Has the Romance Gone? Was It the Drug?

NY Times ^ | May 4, 2004 | ANAHAD O'CONNOR

[neverdem]

For most people taking antidepressants, the risk of a diminished sex drive may seem like a worthwhile sacrifice for the benefits from the drugs.

Up to 70 percent of patients on antidepressants report sexual side effects, yet the number of Americans who take the drugs has ballooned since Prozac was introduced in the late 1980's. Last year, studies show, doctors in the United States wrote 213 million prescriptions for antidepressants.

But what if the sexual side effects of the drugs, often considered little more than a nuisance, had more serious consequences, impairing not only sexual desire in some people, but also the ability to experience romance? The question, which experts are beginning to ask, was at the center of a talk this weekend at the annual meeting of the American Psychiatric Association in New York. Dr. Helen E. Fisher, an anthropologist at Rutgers, presented findings that suggest, she says, that common antidepressants that tinker with serotonin levels in the brain can also disrupt neural circuits involved in romance and attachment.

"We know that there are real sexual problems associated with serotonin-enhancing medications," said Dr. Fisher, author of "Why We Love: The Nature and Chemistry of Romantic Love" (2004). "But when you cripple a person's sexual desire and arousal, you're also jeopardizing their ability to fall in love and to stay in love."

Dr. Fisher and a colleague, Dr. Anderson J. Thomson Jr., have studied the brains of people in love and pored over research from the last 25 years on the neurological basis of romance. Three brain systems, all interrelated, the researchers say, control lust, attraction and attachment. Each runs on a different set of chemicals. Lust is fueled by androgens and estrogens. Attachment is controlled by oxytocin and vasopressin. And attraction, they say, is driven by high levels of dopamine and norepinephrine, as well as low levels of serotonin. As a result, they say, increasing levels of serotonin with antidepressants can cripple the sex drive but also set off an imbalance among the three systems.

Drs. Fisher and Thomson are submitting a scientific paper on the subject for publication this year.

"There are two lines of evidence on this," Dr. Thomson, a psychiatrist at the University of Virginia, said. "The first is the well-documented frequency of sexual side effects. But when you actually talk to patients who have diminished libido and you ask how it affects them, you discover that it has an enormous impact on their romantic lives."

Often, the change is subtle. Drs. Fisher and Thomson point to case studies of people who gradually find their emotions blunted and their ability to see attractive features in others lost. The researchers also point to more extreme cases like people who say losing their sex drives caused romantic feelings toward longtime spouses to evaporate suddenly.

"Everyone is distinctly different," Dr. Fisher said. "Some people are so securely attached that this isn't going to change things for them. But people should be aware that these drugs dull the emotions, including the positive ones that are central components of romantic love."

[neverdem]

PING

[Agnes Heep]

I quote the immortal Moe Howard: "We're gonna get rubbed out after the fight ... and you're worried about a cream puff."

[The Scourge of Yazid]

I'm always skeptical of claims made by drug companies. How does Pfizer know that 70% of men or 40% of women experience sexual dysfunction on a regular basis?

And how did clinical Depression become something that almost anyone is susceptible to?

It's gotten so bad that they're treating people for 'extreme shyness.' What the hell does that mean? I love watching those commercials that show this incredibly skittish woman inching away from other people at a party. Did anyone ever stop to think that maybe those people were pains in the ass, who she just didn't want to socialize with?

[What Is Ain't]

This is depressing news. I may need to get a script.

[E. Pluribus Unum]

Pot bad, Prozac good.

[gathersnomoss]

Prozac + Viagra = Solution

[megatherium]

Pfizer probably bases these figures on phase three drug trials. Thousands of patients are given the drug, thousands of patients are given placebo. This is done double-blind, so neither patients nor doctors know who is getting what. Then the study is "unblinded" and the statisticians determine whether the drug was safe and whether it is effective. This is written up in an expensive package, tied with a nice bowtie, and presented to the FDA for approval.

So it is true that most of the time, it is the drug companies that provide the research that verifies the safety and effectiveness of their drugs. Occasionally, this system is abused. But there is hell to pay if a drug company abuses its trust with the FDA, and usually they are very careful.

The marketing of drugs is where the companies come close to crossing the line. They figure out new uses for old drugs, such as "social anxiety disorder" for antidepressents. But even there, I believe they need to back up assertions with clinical studies. By the way, doctors sometimes prescribe drugs "off-label", for maladies the drugs are not intended to treat. Perfectly legal, though your insurance company is unlikely to pay for it.

[latrans]

Try wellbutrin, it has the opposite effect.

[malia]

What is the ratio of men on anti-d's to women on anti-d's?

I know many, many, many women on anti-depressants, but no men. Granted women talk more---

[GBA]

It's very common to go through some event in life, like a loved one's death, or a divorce, or whatever, and feel the need to talk to someone about how to deal with it. And often such events have such an effect on a person that he/she becomes depressed. It seems to me that such depression is perfectly normal. I mean, who wouldn't be a little bit or even greatly depressed when going through a divorce or when a parent, spouse, child, friend dies?

Yet, it's also very common that one of the first things the medical profession will do is hand you drugs and blame your depression on a chemical imbalance. Then, the person seeking treatment finds that the drugs have nasty side-effects such as sexual disfunction that are also very depressing. A vicious cycle made worse. Not exactly better living through chemistry.

I guess what I'm saying is that if one seeks the services of the psychological or psychiatric professions, be cautious. There are some miracle drugs on the market, but drugs won't do the work for you and can make things worse. Sometimes life just hurts.

[Physicist]

Maybe I ought to take some of this stuff for a while, to give the missus a break.

[birbear]

And often such events have such an effect on a person that he/she becomes depressed. It seems to me that such depression is perfectly normal. I mean, who wouldn't be a little bit or even greatly depressed when going through a divorce or when a parent, spouse, child, friend dies?

Yes, it's very common to become depressed vecause of events like this. And most of the medication literature suggests that you don't thake meds for that kind of depression. And good docs won't prescribe anti-depressants for those kind of events. A good grief counselor is usually what's needed for that, and probably a support group.

If you're spending two weeks or more with a symptoms such as a loss/gain in appetite, not doing things that you once found appealing, a lost interest in sex, increased crying, thoughts of suicide or self harm, etc... you probably do need professional help.. and one of those helpful things could be medication.

[neverdem]

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1: Psychiatr Clin North Am. 2003 Sep;26(3):581-94.

Related Articles,Links

Gender differences in depression and response to antidepressant treatment.

Sloan DM, Kornstein SG.

Clinical Services Department, CardinalHealth, Inc, 218 Colwyn Terrace, West Chester, PA 19380, USA.

Throughout their childbearing years, women are twice as likely as men to experience an episode of major depression. The exact etiology of this difference is unclear, but psychosocial and neurobiologic factors likely contribute. Clinicians should consider gender differences in the phenomenology of depression and response to antidepressant treatment when screening for depressive illness, selecting appropriate treatment and assessing therapeutic response. Treatment considerations when selecting an antidepressant should include the patient's gender, age, and, in women, menopausal status, including the use of concomitant HRT. Further research is needed to refine and extend the existing knowledge base regarding the effect of gender on treatment of depression, including the role of endogenous and exogenous gonadal hormones in response to antidepressant treatment.

Publication Types:

• Review
• Review, Academic

PMID: 14563099 [PubMed]

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May 3 2004 06:56:40

[GBA]

I couldn't agree with you more...but...it's like you said about finding a good grief counselor and support group. My own experience is that everyone in that support group is on some sort of meds. And...also experiencing the side effects. It's so much easier for the medical professional to give out the meds than to deal with the root cause without the meds. But when in the privacy of their own thoughts and looking back, does the patient say it was the work that they did or the medication that made them feel better? What gives them the strength for the next inevitable challenge?

My point is that meds are over prescribed and that real gains are made without them. They are needed, but only when chemical imbalance and not some life events are the cause of the depression.

[RightWingAtheist]

Hey, she knew what she was getting into when she married a high-energy physicist. And if the drugs don't work-well, time to disconnect the storage rings from the main accelerator, if you know what I mean, and I think you do.

[Physicist]

Oh, the LINAC remains on-line. Instead, we've stopped supplying films to the bubble chamber. There are barely enough funds to publish the data we've already taken.

[Rebelbase]

Thanks for posting that. I am one who appreciates the deep philosophical insights of Moe Howard.