Down and Out (of the Bedroom)

Friday, April 12, 2013

Question

Dear Patrick: I finally agreed to talk to my doctor about being depressed. (I lost both of my parents within months of each other, and I am only 25.) My partner was concerned because my libido had fallen to practically zero. The doctor agreed something was wrong and gave me a prescription. But warned me that the pills might have side-effects. Well, the side-effect is that I can't get it up at all. So now I don't even have the consolation of the occasional erection to remind me of who I used to be. I don't know how much longer my relationship can last without sex. The physical release was nice but it also just reminded us of why we were together and how much we cared about each other. I really need some help, and I know you won't write me a prescription.

 

Answer

Go back to your doctor or pick a new one. Explain that the side effects of the antidepressants are making your depression worse. Our understanding of the brain chemistry that causes depression is extremely primitive. The new medications help some people, but not everyone can tolerate them. A competent physician understands this and is prepared for a period of trial-and-error. With depression this severe, I think it is worth it to try more than one medication. Sometimes a combination of drugs will work better than one alone.

The doctor can also facilitate erections and sex, so your relationship (and your self-worth!) doesn't fall apart. If your heart is healthy enough, you may be able to take Viagra or a similar drug. If you don't want to take these medications or can't tolerate them, you can see if a vacuum pump will help you to get an erection suitable for intercourse. Some guys with depression are suffering from low testosterone, and a slight increase in male hormones can bring back the libido.

If depression is deep, it is probably a mistake to try drugs alone. A combination of drugs and therapy often work better than either modality alone. See if you can find a therapist you like and trust. Someone who is well-versed in cognitive-behavioral therapy may be able to help you to improve in less time than a different style of therapist. Or you may need a more patient approach that will give you time to talk through your experience of loss and sadness. Losing both of your parents at such a young age is a great misfortune. Anyone in your situation would be grieving. And I am willing to bet this is not the only thing that troubles you.

Depression isn't just an experience of feeling despair or hopelessness. It is also a self-contained world that reinforces itself and makes itself worse by changing your thinking. Depression alters our perception of reality. We may come to believe that we are more alone than we really are, and so it isolates us from loved ones who want to help. You can recognize depressed thinking because it has an all-or-nothing quality. Things are seen in extreme terms of black-and-white. People are either perfect or no good at all. And so are you. Therapy can help you to identify this downward spiral and get more in touch with reality. Yes, you face genuine challenges, but that doesn't mean you are a failure or that life is over for you.

If you have any spiritual convictions, this is a good time to remain in touch with your community of faith. Many a depressed person has found relief in their relationship with those who share their beliefs. Service to others can also get you out of the self-absorption of depression. If doing volunteer work is too much, have something you do each day to make yourself feel useful. This can mean doing the dishes, watering a plant, caring for a pet, or answering e-mail.

Somewhere along the line, you were given the beliefs that underlie your depression. Medication can't eliminate these feelings entirely, but it can give you a bit of a lift so you can start fighting back. This is a struggle to save your life. I think you know that. So do not harm yourself or others. If all else fails, go to sleep. You may wake up with increased energy, able to resist. Try to remember what you used to enjoy, what seemed beautiful to you, and what made your life meaningful. Allow yourself to have some form of those experiences now. You deserve to go on living, and you deserve to be happy. I hope you will get the help you need to survive this difficult period and create improvements in your emotional world. Sex can really help! I think your instincts are correct, so I'm glad to think that you will tell your doctor what you need. Medical and mental health professionals have no idea how you are doing unless you tell them. The good ones are always willing to listen and look for another solution.

 

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