What do mental illness and sex have to do with each other? Quite a bit, actually, both in terms of the illness itself and the medications to treat it.
Let’s start with meds. Antidepressants that affect serotonin (such as the SSRI class) can do a real number on sex drive/function. This tends to be mediated by a particular type of serotonin receptor known as 5HT2a, which means that some antidepressants that affect serotonin are less likely to cause this problem, such as mirtazapine and vilazodone. Another option is something like bupropion, which doesn’t act on serotonin receptors. I talk more about antidepressants in my psych meds 101 post.
Antipsychotics can also be problematic (more on this in psych meds 101). Antipsychotics work by blocking dopamine receptors, but if there is too much dopamine blockade along a certain pathway in the brain (the tuberoinfundibular pathway to get really geeky with it), you disrupt levels of the hormone prolactin, and boom, you get sexual dysfunction. Different antipsychotics vary in their potential to affect prolactin, so having sexual side effects with one doesn’t mean you will necessarily have the same effect with another medication.
Some mood stabilizers such as valproic acid are quite teratogenic, meaning they’re likely to cause fetal malformations. This means reliable birth control is something that has to be considered along with everything else that goes with a mood disorder. This is easier said than done for a woman in the midst of a manic episode.
Then there is the illness itself. As a nurse, I’ve spoken to clients who are deeply ashamed of reckless sexual behaviour they’ve engaged in while manic or psychotic, things that under normal circumstances they would never even consider doing. At the other end of the spectrum, depression can shut down sex drive and sexual function. These are issues that it’s not easy or comfortable to talk about, so they tend to hide in the shadows, but they can have a huge effect both on an individual level and on a relationship. I don’t have any great insights or answers to share with you, but I do think it’s important to talk about it. It’s also worth considering sex as a potential barometer of your mental health. I remember at one point when my depression was starting to improve I met a man who actually made me feel turned on, and I thought wow, this is the most normal thing that I’ve felt in a very long time.
I’ll close with a quick word on autoerotic activity, to borrow a term from Seinfeld. Orgasm releases happy hormones like oxytocin and dopamine, so it seems to me a little bit of self-love once in a while can’t hurt. And really, we all deserve some self-love, whether it’s in an erotic sense or not.