[Unedited]
Major depressives can skip to the part about SSRIs.
IMPORTANT: I am not a medical professional and any and all of my content does not intend to replace the advice of your physician.
Why am I sharing this very personal and intimate post? Simple: to let other people in the same boat know they’re not alone. Nothing more, nothing less.
Hyper-sexuality
It’s common for bipolar folk to suffer, and I mean suffer, the consequences of hyper-sexuality. Hyper-sexuality is one of a myriad of symptoms that may be experienced during a manic episode. In case you were wondering what exactly hyper-sexuality is, the Mayo Clinic says:
An obsession with sexual thoughts, urges or behaviors that may cause distress or that negatively affects health, job or relationships.
I feel they have only grazed the surface with this definition. Hyper-sexuality might be all of those things, but it should also include simply enjoying sex perhaps more than most do for what it is. In many ways hyper-sexuality is pleasurable for a partner with a higher sex drive, it brings with it more experimentation and trying new things and, and, and all the things I don’t care to justify here.
Top-shelf sex can be expected from the hypo-manic, hypersexualized. Or it could just be that I’m that good. But I’m not that self confident. Am I? Never me.
The Mayo Clinic describes the part of the symptom that is destructive. I get that. Really I do. The realization of the destruction caused comes after the mania has subsided. I won’t go listing specific examples of the things I’ve done to lead to decimated relationships and risk to self, but while hyper-sexuality includes the act of normative sex it also includes those things adjacent to that:
- Spending an inordinate amount of time watching porn. Just watching sex.
- Engaging in sexual acts in inappropriate or dangerous places. Often.
- Thoughts of inappropriate sexual acts with people whom it is inappropriate / illegal to engage in said acts.
- Sleeping with other people’s people with reckless abandon. Frequently.
- Having an aversion to the normative version of sex, replacing ‘regular sex’ with S&M / BDSM etc. that are otherwise not a feature of sex when not manic.
OK, so those are just five of the things I can think of off the top of my head regarding things hyper-sexuality makes one do / think.
SSRI and SNRI Anti-depressants
The cure in the case of bipolar folk is usually one of an anti-depressant or anti-psycotic medications and usually a combination of both. I feel like in this respect there should be no distinction between bipolar disorder and depression though. Both feature medications that are a sex drive killer.
SSRIs work to raise the level of serotonin in the body. This makes one calm and less anxious. Perhaps it works too well and this is why it is the nemesis of libido. Ultimately the hormones that make us respond sexually are unable, or less able, to reach the right preceptors of the brain and ultimately make one less aroused.
Less arousal = less sex. And even when sex does happen it doesn’t feel as good, and likely manifests in poor performance.
If you’re on an SSRI, expect your sex drive to plummet. If I’m wrong, I’ll buy you a beer. If say, you were once a person that enjoyed relatively frequent, uncomplicated and enjoyable sex with your partner then you should prepare them for this IMO.
So, which anti-depressants cause sexual dysfunction (yes, I’m prepared to go as far as saying it’s a dysfunction)? The main culprits, all of which I have been on at some point in my life pre-dx:
- citalopram (Celexa)
- duloxetine (Cymbalta)
- escitalopram (Lexapro)
- paroxetine (Paxil and Paxil CR)
- fluoxetine (Prozac)
- sertraline (Zoloft)
You may not be on an SSRI if it induces mania, but are likely on an anti-depressant in the TCA class, or on (I’m calling it them stimulants in this context) Ritalin and Adderal or an atypical antidepressant like Wellbutrin (like I am).
All of these may have an effect on your sex performance and libido.
Even though Ritalin may increase drive sexual performance usually takes a knock, which is frustrating as fuck. Like planning a road-trip when the car is in the workshop. Glad my Ritalin journey is over.
Anti-psychotics and Mood Stabilizers
This part is for the bipolar folk. You may or may not be on an anti-depressant but your other medication may be killing your mojo.
One of the most frequent culprits is a mood stabilizer. The other is anti-psychotics. Perhaps it’s to do with the fact that you’re too stable, too ‘default’?
Anyway, bipolar brings with anther issue I would like to throw out there: if you were hyper sexual before going on treatment, is your treatment working and is this reduced drive how things should be? I don’t think I’ll ever quite answer that question satisfactorily.
So, OK. You went from hyper-sexual to no sexual. This is different to asexual. In my mind, as is the case for me at this juncture, I can be aware that I should want sex but honestly cannot find a good enough reason to make the effort. And it is an effort. Sex is an effort and no one can tell me otherwise.
I couldn’t be asked to angle for a lay on a date, or on an app like Grindr. Both of these I would say I was proficient at. Now? Not so much. Not so much because I can’t, just because I actually couldn’t be asked. If it happens, it happens and is frankly usually a very uninspiring experience.
Is the difference then that anti-depressants decrease your libido and that anti-psychotics and mood stabilizers extinguish any enjoyment you would usually have had, having sex? Yeah, that sounds about right. If you’re on both you’re fucked. No, but really you are. Trust me, I would know.
Who are the biggest culprits in anti-psychotics and mood stabilizers in causing copulation blues? Perhaps listing the ones that aren’t culprits would be easier… I’ll rather share the ones that I’m on currently, any one of which or a combination of may be the cause:
- Quetiapine (Seroquel, Dopaquel)
- Valoproic acid, Sodium valporate (Epilim)
- Lamotrigine (Epitec)
and Wellbutrin may be related but is a medicine of a different class.
A decreased libido might not be a problem for you though. This might sound counter intuitive… but if I don’t want sex, and have no desire for or feel a societal need to do it, then where is the problem? Sounds like bliss to me. Just saying. Who knows, I might like your personality even. Really, personality is far more interesting than any sex I’ll ever have today.
I am going to do another post about some of the things you can try to solve some of this all. I can’t do it here because bipolar and major depression diverge on how how to minimize side effects (like having a medication holiday is not an option for BP etc…). The common feature of both though is that you should talk to your doctor if this side effect of your medication is a problem for you.
Another post about some solutions / suggestions to minimize the side effects will follow some other time.
