Let’s Talk About Sex (& Mental Illness)

What do sex and mental illness have to do with each other? Quite a bit, actually, both in terms of the illness itself and the medications to treat it.

Effects of medications

Let’s start with sex and mental illness medications. 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 specific type of serotonin receptor known as 5HT2a, which means that some antidepressants that don’t act at 5HT2a receptors 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 at all. I talk more about antidepressants in this Psych Meds 101 post.

Antipsychotics can also be problematic (more on this in Psych Meds 101: Antipsychotics). Antipsychotics work by blocking dopamine receptors, but if there’s too much of a dopamine blocking effect along a certain pathway in the brain (the tuberoinfundibular pathway, to get really geeky with it), it disrupts 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 would necessarily have the same effect with another antipsychotic.

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 when in the midst of a manic episode.

Effects of illness

Then there’s 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, yet they can still 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. You can read more in the post Master of My Domain? The Coles Notes version is that orgasm releases happy hormones like oxytocin and dopamine, so it seems to me that 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.