Sex & Mental Illness – The Difficult Truths, Part 1

This is a wonderful guest post by a good friend of mine in Australia. It’s a topic not talk about but widely dealt with. Please read and enjoy this first installment of the two part story.


Women’s magazines. We hear a lot about sex in certain types of women’s magazines (Cleo, Cosmopolitan, I’m looking at you). Invariably we are doing something wrong;

  • Why you’re not getting enough sex;
  • Have better sex;
  • How to blow his mind in bed;
  • Is he the right man for you?

And so on and so forth. So how come talking about sex and mental illness is still such a taboo topic when it seems that talking about  sex has become so common?

I don’t have the answer to that. But I can tell you one thing – mental illness and a happy fulfilled sex life takes A LOT OF WORK.

Let me repeat that – A LOT OF WORK.

I’m going to speak from my own experience here, but I know from conversations with others that I am far from alone in having experienced these problems. In fact the reason I’m writing is because I’m not alone, but there is still largely silence around the topic (although for a good article on the subject by the wonderful Nicole Lyons click here).

First, lets talk about mental illness symptoms themselves. Tiredness, lethargy, lack of motivation. Can you see how any one of these factors would lead to a decreased desire for sex? I can. Add into that the fact that people are trying to live a normal life with these symptoms; holding down a job, taking care of children, taking care of the house, relatives, you name it. At the end of the day, whenever that may be, you are going to be exhausted. Your mind feels fragmented, following up a thousand trains of thought and worrying about tomorrow. All you want to do is escape into the oblivion of sleep. Certainly you do not want to make the effort to have sex, either with your partner, and certainly not to go out on a date / night out looking for a connection. It’s all too hard (well, it’s not if you are male, that’s the problem).

Picture1

And how about anxiety disorders? They are amazingly common. Or eating disorders, also amazingly common. Both of these can lead to a distorted relationship with your body. You feel fat, even if you are skinny. Or you long for curves, even if other people are envying you your shape. You are worried to the point of obsession about what other people might think of your body, even if that person is a romantic partner who has seen you naked and adores the sight. Your mind tells you lies, but you don’t know they are lies. And as a result you pull away. You are scared of being judged, really ashamed of how your tummy hangs, or your thighs rub together, or that you don’t look like the guys in the gym. So what if that’s not the objective truth – it’s your truth in that moment. And so you turn away from your partner or lover, decreasing all kind of physical contact. The constant anxiety manifests in phrases like “how can anyone want me like this?” “What will they think about the way I look?” And if you do get as far as the bedroom, your anxiety is making you apologise and excuse yourself every step of the way. Hardly a turn on is it?

Picture2

Lets move on a bit. So you have a diagnosis and you’ve been given some medication. This is good, right? Well, lets be honest. It is certainly good that you are receiving treatment, but what about the side effects of the medications themselves? Yes, you’ve guessed it – not good for your sex life!

Picture3

Take Lexapro (Escitalopram). One of the most common drugs used to treat major depression and anxiety.  This quote from http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants/faq-20058104 expresses it well:

“Sexual side effects are common with antidepressants in both men and women, so your concern is understandable. Effects on your sexual function can include:

  • A change in your desire for sex
  • Erectile problems
  • Orgasm problems
  • Problems with arousal, comfort and satisfaction

The severity of sexual side effects depends on the individual and the specific type and dose of antidepressant. For some people, sexual side effects are minor or may ease up as their bodies adjust to the medication. For others, sexual side effects continue to be a problem”.

Great. So the very drug that’s treating your depression can take away not only your desire for sex but also your ability to orgasm. Trust me, that is a horrible experience.  Not only do you not want sex, but if you get to a stage where you are having sex it’s impossible to climax. So you try masturbation, perhaps with tried and tested aids, such as pornography or vibrators. And you can’t get aroused. Or if you get aroused you can’t climax. So what are the odds you are going to be taking an active interest in more and more sex when you know it will only lead to disappointment and frustration for both of you? Yeah that’s right, not good.

And its not just Lexapro, I chose that example because that example is exactly what happened to me. The same source also cites:

“Antidepressants most likely to cause sexual side effects include:

  • Selective serotonin reuptake inhibitors (SSRIs), which include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Selfemra), paroxetine (Paxil, Pexeva) and sertraline (Zoloft).
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and duloxetine (Cymbalta).
  • Tricyclic and tetracyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and clomipramine (Anafranil).
  • Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate). However, selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, has a low risk of sexual side effects.”

Wow. That’s a lot of stuff to think about. A lot of stuff that can seriously mess with your sex life. In a relationship this can escalate into a make or break issue so quickly that before you know it you are on a chasm, Staring into a separate and unknown future. And guess what? Yes that’s right, the worry of this decreases your desire even further.

Let’s be honest, this is especially if the other half does not really understand (and it’s an extremely difficult thing to talk about and a hard concept to grasp unless you have been there). It can make people feel rejected, unloved, cause arguments and unresolved tensions. And that’s assuming you know what is going on and are able to talk about it.  That’s assuming your sexual partner believes you that their own insecurities aren’t lying to them as well.

How much worse is it when that conversation cannot be had because of a lack of knowledge, understanding and simply information?  Not only do you not know what is happening or why, the issues mentioned above are magnified tenfold because of that ignorance.


So, this is part 1 – what can mess you up and why. Next, lets talk about what we can do about it. Stay tuned…

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