Last year, sex blogger and educator Crista Anne came to a shocking realization: She could no longer have an orgasm by herself.
She could come from sex with her partner Val, and she could experience some pleasure during masturbation. But when it came to solo self-pleasure, she found herself totally unable to get to the point of climax, as she'd so easily been able to do all of her life.
Crista Anne, who describes herself on her blog as a "rainbow-colored pleasure revolutionary," found the loss of her orgasm earth-shattering. "Masturbating is my zen," she wrote on the blog in December 2014. "It's my meditation. It's almost my religion." So she set to work on getting her orgasm back, tracking her journey via the hashtag #OrgasmQuest.
The culprit, as she explained on her blog, was a new antidepressant her doctor put her on, which had an unfortunate side effect of anorgasmia, or the inability to have an orgasm. As Crista Anne told Mic, anorgasmia is a fairly common side effect for many medications. But due to the stigma associated with sexuality, doctors rarely openly discuss it with their patients.
"No one talks about this, so everyone thinks they are broken," Crista Anne told Mic. "[That's] bad enough with most health issues, but when you add in mental illness, the sexual side effects can cause a horrible spiral. If you dare prioritize your pleasure, it's somehow seen as selfish or asking too much. It's asking too much to not want to kill myself and orgasm? Really?"
A sex and mental health crisis: You'd think there would be plenty of discussion in healthcare circles about the deleterious effects that a fairly common group of medications can have on sexual health. But if the effusive response to #OrgasmQuest, which went viral back in January, is any indication, these discussions aren't happening regularly enough,
"Started meds a few months back, so I know the struggles," one Twitter user wrote about #OrgasmQuest. "Good to see I'm not alone."
They aren't. Over the past two decades, there's been a huge uptick in antidepressant subscriptions in the United States, as 1 in 10 Americans is now on an antidepressant medication. More than 6% of Americans between the ages of 18 and 39 are also on antidepressants, according to Centers for Disease Control and Prevention data from between 2005 and 2008.
The side effects of popular selective serotonin reuptake inhibitors like Lexapro and Prozac are well-documented: constipation, possible weight gain, maybe the occasional cotton mouth. But there are other side effects to SSRIs that a doctor might not tell you about, including low libido, erectile dysfunction and anorgasmia, as Crista Anne experienced firsthand.
It's unclear exactly why SSRIs are so strongly correlated with diminished sexual response, or why some people are affected more than others. What is clear is that the side effects are common: Estimates vary, but one study has suggested that as many as 30% to 50% of people taking SSRIs have experienced sexual side effects, while other studies have cited even higher estimates.
For these people, taking antidepressants can manifest itself in a "diminished physical response to arousal: You'll walk around less likely to feel horny, or it'll take more stimulus to have the same sexual response, or you won't get the same level of erection or lubrication as you would without antidepressants," sex educator Timaree Schmit told Mic. "I've heard men talk about how when they were on SSRIs, they would have to fake an orgasm because it was so frustrating and it was never gonna happen."
Emma*, 22, has been on various combinations of antidepressants since she was 19. When she first went on antidepressants, "I was a depressed mess, so no one was [particularly] interested in banging me," she told Mic. When she started having sex on Prozac, she found that it was "dry" — even though at the time, she didn't realize it was linked to her medication. "I don't think I really figured it out until I went off antidepressants and started having good sex," she said.
"You'll walk around less likely to feel horny."
These side effects might seem mild — and to a certain extent, when weighed against the alternative, they are. Indeed, a consistent theme in talking to people who've suffered from antidepressant-related sexual side effects is that there's a tradeoff: Either have a healthy sex life filled with orgasms aplenty, or take a pill that makes you not want to spend your every waking moment feeling like the lowest form of life on the planet.
Simple as that decision might sound, it doesn't make it any less painful or frustrating to suddenly lose your sex drive without warning.
"Not craving sex when I used to be a sex fiend is very stifling," Elena*, 24, who has been on Zoloft and is currently taking Lexapro, told Mic. "I feel as if I have lost part of myself, like my soul is muted in some way. I have been grieving my sexual being for two years now. I'm exhausted."
How this hurts our relationships: The issue of being unable to sustain your sex drive (or even having sexual desire to begin with) is compounded in a long-term relationship, particularly if one person is on antidepressants and the other isn't. Even if someone is aware of their partner's sexual issues, it can be frustrating to go down on someone for 45 minutes without being able to bring them to climax, even though you're both tired and hungry and desperate for it to be over so you can order Chinese.
For those on antidepressants, sex can be something of a chore; for those who are in love with someone on anti-depressants, it can be a serious blow to their self-esteem.
Going on antidepressants signaled the death knell of Elena's last relationship. Because she no longer desired sex, her partner felt "unwanted, undervalued and insecure," Elena told Mic. "She felt guilty admitting that she needed physical, sexual touch. And I felt horrible for not being able to give that to her. At some point, this crisis — because it really is a crisis — just becomes a cycle of guilt and insecurity for both partners."
Andrew*, 27, has been on four different antidepressants, including Zoloft and Celexa, which he says "obliterated" his sex drive and made it difficult for him to maintain an erection or reach orgasm. While partners who had previously been on antidepressants were patient and understanding, he said some people would "take it personally" when he couldn't perform.
"Sometimes we could talk it out, and other times it would end with everyone involved feeling bad about themselves," he told Mic. Once, he had trouble sustaining an erection with a one-night stand, and she called him a faggot.
Choosing between sex and sanity: For the 350 million people worldwide who suffer from depression, having a healthy mind and a healthy sex life can seem like an either/or situation. Some might consider going off their medication entirely — but for many who experience severe depression, that's simply not a viable option.
Teresa*, 27, has been on various combinations of antidepressants throughout her life. She was in the process of adjusting her medication when she expressed concerns to her partner that it might affect her sex drive. Her partner "was not exactly supportive," she told Mic. "So I said, 'Well, you can have me alive and fuck me less, or fuck me constantly until I finally kill myself.'"
In the 28 years since the first SSRI was approved by the FDA, one would think that we'd made enough medical advances to allow depressed people to medicate themselves while simultaneously being able to get off. One key problem is that medical professionals can feel ill-equipped to discuss sexual side effects with their patients. In a 2013 study in the Journal of Sexual Medicine, medical professionals in the United States and Canada reported being "underprepared to adequately address their patients' sexual health needs" due to a lack of sufficient sexual health education in medical school.
"Doctors get very little sexuality training," Schmit told Mic. "In the whole of their medical school time, it might be a few hours, and it's going to have something to do with birth control, unless they go into urology and gynecology. It's not like they're really trained to talk about sex."
Worse is doctors who hear their patients out, then disregard their concerns or minimize them. While Crista Anne said she has a "stellar" doctor, she's heard horror stories of people complaining about sexual side effects of anti-depressants, only to be ignored by their GPs: "A lot of the time they are more uncomfortable with that conversation than even their patients," she said.
Emma concurred: "I have talked to my doctors about how difficult it is to come on Cymbalta and they're sorta like 'You just gotta deal with it.'"
This can leave people using their own temporary hacks to alleviate sexual dry spells. For Emma, that means regularly using a Hitachi Magic Wand to reach orgasm; for Andrew, it's occasionally self-medicating with the erectile dysfunction drug Cialis. (Schmit strongly cautioned against this tactic because of the side effects associated with the drug.)
There's also the option of switching medications. SSRIs are no longer the only option for treating depression; there are also tricyclic antidepressants like Tofranil and atypical medications like Wellbutrin, which is less likely to inhibit libido or orgasm. Unlike SSRIs like Prozac and Lexapro, however, Wellbutrin is not used to treat anxiety, which is often comorbid with depression. It's something you have to work out with your doctor, Schmit said.
"You don't have to make your life adapt to the drug," she told Mic. "I would insist upon having whoever prescribes it give you more options."
Ultimately, Crista Anne's #OrgasmQuest was successful: She's now able to orgasm both alone and with her partner, though she says her orgasms aren't as strong or as frequent as they were before going on medication. But considering how much she says her medication has helped her, she's OK with that. "While I obviously place importance on my orgasm, orgasm is not the end-all, be-all of sex for me/us," she said.
At the end of the day, having to choose between an orgasm and your sanity isn't a difficult choice to make. But considering that an orgasm is one of the few luxuries that remind us of the joys of being human, it's a choice plenty of people wish they didn't have to face.
*Some first names have been changed to allow subjects to speak freely on private matters.