Relationships are based on trust, nurturance, honesty, attraction, devotion, and of course, in most instances, sex. What happens if the sex is interrupted by a medical condition that prevents the ability to be sexually functional? There are many medical conditions that cause a lack of sexual interest and/or ability. Heart disease, diabetes, psychiatric illness, and others are just a few of the medical conditions that may interrupt what would normally be a healthy functioning sexual experience. Medication is provided to treat and prevent the course of an illness from worsening, or to maintain a level of functioning. What happens when the medication causes a profound change in ones behavior and thought processes so as to render them impotent, developing a virtually non-existent libido?

Selective Serotonin Reuptake Inhibitors, (SSRIs), do just that. As psychotropic medications used in the treatment of anxiety and depression they are often used as the first line of defense because of their ability to provide excellent results with fewer side effects. Working on the neurotransmitters in the brain, the SSRI's have been implicated by treatment providers of patients with major depressive and anxiety disorders in causing the problem of sexual dysfunction. Sexual dysfunction also creates other relationship issues: lack of intimacy, loneliness, stress, low self-esteem and more. The patient on the SSRI begins to enjoy life again without the depression or anxiety that plagued them. Their partner, on the other hand, begins to feel the side-effects of the SSRI. The literature shows that SSRIs are effective and millions of patients who take SSRIs wouldnt have it any other way. However, even in the strongest of marriages and partnerships, when there is a strong commitment to the health and well-being between the partners, the curse of the SSRI is powerful. The relationship becomes a one-sided affair where there seems to be little room for change. The patient becomes comfortable with their lack of symptoms and their improved outlook and lifestyle changes. Their partners also appreciate the profound changes, but the sexual intimacy that is lacking is hard to ignore. The SSRI flattens the libido of the patient, not the partner. This is where the problem lies.

So what are couples to do? I struggle with this question as so many of my patients come to me with this particular issue. We talk about intimacy and the varied ways that a couple can be intimate. Touching, sharing thoughts, planning together, and talking about the reality of the situation are all ways of striking back. Weighing the symptoms of depression and anxiety against the new symptom of sexual dysfunction is important. This is not simple. This is a struggle for relationship-survival. Many couples break up because of the inability of the partners to connect on non-sexual or altered- sexual terms. Many couples dont even know that the medication has caused the problem, believing instead that that the relationship is deteriorating without the understanding of what is happening.

First speak with your doctor. Be candid and let your physician know that you or your partner is experiencing sexual dysfunction. Most doctors will be sympathetic because they have heard this complaint before. When possible, adjusting the medication is a corrective action. Learning how to listen to your partners needs is also vitally important. The relationship survived a lot more than this issue up until now. Remember the positive qualities of the relationship before the medication and build on them. Couples need to see their strengths and reach beyond the sexual limitations. In the case of SSRIs the treatment does become the problem, but it is not insurmountable. Patience, caring, openness, and willingness are the keys to recovering the libido. Awareness that there is a problem and knowing the causes helps the couple make adjustments that become satisfying to both. SSRIs can be used more effectively to control the symptoms of anxiety and depression when coupled with patient and partner education. It is up to the treatment provider to provide this education to the patient and their partner so that they understand the probability of a restricted libido allowing them to be sexually proactive. There is hope in this area of treatment and recovery.

JJR/NY