or most people taking antidepressants,
the risk of a diminished sex drive may seem like a worthwhile
sacrifice for the benefits from the drugs.
Up to 70 percent of patients on antidepressants report sexual
side effects, yet the number of Americans who take the drugs has
ballooned since Prozac was introduced in the late 1980's. Last year,
studies show, doctors in the United States wrote 213 million
prescriptions for antidepressants.
But what if the sexual side effects of the drugs, often
considered little more than a nuisance, had more serious
consequences, impairing not only sexual desire in some people, but
also the ability to experience romance? The question, which experts
are beginning to ask, was at the center of a talk this weekend at
the annual meeting of the American Psychiatric Association in New
York. Dr. Helen E. Fisher, an anthropologist at Rutgers, presented
findings that suggest, she says, that common antidepressants that
tinker with serotonin levels in the brain can also disrupt neural
circuits involved in romance and attachment.
"We know that there are real sexual problems associated with
serotonin-enhancing medications," said Dr. Fisher, author of "Why We
Love: The Nature and Chemistry of Romantic Love" (2004). "But when
you cripple a person's sexual desire and arousal, you're also
jeopardizing their ability to fall in love and to stay in love."
Dr. Fisher and a colleague, Dr. Anderson J. Thomson Jr., have
studied the brains of people in love and pored over research from
the last 25 years on the neurological basis of romance. Three brain
systems, all interrelated, the researchers say, control lust,
attraction and attachment. Each runs on a different set of
chemicals. Lust is fueled by androgens and estrogens. Attachment is
controlled by oxytocin and vasopressin. And attraction, they say, is
driven by high levels of dopamine and norepinephrine, as well as low
levels of serotonin. As a result, they say, increasing levels of
serotonin with antidepressants can cripple the sex drive but also
set off an imbalance among the three systems.
Drs. Fisher and Thomson are submitting a scientific paper on the
subject for publication this year.
"There are two lines of evidence on this," Dr. Thomson, a
psychiatrist at the University of Virginia, said. "The first is the
well-documented frequency of sexual side effects. But when you
actually talk to patients who have diminished libido and you ask how
it affects them, you discover that it has an enormous impact on
their romantic lives."
Often, the change is subtle. Drs. Fisher and Thomson point to
case studies of people who gradually find their emotions blunted and
their ability to see attractive features in others lost. The
researchers also point to more extreme cases like people who say
losing their sex drives caused romantic feelings toward longtime
spouses to evaporate suddenly.
"Everyone is distinctly different," Dr. Fisher said. "Some people
are so securely attached that this isn't going to change things for
them. But people should be aware that these drugs dull the emotions,
including the positive ones that are central components of romantic