Sex or Serotonin?

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Sex or Serotonin? by Alyssa Katz

I used to feel sorry for my Prozac-popping friends. The
thought that being happy should require dulling one’s libido was, well,

depressing. At the same time, I reasoned, if some people are prepared to
kill themselves to end their emotional pain, self-neutering through
medication is a far less draconian response. And for someone in such a
state of despair, sex is probably a pretty low priority, anyway.

Well, I’ve since had my own chance to find out. Starting a couple of
years ago, anxiety that had always made for fairly harmless background
noise escalated into full bore depression. It was usually mild enough
that I could put on an adequate front in public, but it was not something
I wanted to wake up to every morning, as I did, pretty consistently, at 5
a.m. Of the things that felt wrong, my sexuality was decidedly not one of
them: not only were my nerves and neurons in good working order, but I
found sex provided things a person in emotional distress might
understandably crave, such as intimacy, pride in a job well done and not
least a quality rush. Acts of sex were the only occasions on which the
self absorption that attended my depression was considered appropriate.

But once it was clear that it was going to take more than a good lay to
set my head right, I decided to take my chances in the pharmaceutical
realm — maybe I’d find some way to get around the dreaded side effects.
Towards this end, I first tried Serzone, which has been touted as Prozac
without the limp dick. It didn’t work. Then last fall, inevitably, came
the suggestion of an SSRI — a selective serotonin reuptake inhibitor.
SSRIs work by preventing the absorption of serotonin, an essential
neurotransmitter, back into specific receptors in the brain. This enables
an adequate circulation of serotonin, but with almost none of the side
effects associated with earlier generations of psychoactive drugs. The
result, in theory, is an individual who feels a whole lot better about

When my psychiatrist offered to give me some free samples of Zoloft, my
mind raced to the last time I’d heard someone mention that brand name. “I
don’t have a sex drive anymore,” a friend had told me as we sat in a

coffee shop comparing medication notes. “But I’m feeling too good to
care.” The smile she was wearing was eerie and unforgettable. I had been
suffering through the Serzone, which had roughly the effect of a daily
mallet blow to the head, and her deal sounded pretty good in comparison.
Now, with my very own Zoloft packet in hand, I was poised to become a pod

Since starting on Zoloft, I’ve forgotten what it’s like to crave
impulsive sex; my masturbation schedule has been scaled back to those
rare moments once every week or two when I feel a nostalgic tickle and
with some absurdly vigorous scrubbing can eke out one fair orgasm. (It
has been observed by therapists and patients alike that SSRIs damage
one’s ability to sustain sexual fantasy, making sex with a desirable
partner much more pleasurable than a solo effort.) But my libido is still
a good friend who sends me postcards from time to time to let me know
she’ll be coming home one day.

In the meantime, I have plenty of company. In 1997, about fourteen million
other Americans were prescribed SSRIs, which are most commonly used to
relieve depression but also can take care of afflictions ranging from
panic disorders to irritable bowel syndrome. And it’s hardly news that a
huge number of people who don’t meet the clinical criteria for major
depression are also taking SSRIs. As I’d suspected, what we have here is
a willing barter by a predominantly young and sexually active segment of
the population: erotic satisfaction for emotional peace.

The drugs’ manufacturers, unsurprisingly, claim extremely low rates of
sex-related problems — Eli Lilly continues to report that only 3 percent
of Prozac users have their “libido decreased,” and the figures provided
by Pfizer on Zoloft-related “sexual dysfunction” are an improbably skewed
16 percent of men and 2 percent of women. But independent studies have
found that up to 75 percent of patients taking these drugs, particularly
Zoloft and Paxil, experience sexual problems. One reason may be a

corresponding decrease in levels of dopamine, a neurotransmitter that is
associated with improved sexual function and experience.

Decreased levels of serotonin, on the other hand, have proven to cause a
whole lot of intensely sexual sociopathic behavior in cats, rabbits,
monkeys and rats. As recounted by Theresa Crenshaw and James Goldberg in
their fascinating medical reference, Sexual Pharmacology (Norton,
1996), an entire group of serotonin-depleted caged animals would try to
mount one another simultaneously; the rabbits, being rabbits, also tried
to fuck other species. Some animals compulsively killed smaller species.

Other research has associated a lack of serotonin with an inability to
control impulses, which is probably why SSRIs are effective in treating
obsessive-compulsive disorders. It also could explain a whole lot about
their use in cases of socially unacceptable sexual behavior. Medical
literature is full of cases in which SSRIs have successfully been used to
treat sexual addiction, transvestism, exhibitionism, sadomasochism and
other cases of what psychiatrists call “paraphilias.” They’re
increasingly being used in lieu of appalling treatments like electric
shock and castration to control the behavior of sex offenders.

Drug therapies curb violent sexual behavior in part because SSRIs counter
certain effects of testosterone, and indeed, the majority of the medical
literature on SSRI-related sexual problems has focused on men and their
erection difficulties. For some men, the same effect is beneficial: the
drugs have been found to be consistently effective in treating premature
ejaculation. But it’s women who constitute a two-thirds majority of

people taking SSRIs and who are experiencing the consequences more
quietly. Though we’ve come a long way since hysterectomies were routinely
performed to cure women of “ills” such as masturbation, sexual
voraciousness and hysteria, the sexual effects of SSRI’s have a decided
impact on a woman’s well-being.

They certainly have on mine. Once prone to climaxing early and often,
I’ve become one of those women I never wanted to believe existed: someone
who can come only by herself or through intensive attention from a
partner. I’m still able to have an orgasm, but it’s usually a timid,
fluttery thing that feels the way I imagine men think women’s orgasms
feel. It also feels like I’m betraying something significant. Women’s
fight for ownership of the orgasm — and fundamentally, to our identities
as fully sexual beings — took place only a generation or so ago. Now,
millions of us are voluntarily giving up that part of our lives.

Trying to keep my balance on this shifting sexual terrain, I’ve been
processing my emotions through a mill of hyperrationality: Am I passing
up chances for sexual encounters because I’ve decided there’s no
long-term gain, or because there’s little short-term pleasure? Because I
feel self-assured enough not to seek affirmation from near-strangers, or
because I’ve been anaesthetized? It’s fair to say that much as the pill
was the official chemical compound of the ’60s, SSRIs are fueling a very
different culture today. The medications don’t just affect sex — many
patients also don’t drink or take drugs because of problems with side
effects. And in case you haven’t noticed, professional-class Americans nowadays
like to work a lot — a preference that’s reinforced by the energizing
effects of SSRIs.

With continued developments in neurochemistry, the medical control of sex
will undoubtedly go further. As if to make up for its misdeeds in this
department, Eli Lilly has tested a libido-booster, called Quinelorane,

for possible use among the sexually dysfunctional. Buproprion, an
antidepressant best known by the brand name Wellbutrin, was recently
approved as a smoking-cessation aid and is being studied for its
potential as a dopamine-driven sex enhancer. Other drugs being marketed
to counteract SSRIs include the antihistamine Periactin, the anti-anxiety
agent BuSpar, and the natural remedies yohimbe and gingko. But the
evidence that they work is exclusively anecdotal, mostly based on their
success in correcting male performance; it’s also clear that each in its
own way tends to negate desired effects of an SSRI.

Even if I take my chances and win with one of those remedies, I don’t
know if I’m prepared to accept my sexuality as a limited resource, to be
exchanged for other essential aspects of my personality. There are two
places to go from here, I figure. One is to reconcile myself to the
opportunity SSRIs provide to live a life that’s richer in other ways. The
other is to see these troubles as a warning that revving up my brain
chemicals is not a sustainable option. Watching my libido fall from its
longtime position as my second largest drive (after eating), to a place
somewhere between doing yoga and seeing a Wong Kar-wai movie, has been
humbling and instructive. I think I’ve gotten the point.

Alyssa Katz
and Nerve.com