He's Just Not Up for It Anymore (14 page)

TODAY ANGER, TOMORROW APATHY

Say this about anger, at least it shows feeling and emotion. But sometimes, people metaphorically throw up their hands and choose not to feel angry. In fact, they choose not to feel anything.

I remember looking at her and realizing that I was no longer attracted to her. It was over. This also took away her last and most powerful manipulative tool and, yes, that made her even anger

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angrier. We continued to live in a sexless marriage for two years after that. It wasn’t the first time we had gone for a long time without sex; at another point in our marriage she cut me off for sixteen months, but this time it was my decision. Sex was a weapon. We are divorced now, surprise, surprise. I don’t miss her. And my dog is a heck of a lot more affectionate then she ever was. (Male, 50s)

This couple took turns using sex as a weapon until there was nothing left to fight for. Indifference empowered him, or, at least, he believed it did. She may have seemed angry, at first, that he no longer desired her, in spite of the fact that she had previously punished him in precisely the same way. In the final two years of the marriage, it is possible her hostilities diminished as well, and she became as apathetic as her husband. They didn’t have anything to shake things up, certainly not open and honest conversation, and probably got to a point where neither could remember why they ever fell in love.

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DEPRESSION: THE ULTIMATE

PASSION KILLER

I think that he may not have ever been very interested in sex.

The signs were even there before we got married, but I ignored them. Then depression kicked in. He was no longer able to fake it and didn’t even try to anymore. He never initiated and turned me down at least half the time I initiated. (Female, 40, married for ten years)

Aperson suffering from depression sees the world through gray-colored glasses. He is filled with negativity about the past, present, and future. The American Psychiatric Association’s
Diagnostic
and Statistical Manual
lists nine symptoms, which include:

# Feeling depressed most of the day nearly every day

# Markedly diminished pleasure

# Significant weight change

# Insomnia

# Agitation

# Fatigue and loss of energy

# Feelings of worthlessness and/or inappropriate guilt depression: the ultimate passion killer

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# Diminished concentration

# Thoughts of suicide

It goes without saying that intimate, joyful, and passionate lovemaking is likely to be low on a depressed person’s to-do list. Indeed, the effect of depression on libido has been described as devastating; it has been estimated that 70 percent of depressed people also suffer from a loss of desire. Some therapists claim a clinically depressed patient who retained desire would be a rarity.

70 percent of depressed people also suffer
from a loss of desire.

Fifty-seven percent of our female respondents agreed that their husbands were depressed, and it was the main reason they believed their spouses were lacking sexual desire. (The majority of these women also said their partners were angry.) Of the male respondents, only 34

percent said they felt depressed, although like erectile dysfunction and premature ejaculation, this may be underreported. Thirty-six percent of the women said they themselves suffered from depression, and 40

percent of the men said that their wives were depressed.

The majority of the men who self-identified as depressed said their wives were depressed, too. It’s possible that the wives were depressed because the husbands were. Or it could be, as the late psychologist George Bach observed, that water seeks its own level, and depressed people seek out depressed partners.

THE PARADOX OF SEX AND DEPRESSION

Can depression and sexual activity coexist? Sometimes they can. In our survey, half of the men who strongly agreed they were depressed 120

HE’S JUST NOT UP FOR IT ANYMORE

also identified as masturbating. Twenty-four percent were having affairs. Some were doing both. Men may use masturbation as a quick fix for depression. It can be an instant (if short-lived) mood enhancer.

If anxiety accompanies depression, and it often does, masturbation may also be a temporary tranquilizer. So may a brief encounter. The guilt and fear that usually go along with an affair may be the cause of the depression; or the sexual relief possible in a nonintimate relationship may be purely analgesic.

WHAT CAUSES DEPRESSION?

Depression is believed to be the result of a chemical imbalance in the brain, but there is not yet a way to pinpoint the exact chemicals. Research suggests that it is likely one or more of the neurotransmitters serotonin, dopamine, or norepinephrine.

An estimated 19 million Americans suffer from depression. Needless to say, stress and trauma can lead to situational despair. Often, the healing powers of time or a change in the situation can sweep the depression away. But it is also possible that time does not heal all wounds, or that there was no “obvious” reason to begin with. It has been theorized that the body’s inability to properly utilize nutrients may be a cause, and that genetic predetermination may be one as well. (Although a depression gene has yet to be identified, researchers believe there may be several.)

Clinically depressed people can’t just “pull themselves together,”

anymore than people suffering from excruciating physical pain can just wish it away.

Women are statistically twice as likely to be depressed as men; however, this may be underestimated because men are less likely to seek psychiatric or medical help, which may be why men are four times more likely to commit suicide. Men are also more likely to try and mask their pain with anger, irritability, and alcohol abuse. This is depression: the ultimate passion killer

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likely why almost every female respondent who claimed her husband was depressed also said he was angry. There is a high correlation between substance abuse and depression, and, in males, the risk of heart disease is doubled.

Again, professional help is imperative.

ANTIDEPRESSANTS AND LOW LIBIDO

As mentioned in chapter 2, in 2005, 118 million prescriptions were written in the United States to counteract depression. Antidepressants can, literally, save lives. Unfortunately, many have the possibility of adverse side effects, all of which your doctor should discuss with you.

One of these is ironic: antidepressants may significantly lower an already low libido. In addition, they may cause erectile dysfunction, inhibited ejaculation, and/or anorgasmia (inability to achieve orgasm).

New medications to counteract depression are being developed on a regular basis, and scores are already on the market. Some (for most patients) have minimal sexual side effects, or none. A psychopharmacologist or psychiatrist determines the correct drug or combination of drugs by taking a medical history, through empirical trial and error, and/or with urine analysis. (A psychologist can diagnose, but cannot prescribe medication.) This is a highly specialized and individualized undertaking. There is no such thing as “one size fits all” when it comes to the vast number of different drugs available to counteract depression; the expertise of a specialist is important. In addition, the correct drug or drug combination may alleviate symptoms but not re-move the reasons for the depression. This is why counseling is usually recommended in addition to the medication(s).

Drugs known as SSRIs (selective serotonin reuptake inhibitors) prevent the removal of the neurotransmitter serotonin from the system, and thus, in theory, elevate mood. Some common brand names are Prozac, Zoloft, Paxil, and Lexapro. It may be necessary for a patient to take 122

HE’S JUST NOT UP FOR IT ANYMORE

these; they may be the ones that work. However, they also are the drugs most likely to result in libido lowering and other negative sexual side effects. If the patient experiences those side effects (about 40% do), other medications may be substituted or the dosage may be reduced.

A newer group of drugs add norepinephrine and usually result in less of a negative effect on libido. These are referred to as SSNRIs (selective serotonin norepinephrine reuptake inhibitors). Some name brands are Cymbalta and Effexor. The side effects most likely to occur with these drugs are nausea, dizziness, and dry mouth, although erectile dysfunction and inhibited orgasm have been reported.

NDRIs (norepinephrine dopamine reuptake inhibitors) balance and boost those two neurotransmitters in the brain. The brand names are Wellbutrin and Wellbutrin XL. There seem to be limited adverse sexual side effects for NDRIs, although in a 2001 study, 20 percent of men taking the drug experienced some dysfunction. (Interestingly, the drug is currently being researched as a libido enhancer for women.) Numerous other drugs are available, all with different molecular structures and effects on the brain—far too many to discuss here.

We have touched briefly on the most widely prescribed. We want the reader to be aware that there are options, that it is necessary for an expert to help men choose the correct option, and that it is important to ask questions about possible side effects. Your family doctor may help you navigate your choices of mental health specialists, and give referrals, but is unlikely to be able to adequately sift through all of the possible drugs to make the best choice for you or your spouse.

It is important to remember that clinical depression is a serious and potentially fatal disease and should be treated as such. A depressed person’s lack of libido is in no way a reflection of his feelings for his partner; it is a result of the illness and/or, quite possibly, the medication to cure it.

It is worth noting that of the men who strongly agreed they were depressed, 46 percent said they were taking medication that lowered their libido.

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Not surprisingly, 82 percent of the men who took what they perceived as libido-lowering medication for
any
physical condition reported erectile dysfunction, rapid ejaculation, or difficulty achieving orgasm.

CAN ANTIDEPRESSANTS CAUSE

RELATIONSHIP BLUES?

SSRIs may do more harm to a relationship than just ending desire.

Antidepressants may diminish feelings of romantic love and attachment, possibly even making a person feel that he is no longer in love.

And if patients are often not told about the potential loss of libido, they are just about never told about the possible inability to experience romantic love. Anthropologist Helen Fisher, who has done extensive research on the chemistry of love, told us that when SSRIs elevate the level of serotonin in the synapses of the brain, they suppress the dopamine circuits. These are the circuits that are activated when you fall madly in love. They’re what make you want to be with your beloved every moment, and despair if you’re not. They are also what cause you to sexually crave your new love with an intensity that will rarely, if ever,
Antidepressants may diminish feelings of romantic
love and attachment.

be recaptured after those first few months or years. Dr. Fisher believes that if you elevate serotonin, you tamper with the brain system that allows you to fall in love and stay in love. She states: “We know that the reason people take SSRIs is to blunt the emotions and to curb obsessive thinking and [these] are both central characters of romantic love. So, as you take the SSRIs you’re blunting the emotions, you’re 124

HE’S JUST NOT UP FOR IT ANYMORE

suppressing the dopamine circuits, and you’re trying to kill obsessive thinking. All three of those are primary to romantic love.”

Thus, depression may lower libido, and so may some antidepressants. In addition, these same libido-lowering SSRIs may prevent a person from experiencing romantic love. That person may actually

“fall out of love” while taking the medication, and have it come flood-ing back when weaned off the drug. These drugs may be necessary and have a positive result. At the same time, there may be some surprising, and not so positive, unintended consequences.

As far back as the 1955 musical
Silk Stockings,
Cole Porter had his beautiful Russian protagonist Ninotchka sing about desire with the cool skepticism of a communist agent, which she was. When the handsome American lead says he is madly in love with her, she cynically proclaims “It’s a chemical reaction, that’s all.” Needless to say, she falls passionately in love by the time the curtain falls.

It may be odd to think of love and sex in terms of neurotransmitters, hormones, and chemical reactions. But recently, there has been much evidence of “chemistry” behind romance—lust hormonally driven by androgens and estrogens, the euphoria of new love by high levels of dopamine and norepinephrine and low levels of serotonin, and the serenity of long-term commitment by hormones oxytocin and vasopressin. It is therefore possible that unless a couple works hard at keeping those dopamine and norepinephrine levels high and all the other chemicals in balance, desire will fade.

Many other drugs have potentially negative sexual side effects, including but not limited to medications for blood pressure, heart disease, diuretics, and even certain antihistamines. Twenty-six percent of the female respondents agreed that their partners were taking medication that lowered their libido; 21 percent of the men said this was so. If you or your partner suspect a medication is causing sexual or any other type of problems, talk to your doctor. It may be possible to decrease dosage or switch to a different product.

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ERECTILE DYSFUNCTION:

THE SILENT PASSION KILLER

I just don’t seem to do it for him. In addition, when we do have sex, he isn’t hard; this embarrasses him, so he doesn’t even try anymore. (Female, 36)