, which is exactly what happened to me when I finally weaned myself off Lexapro over the course of a month. Unfortunately, my sex drive came back just around the time my relationship was ending. My ex had often complained that he didn't always feel we were on the same page sexually and he hated that he couldn't get me off, so it was a shame he left just as my orgasms were coming back full force.
"It would have been different. It definitely would have been different," says Dr. Helen Fisher, a biological anthropologist from the Kinsey Institute, when I ask about whether going off Lexapro earlier might have changed our sexual chemistry. "Orgasm is really important for a relationship. It makes you like the person! It makes you trust the person; it makes you want to be with the person; it makes you feel warmth towards the person; it evolved for very obvious reasons, which is to make you want to do it again to be close to somebody and hold somebody. When you're hugging somebody and holding somebody, oxytocin is going up in the brain. Oxytocin is associated with feelings of attachment and calm, and right before orgasms there is a spike of norepinephrine and dopamine that is going to give you feelings of optimism, and energy, and focus, and motivation, and then of course after orgasm there's a real flood of oxytocin again and that gives you a feeling of deep attachment to a partner. So there's a reason that men want women to have an orgasm," explains Dr. Fisher.
Ross, a 32-year-old New Yorker whose girlfriend took 20mg of Lexapro, agrees. "You can understand it's science, but it [was] still hard not to take it personally when I couldn't get her off," he says.
Before I regale you with the joy that is the second puberty experienced when flushing all those nasty orgasm police pills out of your system, it's crucial to note that they do save lives; quitting cold turkey without discussing with your doctor is a no-no. "Some people really need these drugs," says Dr. Fisher. "They need them to get out of bed in the morning, to make the effort to go find a sweetheart."
However, this is not always the case. "Data shows that 70 percent of people who are on these drugs don't really need them," Fisher says. "They [get] back on their feet, and they [keep taking them] because they have the feeling of calm and stability, so they stay on them long-term. [But] when you stay on them, you can jeopardize your ability to fall in love and stay in love."
Yes--there's more than sex at stake here. SSRIs could be screwing up what humans are already very bad at: finding and maintaining a loving relationship. "If you aren't interested in having sex, or you're having less pleasure when you do have sex, it's going to affect your relationships, obviously. There is even some suggestion that it affects whether women make themselves available for sex when they're dating, or whether it can affect that angsty/horny feeling when you fall in love with someone," says Dr. Holland. "Human female subjects on antidepressants spend less time poring over faces of potential male dating partners than the women who are unmedicated."
SSRIs could be screwing up what humans are already very bad at: finding and maintaining a loving relationship.
Over the course of the month that I quit Lexapro, it felt like a sexual re-awakening. "My patients who have weaned off their SSRIs are happy to report they can climax more easily," says Dr. Holland. "It's nice to be able to enjoy sex again, and to connect with your partner on that physical, and often spiritual, level." Skylar, a 28-year-old from Richmond, knows what the doc is talking about. After giving Zoloft a shot for anxiety attacks, she stopped using it because she decided she'd rather be anxious and having orgasms. "Within a matter of a few weeks I was back to normal in the sex department," says Skylar.
Claire, the 29-year-old Brooklynite who was on Prozac, concurs. "I noticed [my sex drive return] more when I was just masturbating by myself, because I [was single] at the time. [I would be] watching porn and using my vibrator and being like, 'This is amazing!'''
While most women return to orgasm-land with a vengeance after being on SSRIs, however, some never come the same again. Post-SSRI sexual dysfunction (PSSD) is a nightmare in reality, in which patients' sex drives and functioning can take years to return to normal after being on SSRIs. Some patients never feel the same again.
"It's frustrating that they haven't found a pharmaceutical cocktail that can be so beneficial for anxiety without those side effects," Skylar tells me. The good news is there is one antidepressant that can actually promote sexual desire and function: Wellbutrin. "Well, the makers of Wellbutrin don't really cop to the mechanism of action of their antidepressant, only describing it as 'non-serotonergic,'" says Dr. Holland, "but it seems as though [it has] an action that increases dopamine levels.
"For many of my patients, they are much happier with the effect of Wellbutrin on their sex lives, over the SSRIs," Dr. Holland continues. "Wellbutrin can also help to cut appetite and improve focus and concentration. Where it's weak is in treating anxiety, and especially treating obsessive symptoms. The SSRIs are much better for that." Not to long after I stopped taking Lexapro, I tried Wellbutrin and had three orgasms during sex on my yoga mat--two clitoral, and one cervical, which until then I didn't actually believed existed. (Thank you, makers of Wellbutrin.) I stopped Wellbutrin because, as Dr. Holland says, it sucks for anxiety, which is my main enemy at the moment.
After a fuck ton of therapy, quitting drinking, and developing a mindfulness practice (seriously), I've earned the bragging rights to say that now, sans SSRI or Wellbutrin, I'm just a little bit nuts. The renewed ability to orgasm is probably helping to keep me so fucking cheery, too. "Orgasms do create a bit of a ruckus with neurotransmitters and hormones," Dr. Holland says. "In particular oxytocin and endorphins, though the endocannabinoid system may also be involved. They do help to relieve stress, obviously, which is likely therapeutic. And yes, there is a study showing that sperm, when deposited in the vagina, can have antidepressant effects.
"Much of the brain even shuts down when you're having an orgasm," she continues. "It's a very deep experience."
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