April and Amy -
I was listening the other day when you addressed the listener who wrote in about depression/anxiety and anti-depressants as it relates to sex and libido. I have a significant amount of personal experience in this area and thought I'd respond so that you might provide even more info to the listener if necessary.
First, my story. Married in a happy relationship now - can't say that for the entire 25, but SOOOOO glad we/I stuck it out. NOW, so worth it. More on that in another note if you'd like, as there is much fertile ground (pun intended) as it relates to sex - especially after 45 years of age. My bride couldn't stop eating, albeit relatively healthily with our first child. Wasn't able to get much of it off by the time of the second and over the years, despite a pretty good fitness regimen (along with raising two kiddos with a husband who travels for a living) didn't make much progress. At times, it was repulsing for me as much as I hate to admit it. Further, a priority on being a mom and growing up in a bit of a prudish/non-sexual environment led to a life with a significant lack of sex between us. I believe that and a stressful job that got overwhelming led to my first depressive episode about 6 years ago.
It was devastating. Couldn't go into my home office. Couldn't get out of bed, despite the fact I MIGHT have slept two hours - max. That's when doctors/friends began to help me. A thyroid check came back negative (but now know it likely was a part of the problem - another story but tightly related) and so it was onto the anti-depressant-finding rollercoaster (because the first - and often the 2nd, 3rd or 4th choices of med don't always work but it takes 6 weeks to know) began. It took several meds ( Paxil, Prozac, Cymbalta, Risperdal) and three doctors before suicidal thoughts finally subsided and I got some relief. Here's the sex/SSRI dilemma: You don't feel like having sex when you are depressed/anxious, and when the SSRI's help with those symptoms and you want to return to intimacy with your partner, you can't orgasm!!! I had a doctor tell me, "Well, that's a trade-off you just have to live with." What. The. Fuck. (or not-lol). There are multiple things one can do/try to alleviate the anorgasmic issues with SSRI's, but they are absolutely experimental as well. It's THE WORST. When I first experienced it, it was like a sledge-hammer to the penis. EVERYTHING happens as normal, and I do mean absolutely everything, until you are normally ready to go over-the-edge, and it just won't happen. You squeeze, push, tense, grunt, etc. and nothing. Your sack hurts - again, like normal. Just NO orgasm or ejaculation. Brutal. I have learned over the last few years, that if you are ridiculously aroused (and by that I mean spending more foreplay time), or you wait a long time between tries, it CAN happen. But there is no guarantee.
That's IF your libido returns. It's one of the main questions doctors ask to determine how you are doing. There is an acronym for the diagnosis questions (that I can't remember now) but libido is a big one. Depending upon the med, libido might still be supressed. Paxil and Prozac zapped mine, but Cymbalta (an SNRI - meaning it has both serotonin and norepinephrine protagonists) helped me feel better, but didn't kill my drive so much.
The thing that really helped me was a suggestion that my psychologist made to me: Make sex your focus. Now this just might be me, but there was something he picked-up on in our sessions that made him say that. So, I got several books on sex, women's anatomy, sex and psychology with women, and just began to make significant changes in our environment and my knowledge - and the drive came back while on the med. So, it can be done. It's like the saying goes that if you walk the walk, things fall into place as you'd want. So, why was this suggestion so revolutionary? Since my wife was a bit of a prude and mom-focused for so long, I had consequently back-burnered intimacy as well. Emily Morse, you guys, Sexy Marriage Radio and a series of sessions with a local sex therapist at a local church also helped tremendously. It opened up so many doors to information I didn't know existed, but mainly those things just made it easier for us to talk about sex. When I took her to the adult store for the first time, she almost choked (not literally of course since we didn't unpackage) on the size of the dildo's on the shelf. But, since, we have had some fun times at the store, including picking out her (our?) very first vibrator which has led to some very fun evenings (along with the first squirt) in our "love nest." Other things I have done: Red light bulbs in all bedroom lamps; red light string under the bed for a lower-light glow; bad-ass (sorry - I know you use it, but it's good) playlist on my phone; silicone cock-ring helps with some of the later-age flaccidity; testosterone shots weekly (doctor prescribed as "T" was very low); trying to add something "new" for each session; not being so hung-up on her initiating - if she does, great, if not, I'm fine getting the opening act going; getting some sexy outfits (for both of us) and her first garter (crotchless of course) panty set with fishnet stockings; kegel eggs; tie-down straps for the bed etc. Not all of these things were easy because I didn't know how she'd react (she told me one time early in our relationship that she felt like a "sex object"), but it's been very positive. She told me the other day that she really likes how I bring new things into the bedroom for our sessions. Woo hoo!!!!
So, my method for overcoming the lack of libido was to just go through the motions (despite not feeling like it immediately) until it came around - which it did. Reading anything about sex (not erotica - the biography on Masters and Johnson was helpful, for example) worked. Doctors have also told me that "drug holidays" can work (where one stops the med for a day or two before sex and then starts again - this worked for a bit until I started to get bad headaches on the second day off which killed my urge as well). I'd also suggest to your listeners that finding a person that they can talk through this with is VERY IMPORTANT. It is not, however, a quick fix. In fact, ALL things related to mental illness, in my humble opinion, revolve around patience, of which I was not blessed with, and it's a paradoxical problem. You are anxious, so you are less patient than you started out being, but you need patience to feel relief.
One of the next big things is to wean from my anti-depressant medication as I now feel it might have been partially mis-prescribed (since I've since been diagnosed with Hashimoto's hypothyroid disease). The good part is that, in my experience, sexual function returns quite rapidly (one reason why drug holidays work), but often the withdrawal symptoms (nausea, headaches, brain-zaps/whooshes, dizziness, heart-palpitations) often negatively impact libido. So twisted. I make it through all this stuff with a daily meditation practice.
One last sexy update you'll love (and could apply to the answer to my question): My wife has had several experiences with female ejaculation (I am not a fan of the term "squirt" - seems so juvenile; FeJac doesn't do it either) with me just recently for the first time EVER (I blame children, but who am I to say). In fact, the last one was soooooo good, it sounded like we stuck the business end of the vibrator (we use a corded Body Wand - great power and long cord) in a glass of water!!! We now use a towel!!! I've had to work a bit to ensure she's not embarrassed and to make sure she knows I think it's very, very HOT, because it is.