Are antidepressants taking the edge off love?
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By Susan Brink
Los Angeles Times -- July 30, 2007
Sure, we know about the sexual side effects of SSRIs. But researchers now
wonder if that's the only aspect of romance the drugs can influence.
LOVE'S first rush is a private madness between two people, all-consuming
and, if mutually felt, endlessly wonderful.
Couples think about the other obsessively -- on a roller coaster of euphoria
when together, longing when apart.
"It's temporary insanity," says Helen Fisher, an evolutionary anthropologist
at Rutgers University.
Now, from her studies of the brains of lovers in the throes of the initial
tumble, Fisher has developed a controversial theory. She and her
collaborator, psychiatrist J. Anderson Thomson of the University of
Virginia, believe that Prozac, Zoloft, Paxil and other antidepressants alter
brain chemistry so as to blunt the intense cutting edge of new love.
Fisher and Thomson, who describe their theory in a chapter in the book,
"Evolutionary Cognitive Neuroscience," aren't talking just about the
notorious ability of the drugs to damp sexual desire and performance,
although that, they believe, plays its part. They think the drugs also sap
the craving for a mate -- perhaps even the brain's very ability to fall in
love.
And that would be bad news, given the widespread use of antidepressants in
this country -- about 10% of adult women and 4% of adult men take the drugs,
according to a 2004 report by Centers for Disease Control and Prevention's
National Center for Health Statistics.
Though they still lack solid evidence that more Americans are having trouble
falling in love these days, the scientists do have animal and laboratory
science along with some human studies to whet their research appetites.
For one thing, there's brain chemistry. The chemicals involved in the
heart-pounding fall over the cliff into another's life, including dopamine,
norepinephrine and serotonin, are the very chemicals altered by many
anti-depressants.
Fisher cites animal studies showing, for example, that female prairie voles,
naturally loyal to one mate, lose interest in him when dopamine is
suppressed. The early human version of mate-pairing -- romantic love -- is
also associated with increased activity in dopamine pathways. And SSRI
antidepressants suppress that activity.
SSRIs are also known to curb obsessive thinking, the kind of focused state
that is central to the first blush of romance.
For both these reasons, Fisher suggests that SSRIs could jeopardize intense
romantic love.
There are few studies on the effects of antidepressants on aspects of love
beyond libido and sexual performance. But in an intriguing experiment, one
Canadian psychologist, Maryanne Fisher (no relation to Helen), reported
evidence in a small 2004 study of what she termed "courtship blunting" in
women taking antidepressants.
Asked to rate the attractiveness of men's faces, women taking the drugs
rated the men more negatively, and breezed through the pictures faster than
women not on antidepressants.
There is also anecdotal evidence -- and although such stories may be
anathema to hard science, they can provide the basis for research questions.
Thomson collects them.
A 20-year-old man who had been on antidepressants from the ages of 15 to 18
was reluctant to take them again, despite feeling depressed. "No one told
him about the sexual side effects. In retrospect, he realized he had the
sexual side effects and that might have contributed to his not dating,"
Thomson says.
Any drug that has sexual side effects, Thomson says, could well blunt other
chemicals the brain uses to intently focus on one person or to work up the
obsession necessary to fall in love in the first place.
Then there was the 42-year-old single woman who had not been on a date in
the eight years she had been taking an antidepressant. "She had not felt any
desire [to date] for at least that period of time,"; he says.
Jerry Frankel, a urologist from Plano, Texas, who's been married for more
than 40 years, was so conflicted about his experience on antidepressants he
wrote to a national newspaper.
";My usual enthusiasm for life was replaced by blandness," he wrote. "My
romantic feelings for my wife declined dramatically." He was willing to risk
depression again in order to regain his old zest for romantic depth.
Fisher and Thomson's theory is new enough that many therapists say they've
never heard it discussed.
But Richard Tuch, psychoanalyst at the New Center for Psychoanalysis, says
he has long been concerned, especially for adolescents, that if
pharmaceuticals interfere with sexuality, they may also be interfering with
a basic system that teens require to learn about the opposite sex. Still,
he's cautious about sounding an alarm. "Antidepressants can save a person's
life," he says.
Mental health experts like him already fear that, with recent publicity
about suicidal risks in adolescents taking antidepressants, people whose
lives could be improved or even saved with medications won't take them.
Prescriptions for antidepressants for people 18 and younger fell by 20%
since the Food and Drug Administration issued a warning in March 2004 that
the drugs may increase the risk of suicide, according to research published
in the Sept. 2, 2005, issue of Psychiatric News.
If people think the drugs will hamper their ability to find Mr. or Ms.
Right, psychiatrists say, even more might avoid the potentially life-saving
medications.
Fisher doesn't quarrel with the drugs' benefits for many with chronic,
severe depression. But she worries about people who take the drugs to get
through a break-up, a death or a job loss, then keep taking them.
"I'm concerned about well-adjusted men and women who go through a crisis and
start taking antidepressants," she says. "They continue taking them, not
realizing they may be suppressing these other systems."
Physicians, she says, aren't asking enough of the right questions when they
ask their patients about side effects. Lack of awareness of a potentially
troubling side effect -- becoming blase about romance -- is reminiscent of
the years immediately after the first SSRI, Prozac, was approved in 1988.
At that time, reports were that only about 6% of patients suffered sexual
side effects, but the low rate is now understood to have resulted because
doctors failed to ask questions about sex and patients were reluctant to
bring it up. A later analysis put that figure at about 30%, and a 2001 study
at as high as 73%. It is one of the top reasons that people stop taking the
drugs.
Doctors may be getting savvier about warning patients about the potential
for sexual side effects. But most probably are not asking patients if they
feel a blunted drive to search for love.
So far, there is no evidence that a dulling of romantic interest is a
universal antidepressant side effect. And when it does appear in people who
need the drugs to live and function, doses might be adjusted, or medications
changed, Fisher says.
Some scientists dismiss Fisher and Thomson's theory. "Antidepressants tend
to tone down the emotions. But they don't interfere with the ability to fall
in love. No," says Otto Kernberg, director of the Personality Disorders
Institute at the New York Presbyterian Hospital and author of six books on
love.
But Tuch says the theory is challenging. "I think it's a call to the
psychiatric community to study this. She's raised the question. Now it's our
responsibility to look into it," he says.
Until more is known, Thomson has some suggestions for people on
antidepressants.
"Regularly ask, 'Do I still need to be on them?' If you're having sexual
side effects, ask if everything is being done to mitigate them, because
those responses might also be linked to unconscious romantic desires.
"And ask yourself, 'How is this affecting my relationships?' "
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