Having A Satisfying Sex Life On Antidepressants

SSRIs, or selective serotonin reuptake inhibitors, are a common class of antidepressants. They’re also known for inhibiting sexual desire and making it more difficult to reach orgasm. Often, I see patients who feel like their sex lives have taken a hit after starting a course of antidepressants, and who want to get back in touch with their sexual selves. The good news is that, while it can be an adjustment, it’s still very possible to have a satisfying sex life while taking an SSRI.

If you’re trying to reconnect with your libido or experience some satisfying sex while on an SSRI, or if you have a client who’s in that boat, these are my recommendations.

  1. Let go of “shoulds.” You want to have a satisfying sex life. Part of that is recognizing that there’s no one “normal” level of sexual desire. Some people have very little desire, or no desire at all, and that’s ok. Your goal here is not necessarily to bring your desire up to a “normal” level; there is no “normal” level of desire. Rather, think about this process more in terms of what it is that you hope to gain from having more desire or more sex. Are you looking for more fun, more pleasure, more exploration, more intimacy, something else, all of the above?
  2. Recognize that willingness can be enough to begin a sexual interaction. If you’re typically the initiator in a sexual encounter, or if you usually wait until you’re really, really turned on to start a sexual interaction, it makes perfect sense that your sex life would take a hit if your libido decreases. Changing up that pattern can help. If you know that you want to have more sex, consider initiating an encounter even if you’re not feeling it quite yet. You may find that your arousal begins to pick up once the encounter is underway.
  3. Invest in a vibrator. SSRIs don’t generally stop you from reaching orgasm–rather, they raise the orgasmic threshold, making orgasm take longer to reach. Sometimes people give up on reaching orgasm because it’s harder to achieve–but investing in a toy like a vibrator, that can cut time to orgasm in half, can make a huge difference. Vibrators aren’t just for female-bodied people, either–there are plenty of vibrators designed specifically for male-bodied people. Nor does it have to be a vibrator; any kind of toy that feels good to you and reduces the time and effort necessary to reach orgasm will help.
  4. Explore. Now is a time to learn more about what turns you on. Explore widely: consider different kinds of stimulation, different activities, erotica, fantasy…explore a broad repertoire of pleasurable and stimulating things to do or imagine, so that you have a wider menu of options to choose from when you’re having trouble accessing desire. This can be an opportunity to discover something new about yourself.

Mindfulness: A “Magic Bullet” for Building a Healthy Sex Life

Nothing kills arousal like anxiety. Whether you’re worrying about the argument you had over breakfast, listening for sounds of trouble from the kids downstairs, or mulling over a big project at work or school, it’s hard to think about sex when you’re pumped full of nervous energy.

These anxieties may be well-founded, and good reasons not to have sex in this moment. You can always decide that this is the not the time, not the situation, or not the person for you. If something in particular about this situation is pinging your anxiety radar, listen to your gut and do what feels right for you.

But what about regular, day-to-day free-floating anxiety? Type A worries, or “being wound too tight?” Any kind of anxiety can get in the way of desire, but this latter type can last for years. Assuming you might want to experience desire even before becoming a less anxious person, mindfulness is the ticket.

Learning strategies to quiet your mind and settle into a place of awareness is key. You can begin to build this ability in literally countless ways but here are a few:

  • You might practice tuning in and being present when you’re doing the dishes. Slow down. Breathe. Notice the sensations in your body. Don’t rush. Just be with it.
  • Be present in your body and notice the sensations of being in the shower. Check in with all of your senses; what do you smell? Hear? Are there different textures? Can you feel your feet where they touch the floor?
  • Notice the sweet moments in the day. The sun on your cheek, a moment of quiet, or any other moment you experience as pleasant. Instead of letting it pass in a millisecond, be with it and see if you can stay with it for maybe 3 seconds. Then you can expand to not just lovely moments, but just any moment. Take a look around and take a breath. That’s being in the moment.
  • Take a few minutes to sit or stand still and pay attention to your breathing, to the in and out flow of air. Just notice it, don’t try to change it. See if you can stay with your body and your breath for 5 breaths. Don’t try to control your breathing, and don’t worry about your mind wandering, just be there.
  • If you WANT to control your breathing, put some very light attention on lengthening your exhale in a really relaxed way. Don’t worry about the inhale at all; it will happen automatically. Aim for your exhale to be twice as long as your inhale.

Aside from lowering anxiety, reducing stress hormones in your body, and about a million other positive effects, being present in the moment and in your body can make the difference between ok sex and great sex. You can practice mindfulness alone, and you can also practice being present in the moment, and in your body, with your partner.

  • Next time you’re holding hands, notice what it feels like in the place where your hands meet.
  • Next time you’re making out, see if you can be right there with your whole self. When you find your mind wandering, just refocus; look right at your partner, and say “hi”. Notice that connection, and stretch it out a little longer, just like the sun on your cheek.
  • When you experience arousal, don’t reach for a goal, even if that goal is orgasm. Stay with your body sensations, and try floating in that space for a little while. Sex can be a perfect distraction from anxiety, and is great for your body and mind. But it might take practice not to hurry, not to reach, not to pressure yourself. Just enjoy it. Start with just a few minutes; work your way up. Soon you can enjoy an hour or an afternoon of lovely, embodied, spa-like sex.

When you feel yourself tensing up during a sexual encounter, or feel your mind spinning out into an obsessive worry when you want to be focusing on your or your partner’s experience of pleasure, with practice, it will feel intuitive to draw on that practice of mindfulness, to take a moment, feel what you are feeling, and come back to the present.

Note: you can’t do mindfulness wrong!! Don’t make this another thing to worry about. Practice being in the present moment, which might be quite “imperfect” with all its thoughts and sensations and feelings. It’s all ok. It’s all your life, and this isn’t about changing it. It would be too bad if you missed it because you didn’t take a moment here and there to notice it, though. Take a moment here and there. It’s worth it.

After Will Lily: How To Use What You Learn in the Brief Assessment

If you don’t know my Will Lily assessment tool yet, it’s a sequence of questions designed to open up a thorough, comfortable dialogue about sex with your client, and sort out multiple factors that tend to affect sexual pleasure and function. If you want to learn more, I share the whole assessment at no charge in my 2 part video workshop. You can sign up here.

Today, I want to share some context for Will Lily in order to help you make better use of it in your own therapy room. This blog post is the first in a two‐part series. The first post will give some larger context, describing how Will Lily can guide your treatment planning, and the second will dive into the specifics of how to follow up on the information you get from Will Lily.

I use Will Lily as a screening tool in the intake session. In addition to opening and normalizing the topic of sex, it efficiently narrows the field regarding which systems might be involved in any sex issue that might come up. If there are several sex issues involved, it helps distinguish between more and less pressing issues.

Once you’ve gone through Will Lily, you will know where the problem is and what you are actually treating. You will be able to focus your efforts, which will make you much more effective at helping. That’s why it’s important that you ask every question in Will Lily. If you skip one, you won’t get a complete picture of the issue.

For instance, if I spent the whole session discussing my client’s distress over low desire, I might not hear about arousal issues, like changes in erectile function. I might miss an important health issue that must be addressed immediately in order to prevent harm. (By the way, if you haven’t heard about the relationship between arousal signs and heart failure, you can read more about it here—it’s incredibly important, and more people should know about it.)

Will Lily helps clarify multiple aspects of any sex issue, but it really shines when a client has desire issues. Desire is so multifactorial! Just about everything affects desire. Will Lily is designed with that complexity in mind. The six questions cut through the tangle of overlapping factors to sort out what is affecting desire.

Here are some ways the different pieces of the brief assessment relate to desire:

  • A lack of willingness to engage in a sexual encounter is likely to affect desire. If a person feels any little bit of internal or external pressure, that can devastate desire. So can other factors that affect willingness, like fear of becoming pregnant, or contracting a sexually transmitted infection.
  • Pain can clearly affect desire, because nobody wants to have unintentionally painful sex, and nobody thinks it’s hot for their partner to experience that, either.
  • Erectile issues, which indicate problems with physiological arousal, are potentially early warning signs of life-threatening illness, and also wreak havoc with desire. The person with ED can develop low desire via performance anxiety, aversion to the drama that ensues with their partner, or any number of other reasons. The partner of  the person with ED can develop low desire too, for similar reasons.
  • Difficulty reaching orgasm can create internal or external pressure, performance anxiety for either partner, guilt, and deception. Sometimes it makes people think “I just don’t see what’s so great about sex,”  which, naturally, leads to a lack of desire for sex.
  • A sense of dissatisfaction after sex for any reason indicates a level of distress that is very likely to affect desire.

I hope this context helps you use Will Lily to illuminate underlying issues and develop a sound, strategic treatment plan. In part two of this series, I share examples of good follow up questions to build on what you learn from Will Lily. You can read it here