Can't I be happy AND be able to have an orgasm?

January 19, 2009 4:57 PM

Argh. So, a while back I was diagnosed with dysthymia (which is a clinical term for long-term moody, irritable, melancholy, anxious...while not quite clinically depressed and not quite having anxiety disorder). I've felt this way forever, and I'm trying to figure out my next step.

I was in therapy for at least 10 years and made a lot of progress on a personal level, but it never really translated to a higher happiness baseline or less anxiety. I tried CBT for a while, but didn't find it particularly effective. About 8 months ago, after contemplating it for most of my adult life, I finally decided to try anti-depressants. As far as my mood goes, they were great! They made me feel a lot less down, a lot more like the self I want to be and a lot more in-line with the very good state of my life. They weren't quite as effective with the anxiety, but it was still an improvement -- at least acceptable.

I would still be on them, were it not for the side effects. Zoloft gave me tremors, made me jittery, made it hard to settle down and get to sleep at night, and gave me delayed or non-existent orgasms, so I switched to Lexapro. That was much better with the tremors and the jitteryness, and I was on it for about 6 months. However, I still had the sexual side-effects. My psychiatrist added some Wellbutrin to combat those, but instead they made them much worse. My sexuality is very important to me and, when soon after I started dating my girlfriend, it just became intolerable and kinda gave up on the meds and tapered them off.

That was a couple of months ago. My sexual response has returned (thankfully!), but so has my moody, melancholy, anxious blah blah crappity crap.

So...what now? Go back to trying various meds (I would go to a new psychiatrist as I wasn't thrilled with my previous one)? Or, the naturopathic doctor my friend saw for her post-partum depression and liked a lot? I feel pretty done with talk therapy and pretty confident that this is a chemical/physiological issue.

I would be happy to be on the Zoloft or Lexapro for ever and ever if not for the intolerable sexual side effects.

I guess I'm also feeling a bit discouraged...so if anyone wants to say, "Hey, I had a similar thing and kept working at it and finally triumphed, so keep it up!" I'd appreciate that kinda thing, too.

Thanks!

posted by The Dutchman to health & fitness (10 comments total)

Everyone responds to medication differently and it can take a while to find the right one for you. Unfortunately, this process can drag out over months and years since you have to wait for the drug to become effective (or for the side effects to wear off.) I've been fortunate to find the right one for me, but it has taken several tries. Don't give up yet. It will be worth it when you find the right combination.
posted by imposster at 5:41 PM on January 19

I suffer from a pretty intense anxiety disorder (that goes hand in hand with different levels of depression) and I've been hesitant about the meds, mostly because of the potential side effects. I'm still not ruling it out, but I have found a few things that help. Regular therapy is key. Something else that I initially thought was bullshit but now I am actually kind of into it is the idea of mindfulness. It's this meditative zen kind of stuff that basically involves a lot of deep breathing. Sounds hokey, but there's actually a physiological basis for it: deep breathing slows down the crazy neurons shooting off and contributing to anxiety, it also slows your heart rate a bit and gives your brain more O2. All of this together helps you be able to think clearer and can often alter your mood. Another great exercise is the body scan. Lie down on your back with your arms at your sides and focus on breathing air into your toes on your left foot and just think about your toes. Then think of the air going into your feet, your ankle, your knee, your thigh, your hip and then move into the other leg. Go through your whole body and before you know it, you're pretty calm. And not unhappy. Not necessarily jumping for joy, but it's worked well for me, and I've even been a skeptic.

All I can tell you is that I haven't necessarily triumphed, but it is not (currently) ruling my daily life, just certain elements of life, which is a big relief. It gets exhausting being anxious and moody all the time, especially when you know that that's not really you.

Best of luck.
posted by cachondeo45 at 6:10 PM on January 19

I have dealt with dysthymia my entire life (since I was five or six years old) but I was only on meds for about a year when it got really bad, after my first heartbreak. I was on Prozac, a weekly dose, and I don't really remember any side effects but it's possible (I wasn't in a sexual relationship at the time, so didn't notice any lack of drive). Since stopping the meds, I've been depressed a few times but have managed through therapy and/or sheer will.

So. The good news is that you might not need to be on meds forever. For me, I just needed to find a new baseline level of happiness-emotion to strive for, and I'm able to get maintain that for the most part without aid of therapy or pills. If your doctor thinks that's possible, it might be worth it to deal with the side effects for a limited time with an aim towards longterm emotional stability.
posted by peanut_mcgillicuty at 6:57 PM on January 19

This probably won't be a popular answer but here's my suggestion for what it's worth. Psychotherapy. It's very, very different from CBT. It takes a long time and it can be really hard. But the emotional healing I found through psychotherapy with a highly-qualified professional has basically completely removed the overwhelming clouds that I used to consider my lifelong dysthymia (and which I tried many times in the past to treat with medication).

In psychotherapy you deal with a lot of the "noise" until you get to the "signal" which is at a core level, your deep original wounds and how you re-create them in your current life. Then you heal them. The healing part is surprisingly easy, it's finding the wounds that's godawful hard.

Being on the other side is pretty awesome. No drugs, and a seriously cool level of awareness. it can't be beat in my book. But you have to be really open to it.
posted by eileen at 8:38 PM on January 19

I would suggest finding a new psychiatrist and trying a new medication. Be prepared that it may take awhile to find the right medication with the fewest side-effects, but there are a lot of options out there. Good luck.
posted by whatideserve at 9:04 PM on January 19

You're probably always going to have *some* sexual side effects associated with antidepressants/anxiety meds, but they will very likely lessen over time, even if it takes six months or a year.

I don't know if you're willing to hold out that long. But in my experience, different meds made me jittery/and/or gave me sexual side effects and for those reasons I stopped taking them--that is, until I felt that mitigating my depression was more important to me than sexual function, etc. What I found was that after a period of time I learned to kind of "overcome" (ahem) those problems.
posted by prior at 9:28 PM on January 19

Agreeing with you that it's a chemical/physiological issue for you, since years of therapy didn't help you much, and antidepressants did. So just continue trying different antidepressants and see if you can find one that helps with the dysthymia and has minimal side effects for you. It helps to have a good relationship with a psychiatrist who is sympathetic to the side effect issue and will help you find the right med.
posted by exphysicist345 at 11:25 PM on January 19

I'd definitely get on meds. Dysthymia can spiral into major depression & anxiety if left untreated.

So at least get a psych evaluation.

It might take awhile to get the right drug cocktail going but there are plenty of new meds out there that work well with few side effects. Wellbutrin for instance has a small chance of taking away sex drive (YAY!), can help you quit smoking and has a funny side effect of weight loss (it kind of makes you anorexic - or at least, not hungry).

I'm bipolar and will prob be on meds for the rest of my life - but it's worth it because it allows me to uhhh have a life and not f*** up relationships, jobs, and you know, live with violent mood swings and difficulty.

Full disclosure: I'm on Lamictal (mood stabilizer), Xanax (for anxiety, taken as needed), and Wellbutrin. It's a combo that seems to be working well for me and I have my life back!
posted by HolyWood at 8:11 AM on January 20

I've been on five? six? or so different antidepressants, in various combinations, over the past 7 years, and only this year did I find a combination that didn't suppress orgasm. So there is a chance that finding a new psychiatrist and testing new meds would bring you relief. But it may take a few more tries, and it sucks to deal with bad reactions.

I'd definitely discuss trying antidepressants that hit multiple or different neurotransmitters -- the first set of drugs tried tends to be SSRIs that only hit serotonin, and those have the highest incidence of sexual side effects, from what I've read. Antidepressants that act on dopamine or norepinephrine have very different sets of side effects but are less commonly prescribed. Most docs run through the basic list of SSRIs before moving to the other meds.

Also, I highly recommend finding a psychotherapist to help you deal with the day-to-day of dysthymia and help monitor you for potential spirals into major depression.

Good luck!
posted by ahimsa at 12:18 PM on January 20

Thanks for all the answers so far. The encouragement is definitely helpful. Just thought I'd add that I do currently have a therapist that I speak to weekly and like a whole lot. Re-reading my original post, it clearly looks like I was saying I didn't have one now. I meant that I was done trying to get talk therapy alone to fix this issue.

Also, just an update: Tomorrow, I'm speaking to a local therapist who comes recommended (mine is by phone and far away) to give them my background and get a referral for a new psychiatrist. So...I'm moving forward.

Thanks again for your time and help everyone!
posted by The Dutchman at 4:14 PM on January 20