Should I trade my chemical happiness for a hard-on?
July 25, 2011 3:09 PM   Subscribe

Should I choose sex over Celexa?

So after a decade of shoddy treatment for my depression and panic disorder—mostly due to irregular employment/health insurance, and an anxiety-amplified fear of medication—I’ve finally found something that works wonders: Celexa.

About three weeks into it (Citalopram, 20 mg per day), I have to admit I’m feeling pretty great. It’s smoothed out my anxiety. It’s greatly quelled the irrational terror I used to wake up to on a daily basis. And it’s pretty much curtailed my constant, obsessive worrying over my professional life. I’ve been living dread-free, feeling glimmers of cheer, and welcoming back some of the long lost endearing aspects of my personality. My new confidence has even compelled me to start dating—something I have always feared and felt unworthy of. And guess what? I can be pretty attractive to women when I’m not mired in self-loathing. For the first time in years, romantic options are opening up for me.

But there’s always a catch, isn’t there? I’m feeling the sexual side effects. And not the beneficial, it-takes-me-an-hour-to-cum side effects. My libido has plummeted. It’s aggravatingly difficult to get physically aroused. And when I do concentrate enough to get an erection, I usually can’t keep it. It’s like a physical disinterest grips my body. I’ll be watching porn or making out with a girl and I just feel this numbing boredom wash over me. Like I may as well just be doing the dishes.

The dating has been great. It's enhancing my life, and I’d like it to continue. And as a 28-year-old male, the ability to have sex is a key component to my self-esteem/happiness. So I’m strongly considering tapering off the Celexa. I’ve booked a therapist who’s willing to try CBT with me. I exercise regularly. I’m basically hoping I can find a way to live happily while still enjoying sex. (And the literature tells me that Celexa lingers in your system long enough to where you can’t really take a “pill vacation” for a roll in the hay.)

But I’m really worried that if I taper off I’ll revert to my panicky, isolating, suicidal old self. In which case, my dating life would probably sour anyway.

So, MeFites, anyone out there give up the happy pills for the hard-on? Was it worth the trade-off?

If you’ve made the tough decision, please do tell me your tale. Would love to hear the good and the bad.
posted by sureshot to Health & Fitness (12 answers total) 4 users marked this as a favorite

I don't think you're at this point yet. It has only been three weeks. You have no idea what the effects will be in two months, positive or negative. It's quite possible both the "feeling really great" and "can't have sex badness" will revert towards a more normal mean. Or not.

But you can't know yet.
posted by Justinian at 3:25 PM on July 25, 2011 [2 favorites]

Ask your Doc, for sure, I did. I had pretty crippling anxiety for a while after some life events and started taking paxil. It worked wonders for me too, but no possibility of sex/wood at all. So after I was feeling pretty comfortable and safe and acting like a "normal" personal I cut my dose in half.

It's still effective for my anxiety, but I'm physically functional now too. I wouldn't quit the meds altogether though.
posted by snsranch at 3:26 PM on July 25, 2011

First of all, I hope you're working with a good psychiatrist on this. They are powerful allies and side effect management is one of the most important things they do. There may be a third option you don't know about - like adding Wellbutrin to the mix. You shouldn't have to sacrifice stability for sex or vice versa. Good luck.
posted by rabbitbookworm at 3:26 PM on July 25, 2011 [2 favorites]

This is difficult, of course, and IANAP. But logically speaking, there is no reason you can CBT your way to fixing what's basically a neurochemical issue; you can find ways to deal with your self-defeating strategies or thought-patterns, but the drugs are there to give you breathing room to achieve things you thought you couldn't do before, not to 'fix' you or give you happiness. If you've found something that works so well, there's a chance there's another medication that would work without the same side-effect, and there's a chance that the other meds would just have different side effects. There's also a chance that your libido will eventually recover once your mind is fully enough acclimatized to the medication. There's little chance you simply don't need meds.

Going with the idea of experimenting on different meds, I'd say keep that as a long-term possibility and give the whole 'acclimatization' possibility a chance. Also, give yourself a chance to get comfortable with your new strengths. I know feels like now's the time to catch up for lost time, but romance isn't the only aspect of life you hadn't been experiencing fully, right? Give yourself more time than 3 weeks to really get reacquainted with your life. Try non-extreme solutions (such as dating low-sex-drive people and/or making friends for now) first. Wait till you meet someone you're crazy in love with and are willing to take the risk for before you play a game of chance with your own mental balance. Even then, talk to your psychiatrist about lowering your dose or mixing in another medication.

On preview, I agree that many depression meds tend to even out, and it won't always be 'great' but generally will taper off to more 'normal', which ups the possibility your sex drive will come back along with other more ordinary feelings/perceptions.
posted by reenka at 3:30 PM on July 25, 2011 [2 favorites]

A) Some side effects wear off as you continue to get used to the medication -- for me, it took a 6 weeks to see the full effects of Celexa. So you're probably going to feel even better in a couple weeks, and *maybe* the sexual side effects will wear off.

B) If you find a med that works for you, think long and hard (sorry) before going off of it -- many people report that they are not as effective the second time you take them. So it's possible you would taper off now only to decide to take Celexa again next year, only to find it's not as helpful. And typically people have to go through 3 meds to find the right fit -- I'd be loathe to start fidgeting with it since you found a good fit on the first try.

C) Definitely talk to your shrink -- good ones can lower this dose and add a little of something else (often Wellbutrin) to find a middle ground.

Lastly, has forums with really experienced people who've faced this decision -- it would probably be a good idea to check in with them, as well.

Good luck!
posted by MeiraV at 3:32 PM on July 25, 2011

I also suggest waiting it out. I'm female, but I too experienced difficulty orgasming when I began taking Citalopram. It turned out to be temporary (thank God!) and I was back to my regular orgasming behaviour probably after a month or so.
posted by oceanview at 3:37 PM on July 25, 2011 [1 favorite]

I had similar issues, although of the "can go for hours without cumming" variety(which also isn't that fun), a few years back when I was suffering through some pretty deep shit. I was taking Celexa too, with an Abilify kicker. It was the only thing that ever worked for me. After consultation with my psychiatrist, he put me on a low dose of busbar which counteracted the side effects. I took those three pills for a while and felt the best I had in years.

Talk to the doctor- that's what they're there for.
posted by dave78981 at 4:05 PM on July 25, 2011

I'd give it at least another 3 weeks before you decide whether to stop or keep going. As others have said, the side effects change over time (and oddly, once you hit a steady state, many will go away or lessen).

Anecdata: I had horrible, horrible insomnia as a side effect when first starting Prozac. Once I hit steady state, it went away completely - and the only time it ever came back was if I stopped taking the Prozac for more than a month and then started back up again. I handwave-scienced it as being something about the sudden ups and downs of the drug in my body; once it had been 4-6 weeks, I no longer got the swells and dips of the drug and also no longer got the insomnia.

If you do have to stop Celexa because of the side effects, Lexapro is an S-stereoisomer of Celexa; it's reputedly got a lower side effect profile than Celexa but similar pharmacology, so it may be worth taking a look at it. However, it is not available in generic form yet.
posted by subbes at 5:46 PM on July 25, 2011

I was going to 3rd Wellbutrin.
posted by sully75 at 7:29 AM on July 26, 2011

Yep, Wellbutrin.
posted by jmmpangaea at 8:10 AM on July 26, 2011

nthing Wellbutrin added to the mix. Taking both will likely solve your depression/anxiety AND libido issues.
posted by srrh at 8:18 AM on July 26, 2011

I also suggest now that your brain feels way better - if you're not already doing this, and you are able - getting in kickass physical shape. I know that taking a variety of things has affected my libido in the past, but there is no question that when I was lifting, aerobicking, and sleeping enough, it didn't necessarily 100% counter the effects of the stuff I was taking, but it definitely made a big difference.
posted by bitterkitten at 9:45 AM on July 26, 2011

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