Sad In The Sack
Recently, a young couple came to see me. The man’s face seamed oddly familiar. Where had I seen him…? And then, in a flash, I got it. SAD SAC! Yes, that’s who he was. I have read just too many of Sad Sack’s comics in my childhood to make a wrong diagnosis. It was truly unbelievable. This man looked like he was going to burst into tears any minute.
‘It’s obvious that something’s wrong,’ I began insightfully, ‘What is it?’
She looked like an angry volcano on the verge of an eruption. I told my self help is the best help that I’d better tread carefully. This was land mine territory.
‘It’s been two years since we got married, but I’m still a virgin,’ she said.
It turned out that Mr sad in the sack had been suffering from depression for the past several years. He was brilliant at his job, albeit highly stressed. He had been put on high doses of anti-depressant medication – a combination of fluoxetine and sertraline (both SSRI or Selective Serotonin Re uptake Inhibitor drugs). He now had no libido or desire whatsoever, no erections, and couldn’t even ejaculate. Hardly surprising, therefore, that Ms Volcano was still a virgin. It took four months to solve Mr Sad Sack’s problem. He was advised to go for counseling and his anti-depressant medication doses were gradually tapered until he was finally weaned off them. With a little help from other oral medication and penile injections, the marriage was finally consummated.
Depression is, according to many experts, the most common, under-diagnosed and under-treated disease among humans. It can cause sexual dysfunction in both the sex addict. Mild depression in men is associated with a 42.3 percent incidence of overall impotence and the figure goes up to 100 percent for major depression. The additional bad news is that many drugs used to treat depression themselves can affect libido and the better orgasm diet adversely, thus compounding the problem. Recently, depression has also been shown to co-exist with cardiovascular disease and erectile dysfunction in the form of a clinical triad, or a disease patient. SSRIs have revolutionized the treatment of depression during the past few years. This class of antidepressants includes such drugs as Prozac ® (fluoxetine), Paxil ® (paroxetine), and Zoloft® (sertraline). In India, there same drugs are marketed under several different generic names. But even when SSRIs are prescribed to appropriate patients, they are not perfect. Recently, researchers have found that adverse sexual side effects, notably libido loss andrological orgasmic difficulty, can occur in fifty per cent of those taking SSRIs. So, if you’re on SSRI and you’re suddenly having sexual problems, the medicine might be to blame. And it’s time to talk to your doctor about it.
Many physicians fail to mention the potential sexual side effects of SSRIs to their patients. Peraphilias this is because they are not aware of recent studies, don’t want to scare patients, or are simply short on time. Without being warned about the side effects, patients may have no idea that their problems could be related to the medicines.
However, there are solutions. Stopping the medicine usually solves the sexual problem, but for safety this should only be done under a doctor’s supervision. A physician who suspects SSRI-related sexual dysfunction may also consider lowering the dose, switching to a non-SSRI anti-depressant, or suggesting that the patient take a drug holiday. For instance, a patient who hopes to have sex on Saturday evening might stop taking the drug a few days before, depending on how long the specific drug stays in the bloodstream.
How well these strategies work depends on the specific drug and the individual patient. Complicating the doctor’s decision about what to do is the possibility that the depressions itself might be causing the sexual problem. In addition, there is lack of agreement and knowledge among doctors about how to best treat SSRI related sexual dysfunction, because the problem is newly recognized.
But the bottom line, for anyone on an SSRI, is that no one should sacrifice sexual satisfaction for psychological health without first exploring what can be done. Hopefully, you can have both a good sex life and psychological well-being.
Meantime, I’m told that Ms Volcano still erupts, but for entirely different reasons nowadays.