DR. HOOK- Sad or sexy? Depression meds offer bad choice

Louis Armstrong beautifully sang, "And I think to myself, What a wonderful world." Joan Jett wore tight black leather pants and strummed, "I love rock and roll." Nat King Cole sang the classic song, "L-O-V-E," which I might add I do a great rendition of on karaoke. Captain and Tennille won a Grammy for, "Love Will Keep Us Together." If I could write a song, it would be "I Love Antidepressants." I do! I sometimes wonder if we should put the antidepressant, Lexapro, into the tap water; maybe there would be world peace.  

   I probably will get a lot of criticism for saying I believe in antidepressants, but antidepressants have changed the lives of millions of people. When I say "changed," I mean in both positive and negative ways. To live a life without depression is like a summer breeze instead of a musty, cold dungeon. 

However, for some people who take antidepressants, there is an unpleasant side effect: sexual dysfunction. So, is it better to be depressed or better to be happy without sex? Can you put fun into dysfunction?

   Charlotte on Sex and the City was making out with a sex-addict, and he suddenly stopped making out. Charlotte was upset with him, and he confessed that he used to be a sex addict and totally crazy. However, he was now taking an antidepressant and felt better than ever– but no sex drive. Charlotte frowned and asked him if he preferred a life without sex, and he said, "Yes!  Want to rent a movie?"

   Shakespeare wrote something to the effect that alcohol provokes sexual feelings but takes away the performance– a Catch 22. Some patients with sexual dysfunction on antidepressants have more desire for sex. After all, they are feeling good now! The self-esteem is good, primary relationship is going strong, and the libido is running high. However, when it comes time for sex, having an orgasm is about as challenging as being a contestant on Fear Factor. It's even worse for some people, because it's like they've had a stroke to the genitals– no feeling at all.(Foreigner's song, "Cold As Ice," comes to mind.)

   For some people with sexual side effects on antidepressants, there is no desire for sex– at all. A candle-lit dinner, followed by a romantic play, soft whispers and romantic gestures– only to be followed by watching the 11pm news and then bed– for sleep, of course.  

   In a healthy relationship, sex is deemed to be important because it holds a special connection for the couple. The majority of my patients who have no libido on antidepressants prefer to be depressed off medication rather than have no libido. However, the romantic life of a depressed person can be as exciting as Masterpiece Theater.

   I'm a huge advocate of psychotherapy. In LA, suggesting psychotherapy to a patient is like suggesting she/he drink bottled water and exercise: great, dude! However, in other areas of the US, suggesting that someone see a counselor is like asking them to wear a straight-jacket and live in a padded-wall shelter.  

"No way, Doc! I'm not crazy. I saw One Few Over The Cuckoo's Nest."

   I tell my patients that psychologists are like mentors: they teach you coping skills and help you learn about yourself and how to deal with life. True, there are some very bad psychologists out there (talk to me!), but there are some very good psychologists who can broaden one's horizons and improve one's quality of life.

  Not everyone who sees a psychotherapist will be able to overcome depression without an antidepressant. And the majority of people on antidepressants do not have sexual side effects. However, for those with sexual side effects, antidepressants are as fun as Merry Go Round: pleasant, calm, but no excitement around the bend.