In the UK, nearly 40 million prescriptions for antidepressants are doled out annually to people who feel that their life is a mess. Some are suffering from a clinical mood disorder which distorts their perspective and makes the glass of water look perpetually half-empty. Others, however, are entirely justified in believing that their life is a mess, because it is, and no pill is ever going to solve their problems. What they really need is emotional support, financial help, sex therapy or relationship counselling. What they get instead, is a prescription for ‘emotional blunting’. Their situation doesn’t change, but the pills take the edge off things, and as long as they can put up with a dry mouth, constipation, weight gain, nausea, insomnia, impotence, inorgasmia and loss of libido, things don’t bother them quite as much as they once did.
Of all the nasty side effects of anti depressants, low libido is probably the most well documented, but least understood. Two recent studies into sexual dysfunctions as a side effect of anti depressant medications found that 70% of women who experience difficulties during treatment were actually suffering from sexual problems prior to their diagnosis. Was the depression a cause of, or a response to, the sexual dysfunction? Doctors don’t know yet. What they do know is how to mix brands of anti-depressants to minimise side effects and improve libido. Mirtazapine and Tazadone for example, have less negative effects on sexual function and although the anti-depressant Zyban doesn’t necessarily increase desire, it can improve sexual pleasure, arousal and orgasm.
Though we have a tendency to unquestioningly accept the wisdom of medics, the fact that a doctor prescribes an anti depressants does not necessarily mean it is the most effective course of treatment for the patient. One in six people in the UK now uses anti depressants and they are the second-most prescribed drug after antibiotics – and 90 per cent of those diagnosed with depression now take SSRIs either continuously or as repeated courses over several years – which surely smacks of over-use. It wouldn’t matter if they were doing universal good, but a 2008 meta-analysis of their effectiveness found little evidence that they did anything to help people with mild to moderate depression. Privately GP’s admit that they would prefer it if their patients had greater access to therapy, but in it’s absence drugs are all they have to offer.
Several studies have established that more than 80 percent of major depression cases are preceded by a serious or traumatic life event. In cases where, for example, someone has been bereaved, anti-depressants can ease the pain in the short term, but there is also a counter argument which says that people should work through the traumas in their lives rather than masking the pain with pharmaceuticals. It is not known why some people are more vulnerable to depression whereas others, in equally difficult circumstances, don’t suffer to the same extent. There does seem to be a genetic risk factor – having a parent or sibling with depression increases the likelihood of developing depression especially for females. And women are twice as likely to be affected as men which suggests that hormones also play a part – in women the onset of depression is higher at puberty, during the menstrual cycle and during pregnancy.
Though anti-depressants do help people with clinical depression, studies repeatedly show that cognitive behavioural therapy or psychotherapy are equally effective during the crisis period and unlike drug options, the results last forever. More recently, the process known as Mindfulness Based Cognitive Behavioural Therapy (MCBT) has been found to be particularly helpful, especially for women. Studies show that women have a greater tendency toward ‘ruminative thinking’ – repetitively and passively focusing on symptoms of distress and their possible causes and consequences – and when it comes to sex, mental distraction allows anxiety and insecurity to kill sexual arousal. MCBT trains the brain to ‘be present in the moment’ enabling people to minimise mental chatter and self criticism and heighten sensual experience and sexual responses. Online courses in MCBT are available here. To become proficient you will need to practice for 20-40 minutes each day. It takes 6-8 weeks to begin to alter brain wave patterns but research carried out in 2005 involving MRI scans of experienced meditators compared to non-meditators revealed increased cortical thickness in the parts of the brain related to all the senses, including touch and skin sensitivity. The average cortical thickness of 40-50 year old meditators was similar to 20-30 year old controls and although the study didn’t enquire, I’m betting none of them was suffering from a low libido.
Suzi Godson Sex Counsel 15.10.11 The Times
Ever since my wife lost her job she has become depressed and socially isolated. I encouraged her to go out and make new friends but she wouldn’t, so I gave up. Now she has become obsessed that I might be having an affair (I’m not) and questions me exhaustively — sometimes becoming very upset — every time I come home from work. I find it exhausting and can’t cope with her jealousy any longer. What can I do to get back the woman I married?
A I know that you mean well, but telling a woman who is sitting at the bottom of a very dark and lonely emotional hole that she should “go out and make new friends” is like telling a bereaved young mother that she can have another child. It may be technically correct, but it completely ignores her feelings of pain, loss and vulnerability. While I appreciate that it is not easy to live with someone who is depressed, your wife needs support, not a set of instructions. Making new friends can be difficult when you are in rude health, so try to imagine how intimidating that challenge can be to someone who feels as redundant as your wife does.
Unemployment is a well-known trigger for depression and research by Morten Blekesaune, of the Institute for Social and Economic Research, has established that losing your job also increases the chance of losing your relationship. Because depression tends to make people withdrawn and lethargic, it puts pressure on the functioning partner, who is forced to take responsibility for paying the bills, cleaning the house, making social arrangements, calling the repair man or minding the children. Inevitably, that domestic imbalance builds resentment.
In simple terms, depression creates distress, and distress makes people depressed. It is a vicious circle, which is very difficult to break, and married couples who are dealing with depression are nine times more likely to divorce.
I know that it must be infuriating to live with relentless pessimism and paranoia, but you need to keep reminding yourself that your wife’s jealousy is an expression of her fear and insecurity. She has lost her job, her social network and her self worth, and now she is afraid that she will lose you. Every time you leave the house to go to work she is reminded of her own redundancy, and with no one to talk to, she has all the time in the world to brood about the great relationships you have with your office colleagues and the terrible relationship you have with her.
Rather than trying to convince her that things will get better if she simply “makes more of an effort”, you need to accept that she is suffering from an illness, and encourage her to seek help. Cognitive behavioural therapy in combination with antidepressants is a fast and effective treatment for depression, but there are also lots of online services, such as Moodscope and Beating the Blues, that she could access at home.
You don’t mention your sex life, which is unsurprising. Depressed people rarely feel like having sex. Nor do angry people, and it is quite clear that you are at the end of your tether. In the space of a few sentences you say that you find your wife “exhausting”, that you “can’t cope” with her jealousy and that you “gave up” encouraging her to make new friends. If you can’t contain your irritation in a short letter, I doubt that you can face to face. Living with a depressed person increases your own chances of becoming depressed, so I think you need to talk to a counsellor. Check relate.org.uk or the British Association for Counselling & Psychotherapy, at bacp.co.uk.
Offloading your frustration will help you to be a little more affectionate with your wife. Research shows that people who are in caring, supportive relationships recover from illness and trauma more quickly, so focus on ways to cheer her up by injecting some humour into your lives. Walk, swim, cycle, cook, learn to tap dance or blow glass. It doesn’t really matter what you do as long as you have fun together. You may not get back to full sex for a while, but in the meantime, touching, holding hands, cuddling or kissing will keep you physically connected and remind your wife that you love her, that you don’t think she is a “nuisance” and that you want back the woman you married. Be strong.