Sex and Bipolar: Facing the Meds Challenge

John McManamy Health Guide
  • This is the sixth in our series on sex and bipolar. In this post, we look at the issue of meds. MB speaks for a lot of us when he writes (in response to last week’s piece):


    Now that I am steady on my medications, I find my sex drive is lacking. What can I do to get it back?


    Likewise, Shelly (in response to an earlier post) recounts:


    Unfortunately I had an experience with my first med that made it impossible to have an orgasm - for over a year!  Think of what that does to an already fragile mind.  It took me another six months to work through the distorted thoughts.


    At a symposium I attended at the American Psychiatric Association’s 2004 annual meeting, “Sex, Sexuality, and Serotonin," Helen Fisher of Rutgers warned that serotonin-enhancing antidepressants blunt the emotions, including the elation of romance, and suppress obsessive thinking, a critical component of romance. "When you inhibit this brain system," she warned, "you can inhibit your patient’s well-being and possibly their genetic future."

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    Antipsychotics and mood stabilizers pose their own set of problems. 


    Clearly our sexual drive is a vital part of who we are and how we relate to those around us. In no way should what amounts to long-term chemical castration be regarded as an acceptable trade-off for our own emotional stability. But there is another consideration. As Maniclove writes:


    Since my first sexual experience as a teen I was always in need of sex. To the point of not being able to wait for my girlfriend ( whoever it was at the time ) to come over.  I would just do it with the nearest willing female I could find. The sex was always long and intense, group sex was normal. However, as I got older my sex drive ruined every relationship I have had to date. It would be nice to be in a traditional relationship with a nice lady that understands me.


    Clearly, a medication to slow down Maniclove a tad would be enormously helpful. Indeed, one of my readers (alas, I cannot track down the post), reported that thanks to her meds, her sexual drive has moderated to the point where she is now able to enjoy a healthy (rather than out-of-control) sex life.


    This brings us back to MB, who has been stabilized on his meds, but at the expense of his sex drive. I can almost imagine what he is thinking: Is this the way it is going to be - for the rest of my life?


    The reality is that treatment and eventual recovery involve a number of short and medium-term trade-offs. Unfortunately, our psychiatrists are very bad at explaining this to us. My guess is that oncologists do a much better job. Patients on chemo-therapy appear more than willing to endure the worst year of their lives, knowing there is a strong possibility their cancer will not return. Those of us on psychiatric meds have no such assurance.


    Small wonder the compliance rates for those taking cancer meds are much higher than for those of us on psychiatric meds.


    Imagine if our docs were to sit us down and tell us that there is light at the end of the tunnel, that as our own illness-management skills improved, we could gradually lower our meds doses and find ourselves returning to full function, perhaps leading the kind of lives our illness has always sabotaged us leading.


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    What would you be willing to trade for that possibility? (And I emphasize this is only a possibility - there are no guarantees.) Six months with no sex drive? A year?


    Your comments are most welcome ...

Published On: January 08, 2012