Deep Blue

Friday, December 21, 2012


Dear Patrick: I have struggled with depression off and on since I was a teenager. My doctor is recommending anti-depressant medication. Other things I tried (cleaning up my diet, doing yoga, meditating, running, keeping a journal) have not helped.

            When I have tried these pills in the past, I find that they affect my libido and my ability to perform. Do you have any tips on how to keep your relationship going while you pursue treatment? I hope the medication will make it easier for my girlfriend to stay with me, but I worry that she will get bored and give up on me if we stop having sex for a few months. I hope I can take the medication temporarily, and then stop it when I feel better.

            When I am really depressed, I don't want to have sex anyway; it isn't much fun, and I can't seem to stay aroused. At least if I am taking pills, I am trying to get better, but I don't know if that is enough for her


I recommend a multi-pronged attack on this problem. First of all, I want to validate the fact that people with major depression are often unable to make it go away of their own accord. Genuine depression cannot be lifted by force of will. Exercise and diet are good things to improve, but they may not get at the root cause of your depression. Unfortunately, we still don't know enough about why some people are stuck with a permanent, serious case of the blues. This makes it hard to devise foolproof treatment. We do know that depression is accompanied by an imbalance of brain chemistry, and some medications seem to make this better for some people. So this is a legitimate intervention that merits experimentation.

            Discuss your sexual concerns with your doctor. Explain that you are in a relationship which is already under stress because you don't feel well. Some medications (or combinations of them) are less likely to affect your libido and performance than others. Some drugs need to be taken for a certain amount of time so they build up to an effective level in your system. Keep track of that figure so you give one medication a fair trial before you give up or switch to another. Don't jinx yourself by assuming that every anti-depressant will cook your noodle beyond al dente. Some guys find that when their depression is lifted or gets even a little bit better, sex becomes more of a priority. Need returns, and appetites are once more enjoyable to satiate. If you do encounter sexual problems, go back to the doctor with that feedback. There are medications for erectile difficulty which you might want to try. Vacuum pumps have also been developed that help some men to achieve an erection that is suitable for intercourse.

            Make sure that you explore all your erotic options, if your partner is willing. Some guys find that they can get an erection even on antidepressants if they get the right penile stimulation. A good hand job or oral sex can do the trick. If your girlfriend is willing to go down on you, you should, of course return the favor. (Or you might just want to go down on her even if she doesn't like sucking cock.) Some guys find that using a vibrator helps them to get it up. If not, it can be fun to use the vibe for her pleasure. (Sex toys personify the great rewards of learning how to share.) Some women report that men who don't get rapid, rigid erections are better lovers because they slow down, pay attention to the woman's whole body, and learn how to stimulate her clitoris instead of just focusing on penile penetration.

            Another important prong in this plan is to combine therapy with the medication. Research has shown that this is the most effective way to treat depression. If you feel bad, there's probably a reason. Being able to talk about the past and negative patterns in your life can be remarkably helpful. An objective outsider can validate your experience and perhaps highlight solutions that will not occur to you if you are stuck in a loop of negative thinking, alone at 3 a.m. and listening to sad music. If you feel uncomfortable with traditional talk therapy, this is not your only option. Cognitive-behavioral therapists stay largely in the present. They treat depression as a learned (if maladaptive) response that can be changed by identifying harmful thoughts and deliberately replacing them with cognition that will support you in creating a happier way of life. Some people feel that depression is almost a birth defect. But even if this is true, cognitive-behavioral therapy still works because thinking, feeling, and behaving in new ways rewire the brain. We can literally change brain chemistry through changing attitudes and activity.

            This could be a time to reconnect with yourself and accept yourself at a deep level. Any time people have concerns about sexuality, I recommend deliberately including fantasies and self-stimulation in your regimen. This is a powerful way to remind yourself that you need kind treatment. It's also a good way to recalibrate your sexuality. Could be that difficulties are stemming from not getting what you really want. As we continue to age, learn, and grow, our sexuality often changes, so if we don't remain open to change (and continue to examine the state of our being), we can wind up in a stuck and frustrating place because the things that used to work are no longer red-hot buttons. Erectile problems are assisted by masturbation, especially if it is okay to include this in partnered sex. That way you know you can always fall back on a form of stimulation that has the greatest chance of keeping you hard.

            Some guys fear that masturbation will take energy away from partnered sex; this is not necessarily true. You don't want to jack off three times right before a sex date with your girlfriend—obviously. Retail success may depend on location, location, location, but good sex is often a matter of timing, timing, timing.

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