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What to Do When the Cost of Getting Healthy Is Your Sex Drive
We’ve all seen those ads for prescription drugs—you know, the ones featuring attractive people relaxing in bathtubs and playing on boats, followed by a rapid-fire list of side effects ranging from dry mouth to, you know, death. There are even commercials for drugs that curb the side effects of other drugs. Just because our world doesn’t feel enough like a weird hall of mirrors already.
And these ads certainly seem to be doing the job; people definitely seem to be asking their doctor if drugs are right for them. The Mayo Clinic estimates that, in the United States, 70 percent of the population is on at least one prescription drug. Many of those are for conditions like diabetes, high blood pressure, or yes, erectile dysfunction.
However, close to 20 percent of folks take a drug for psychiatric reasons. Despite advances in research, psychiatric drugs still operate in somewhat mysterious ways. For many people, the key to finding a pharmaceutical solution to a mood disorder is trial and error. You pretty much have to experiment with different combinations and dosages to determine which drug can offer you the most relief while causing the least intrusive side effects.
It’s an imperfect system and one that can be (read: totally is) very frustrating, and this can be especially true for drugs that manage depression: If you do find the right drug, one of the ways it works is to adjust the brain’s use of serotonin and norepinephrine, two of the neurotransmitters that control feelings of alertness and arousal. Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. Locher C, Koechlin H, Zion SR. JAMA psychiatry, 2017, Oct.;74(10):2168-6238. Changing the flow of these hormones in the brain can help regulate mood and thought, as well as reduce overall feelings of exhaustion, frustration, and other negative feelings. Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review. Lee Y, Rosenblat JD, Lee J. Journal of affective disorders, 2017, Nov.;227():1573-2517.
You might also like Unfortunately, they can also reduce (or completely obliterate) your sex drive and ability to finish the job. And while drug side effects are often viewed as par for the course, when it comes to seeking help for mental health issues, they can feel like a making a deal with the devil. In order to get relief from internal chaos, you sometimes end up swapping out a part of life that makes you feel, you know, alive.
Fixing Depression (but Freezing Your Libido)
A 2010 study found that sexual side effects were pretty common and that they had a "significant impact on the person’s quality of life, relationships, mental health, and recovery." Well, sure. When you’re experiencing stuff like a lack of arousal, decreased sensation, decreased pleasure, and absence of orgasm, that probably negatively impacts your quality of life. And around 70 percent of folks taking SSRIs like Prozac and Paxil report some sexual dysfunction.
What, exactly, does that mean?
"Sexual side effects can range from mild to marked," says Dan Goodman, M.D., of The Midtown Practice for Psychotherapy and Psychiatry. On the more mild end, that might look like "a slight decrease in libido, a decrease in arousal, or a delay to orgasm." On the more dramatic side, "this might include more significant and potentially complete loss of interest in sex, an inability to get an erection, or absence of orgasm."
Which means that if you’re on an antidepressant, you can also expect that you may experience at least a mild downturn in your sex drive. This can be frustrating for everybody involved, but what’s even more frustrating is the feeling that there’s nothing to be done about it.
What You Can Do
Sometimes it seems like we have to brush off a low libido as the cost of doing business when on SSRIs. In fact, many people (including doctors) assume it’s what they have to live with, and many psychiatrists don’t think to bring it up until the patient does.
But when a lowered libido is the reason that a person goes off the drugs that are otherwise helping them immensely, this can be a serious issue. As many as 30 percent of patients stop taking their meds, and the "minimization of antidepressant-associated sexual dysfunction could be an important factor in successful treatment and health outcomes." Which basically means that if taking a drug means someone can’t get it on, they probably won’t stay on it. Which... sounds about right.
To avoid patients abandoning treatment altogether, a lot of psychiatrists are willing to work with patients to find, if not a solution, then at least a compromise.
"Sometimes a dose reduction (or brief one or two-day ‘holiday’ from medication) improves the problem, but for other patients, sexual side effects don't remit until the medication is stopped," Goodman says. "Some people with side effects may choose to continue medication anyway, as benefits are sometimes very meaningful and may outweigh the side effects. But weighing the importance of therapeutic benefits against side effects is always a highly personal and individualized decision."
That can be a tall order, though; often, trying numerous doses or different drugs means a lot of office visits, a lot of drug costs, and really good insurance. Many folks don’t have that kind of privilege, and as a result, have to live with the crummy side effects just to limit their overall time and cost commitment. But if you do have the opportunity to change this up, it’s worth getting past the embarrassment and talking to your doctor about trying something new.
Nicole Prause, Ph.D., a sexual psychophysiologist who studies these exact side effects, says the most important thing is to be very frank with your healthcare provider—after all, they’re medical professionals.
"Be straight, be clear," she says. "They know exactly why you are asking, and are used to adjusting for it."
These side effects shouldn’t surprise your doctor, Prause says, and they should be willing to work with you—especially if it means not going off your medication. But there are also cases when doctors may not immediately weigh these consequences.
"There are antidepressants that are specifically designed not to have those effects, but patients may need to make clear that they want those," she says. "For example, bias may cause a doctor to assume an older adult is not concerned with orgasms."
Prause recommends asking your doctor in a straightforward manner what side effects you can expect, and asking candid questions, like "Would you prescribe something that is not going to make it difficult for me to orgasm?"
And Talk With Your Partner Too
Additionally, this is a conversation that people in relationships should consider having with their partners—ideally before going on a new medication. Prause advises that folks "might warn their partner that this is a common effect... and is not an indicator of their skill."
Removing the focus from orgasm can be useful, she says, because for many couples, sex is still enjoyable even without the grand finale.
"It is not unreasonable to ‘practice’ not having an orgasm intentionally before going on antidepressants, as this might help the couple remember that they have been able to make that choice and still enjoy other activities."
The unfortunate reality of sexual health is that often, both in the medical community and among those who are going through treatment, it’s viewed as a nice bonus and not a necessity of life. But if you’re willing and able to fight for your right to orgasm, it can be worth your while.
Hanna Brooks Olsen is a writer and political consultant who also has an exercise habit. She enjoys plant-based proteins and working out in t-shirts with snarky phrases on them. You can follow her on Twitter @mshannabrooks.
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A Pilates Workout With Little Moves and Big Results
Join Cody for $20 a month and access more than 2,500 workout videos to establish an at-home yoga practice, challenge your strength, and up your endurance with HIIT and cardio exercises!
If you tend to get in workout ruts and overwork the same muscles, this routine, which targets hard-to-reach spots, is just what you need. Although they may be tiny, the low-range moves involved sure are mighty. And you'll feel it from head to toe in a little over 20 minutes.
You might also like You'll start with a killer series of weighted hip lifts. From there, the instructor will work your abs with elevated crunches, leg extension crunches, bicycles, and leg crosses. Finally, you'll move on to kneeling single-leg lifts and crossed-leg lifts that will have your lower body burning. You’re definitely going to want to make it to the final 4 minutes where you recover with a full-body stretch. Trust us, your muscles will thank you tomorrow morning.
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I'm Handling Death Without Faith, but It Really Sucks
I put my dog to sleep yesterday.
If you haven't had the experience, well, it's terrible. It's long and drawn out, like a nightmare in slow motion. There’s a calm, clinical explanation of the procedure, followed by paperwork, then decisions you have to make when you can barely breathe, much less think. There’s being asked questions like, Do you want his ashes?
No, I have my father's ashes, I said. I don't want any more ashes.
I was holding my dog's lifeless body as the doctor went for the door. I'll give you a few minutes, she said, and I cried at her, Ohgodpleasedon'tleavemealonewithhim. I watched his slack face fall toward me as she gently lifted him from my arms.
The whole time, I thought about my dad. Trying not to let my limbs spontaneously fall apart, I squinted at the florescent lights, whispering, Please please just give me a sign please let me know you're here let me know I'm OK please please please.
I wish I could tell you I felt something.
I left the vet clutching my dog’s leash. They kept his collar; I wanted to go back and get it, but I couldn't make myself. As I walked to my car, a woman called out to me, waving a bunch of tissues in her hand. When she saw my face, she burst into tears and told me how sorry she was; she'd been there before. It's horrible, she said. She put the tissues in my hand and gave me a big hug. He was right there with you the whole time, and he's with you still. He will always be with you. You will see him again. He's crossed that rainbow bridge; he's in a better place.
You might also like I wish I could tell you I felt something.
I wish I could tell you I was surprised, or disappointed, that my dad didn't show up last night. Truthfully though, I don't feel my dad anywhere. I never have. I feel like other people are more sure of my dad's continued presence in my life than I am; I get told all the time that He's still with me, he's smiling down on me, he's proud of me... I know these phrases are meant to bring comfort, but the truth is that I long for the sort of certainty they evince, and I'm just not equipped for that kind of faith.
Ghost sightings run deep on my mom's side; I grew up listening to stories about how, during the war, my grandmother evacuated her house because she was warned by her long-dead grandfather; there was a bombing minutes later, and every window of the house was blown in. And she used to chat it up with her mother-in-law in the coat closet, relaying messages in Yiddish to my grandfather that she couldn’t possibly understand because she didn’t speak it.
Then there’s her mother, my great-grandmother, who was pulled from the curb just as a car sped by; that night, she was visited by her dead father, who warned her to be more careful, as he couldn’t be around all the time to take care of her. I'm not sure why this talent, or gift, or whatever, skipped my brothers and me. Maybe we're too skeptical, we weren't raised in a faith, we were never asked to believe anything for which there was no proof—maybe you really need to be hard-wired for that sort of stuff from an early age.
My dad lives on in other ways. And for the most part, it is enough. He’s there in the light-hearted jokes we can now make at his expense, in my terrible Korean accent, in the ways in which my brothers uncannily resemble him both in stature and demeanor. When I am pushing my body to its physical limits, when I can't stop fighting a painstakingly uphill battle, when I pass his terrible jokes on to my students, I know I am my father's daughter. When I create art, he would say that, too, is from him, but let's keep this between us—he couldn't draw for sh*t.
I don't know what's after all this.
I hope my little boy lost is somewhere nice. I hope there's a rainbow bridge that leads to lots of cheese.
In the end, maybe we don’t all need faith. Maybe love is enough religion, for me: I love my family, I love my inimitable sisterhood of friends, I love my job, I love tuna sandwiches served with a half sour pickle, I love the adrenaline rush I get in an airport terminal, I love a quiet day of napping and reading and painting and watching RuPaul's Drag Race. Maybe I can hang my little heart on all that love, and hope the rest works itself out.
I still wait for my dad to appear in a closet and tell me something awesome, or just normal, just him. I had a dream last night that Dad hugged me and told me he was sorry. Did he visit me? Or was it the Xanax and glass of chard I downed when I got home from the vet? I guess the point of faith is that you don't need proof, but since I don't have that gift, I'll just say that it was nice to see his face.
Mikayla Park is a teacher/nonprofit creative person residing in the slums of Beverly Hills. Find her, and her two charming rescue dogs, everywhere at @mikaylapark.
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Are Any of Those "Healthy" Sugar Alternatives Better for You?
Sugar has gotten so complicated. There’s plain old white cane sugar, raw sugar, brown sugar, coconut sugar, beet sugar, agave, honey... every month it seems like some new, allegedly better-for-you sugar-based sweetener debuts on the market. Still, while there are many different kinds of sugar-based sweeteners that are marketed as healthy alternatives to white sugar and high-fructose corn syrup, they don’t necessarily live up to the hype.
Whole Fruit Vs. Added Sugars
Summer Rayne Oakes, certified holistic nutritionist and author of SugarDetoxMe, says that before digging into the healthy sugar myth, we need to draw a line between sugars that are tied up in fiber, like the sugar in an unprocessed piece of fruit, and "free sugars" that are added to foods to make them sweeter.
Because the fiber is stripped out when sugar is processed, the concept of any type of plant-based sweetener being more "natural" than any other plant-based sweetener really depends on how you choose to define the term. If you define it as simply "coming from nature," pure white cane sugar is, in some ways, just as natural (although significantly more processed than) maple syrup, honey, or agave.
Cane sugar is produced by chopping up sugar cane, extracting the juice, boiling it down, and then (for white sugar) removing the molasses. After that, it is processed into those pure white crystals we love to hate and hate to love. For turbinado or unrefined brown sugar, identifiable by the larger and less evenly sized crystals, some of the molasses is left in, and it skips the final refining process. For refined brown sugar, molasses is added back into the refined white sugar after it is processed.
The methods of production for other free sugars don’t vary greatly from this model. Just as with cane sugar, coconut sugar and maple sugar are made by pulling the sap out of a plant and then boiling the sap until the water evaporates. Maple syrup and agave nectar are made in the same way, but the boiling process is stopped when it reaches the desired consistency. Even honey goes through a series of steps to take it from plant nectar to sticky sweet, although it’s done by bees rather than humans. Bees collect the less-concentrated liquid nectar, bring it back to the hive, process it, and eventually, it becomes honey. We use machinery, and they use their mouths and stomachs, but the process isn’t all that different.
Types of Sugar
There are a few main types of sugar that can be found in everything ranging from the banana on your kitchen counter to the processed sugar in your favorite pastries. There are the monosaccharides (one-molecule sugars), glucose, fructose, and galactose, and there are also disaccharides (two-molecule sugars), called lactose, sucrose, and maltose. We’re going to focus here on the sugars that are used as "added sugars," rather than stuff like lactose, which occurs naturally in dairy products but isn’t really added to any commercial products except infant formula. Because of this, lactose is not of great concern in the added sugar debate.
1. Glucose
Glucose is food for our cells, and our body produces it naturally. It is also what is measured when people talk about a food’s glycemic index, a number that indicates the impact a food will have on blood sugar levels within two hours of consumption. Balancing blood sugar can be a difficult task, especially for people with diabetes, but a well-functioning system knows what to do with reasonable amounts of glucose when it arrives in your stomach. Whole foods that are high in glucose include dried and fresh fruit, as well as also grains, beans, nuts, and vegetables like sweet bell peppers.
2. Fructose
Fructose is the sweetest-tasting of the natural sugars, can only be broken down by the liver, and much of it is turned into fat. Since it’s in the liver rather than going straight into the bloodstream, it takes longer for the human body to process fructose and, subsequently, it doesn’t cause the sudden spikes in blood sugar that other forms of sugar can trigger.
Because of this, sweeteners high in fructose have often been lauded as "healthy." But Robert Lustig, M.D., professor of pediatrics at University of California, San Francisco and director of the UCSF Weight Assessment for Teen and Child Health (WATCH) program, warns that fructose "floods the liver, creating fatty liver disease and insulin resistance."
And that’s just the start of it: High fructose consumption has been linked to gout, weight-management problems, and a long list of other ailments that can take a while to manifest but that are very serious when they do.
3. Sucrose
Sucrose is made of one molecule of glucose and one molecule of fructose, and because it has the properties of both, it goes through the processes of both, impacting both the blood and the liver. While sucrose exists in many fruits, vegetables, and natural sweeteners, table sugar is pure sucrose, or 50 percent glucose and 50 percent fructose, with nothing else (like fiber) present to slow down absorption. The glucose half of sucrose hits your blood quickly, spiking blood sugar levels, while the fructose half makes its way through the liver, causing the long-term problems Lustig warns of.
So Are Those Alternative Sugars Really Better for You?
The high-fructose products being sold as alternatives to white cane sugar are often marketed as nutrient-rich, but they don’t contain nearly enough healthy vitamins and minerals for their health benefits to outweigh their health consequences. Coconut sugar, for example, has trace amounts of minerals like calcium and iron, but it is also up to 80 percent sucrose. The glucose half of the sucrose in coconut sugar contributes to its relatively low glycemic index (GI) score, which has been reported as 35-42.
You might also like However, the glycemic index measures the short-term impact that a carbohydrate food has on a person’s blood sugar, not the long-term health impacts fructose has on the liver. In the end, coconut sugar is still 35 percent fructose. So while its GI score is lower than sugar (which has a GI score of 63-69), that doesn’t necessarily mean coconut sugar has earned a stamp of healthfulness.
Consumption of unfiltered and unpasteurized raw honey has been tied to weight management by natural wellness folks (and has been shown to be antimicrobial and anti-inflammatory, as well as to potentially provide allergy relief). Birch pollen honey for birch pollen allergy--a randomized controlled pilot study. Saarinen K, Jantunen J, Haahtela T. International archives of allergy and immunology, 2010, Dec.;155(2):1423-0097. But honey still has a GI of anywhere between 55 and 74, and honey is still 82 percent sugar, and the majority of that is fructose.
Agave is specially marketed as a healthy alternative to white cane sugar for people concerned about their blood sugar levels because it is so high in fructose, as opposed to glucose; agave is about 84 percent fructose and 71 percent sugar. But there are potentially scary long-term consequences of high fructose consumption that are often overlooked (and are currently not very well understood).
Becca Rosencline, a certified holistic health coach, likens the marketing of alternative sweeteners like agave, honey, and maple syrup to the way hybrid vehicles have been marketed. Claiming that a non-cane-based sugar is healthy, she says, is "the equivalent of saying that a hybrid car is good for the environment. In reality, it’s not contributing positively, it’s just impacting the environment less negatively."
Justine Horne, a registered dietitian currently working toward a Ph.D. in genetics and weight management, agrees that we shouldn’t be buying into any of the healthy sugar hype. "At the end the day," she says, "research has consistently shown that all added sugar has essentially the same impact on our overall health: That’s right, maple syrup and honey are not healthy alternatives to refined white sugar or brown sugar."
Horne recommends that people limit their consumption of added sugar to less than 5 percent of their total calorie consumption, which is half of the USDA Dietary Guidelines maximum limit of 10 percent and less than one-third of the added sugar the average American consumes on average daily. It’s not all about numbers, though. Each person is different, and every diet should be tuned to our specific needs.
Oakes, Rosencline, Horne, and Lustig all advocate for the conscious cutting out of added sugar in foods and drinks, as well as a decreased consumption of fruit juices and smoothies. Instead, they agree we need to put an increased focus on finding sweetness in whole foods like fruit, which metabolize much more slowly than pulverized, pureed, or otherwise processed fruit products and doesn’t overload the liver.
The bottom line: Just because a label says "natural" doesn’t mean it’s any better for you, and trading one added sugar for another isn’t necessarily going to solve the problem. Processed and added sugar isn’t all the same, but none of it should be a huge part of your diet.
Pippa Biddle is a writer interested in culture, complex systems, and making sense of the world. Follow her on Twitter @PhilippaBiddle.
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