Five Things to Keep in Mind in Bipolar Sexual Relationships

Patient Expert

Following is a longer version of my slideshow, Five Things to Keep in Mind in Bipolar Sexual Relationships, which in turn is based on six recent posts here at HealthCentral on sex and bipolar ...

Ah, Valentine's Day, when our thoughts turn to love - and lust. When it comes to sex, think of bipolar as a force-multiplier, as much a turn-on as a turn-off. Oh, the possibilities. Alas, the risks. Following are five things to keep in mind, gleaned from life experience.

Hypersexuality does not equate to great sex.

Hypersexuality in mania and hypomania is well-documented, but we have no evidence that enhanced sexuality translates to being better in bed. What is reasonable to assume is that our ups - and even our downs - intensify our experience. In essence, our brains are reacting like photo-sensitive paper to light.

This, in turn, may ignite our partners and lead to the type of cosmic bliss you read about in Persian poetry.

But the very intensity of our world can also prove very frightening to our partners. Maybe we are so into our own needs and desires that we lose sensitivity to those of our partner. We fail to pick up vital signals. We fail to make the necessary adjustments

Thus, if we are prepared to brag about how bipolars make the best lovers, we also need to accept the fact that there are times when we are probably the worst.

Depression, not just mania, sets us up for risky sex.

The conventional wisdom is that we lose interest in sex when we are depressed. This is especially true in our "clinically dead but breathing" states where we are feeling too little. But we also experience intense psychic pain, which is about feeling too much, which in turn creates a desperate need for release. In this context, sex can be thought of as a form of self-medication such as alcohol or drug use, or as a risky behavior such as over-eating, especially if we fail to exercise good judgment.

A 2006 NIH-funded study of a large teen population found that those who were depressed were far more likely to engage in risky behaviors such as drug use and sex. The study corroborates earlier findings.

Thus both sides of the bipolar equation find us at risk, up as well as down. Psychic pain has that kind of effect on us.

Great sex can lead to bad decisions.

Whether it's sex or bipolar we are talking about, you can count on the fact that somewhere in the brain an over-active neural circuit is zapping way too much dopamine at a normally quiescent piece of cortex. Dopamine is vital to pleasure and feeling alive, but amp up the activity and we tend to make disastrous decisions.

One thing the brain science is emphasizing loud and clear is that our reason guides us far less than we think. This is not necessarily a bad thing. We may admire Mr Spock's logic, but his lack of emotion renders him unfit to perform all manner of duties, whether on the bridge of a starship or in the bedroom. Nevertheless, there are times when it is wise to listen to our inner Mr Spock, namely:

Sex and its after-glow have a way of turning even the chronically normal into honorary bipolars. This translates to two of you not thinking with your brains. In this state, it's all too easy for the two of you to confuse ecstasy with love. Or to forget about the person who really matters in your life.

Find a meds strategy that works for you.

Our sexual drive is a vital part of who we are and how we relate to those around us. In no way should we have to accept permanent eunuch-hood as the price of emotional stability.

Nevertheless, so long as we can see light at the end of the tunnel, it's wise to consider a number of short and medium-term trade-offs. Over time, we can work on getting our meds down to manageable levels. Unfortunately, our psychiatrists are very bad at explaining this to us, much less working with us on a six-to-twelve month strategy aimed at lowering our doses to less debilitating levels. Too often, we are left wondering:

Is this what it is going to be like for me - for the rest of my life?

Keep in mind: Some individuals welcome meds as a way of normalizing their over-active sex drives, which in turn normalizes their relationships and their lives.

Enjoy yourself. Enjoy your partner.

A lot of experiences in life are highly over-rated. Sex is not one of them. Engage mindfully and responsibly. In the words of the 13th-century Sufi wise man, Rumi:

The way you make love

is the way God will be with you.

Further Reading

Sex and Bipolar: A New Conversation

Sex and Bipolar: The Conversation Continues

More on Sex and Bipolar: The Dopamine (Dis)Connection

Sex and Bipolar: Can Depression Lead to Over-Sexuality? Challenging the Conventional Wisdom

Sex and Bipolar: Sparing a thought for the "Normal" Partner

Sex and Bipolar: Facing the Meds Challenge

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