Sex and Depression: The Monster Under The Bed

I first met JoEllen Notte at a sexuality conference called Playground, in Toronto in 2015. She was talking about the impact antidepressants have on sexual function and relationships and referred to this as “the monster under the bed”, the conversation no one was having. This came to light for her when she changed her antidepressant medication. She was on a date with a lover, and she realized that she couldn’t orgasm. It wasn’t happening. She describes the weird sensation of watching her orgasm through a glass window, waving at her, but she couldn’t access it. She “got out the big guns”, i.e. her hitachi magic wand, usually an express route to orgasm. Still, nothing.

This disturbed her (understandably), so in 2014 she launched an informal online survey, curious if anyone else on antidepressant meds had experienced sexual side effects. The response she got was overwhelming: loss of libido, genital numbness, erectile dysfunction, inorgasmia (the inability to orgasm) were the most common. The thing that I found particularly fascinating was how many of these people received very little or no information about these potential side effects when they were prescribed their meds, and again, how a majority of the group struggled to bring this up with their doctors.

Sex and depression has kind of exploded lately, with JoEllen leading the conversation. She’s written about it for the BBC, and has been interviewed on Vice. She writes often and eloquently about communicating about sex and depression in relationships. She’s followed up her initial survey with two more, and now she’s writing a book. I’ve been pondering a few things since we last talked, so I decided to send her an email and ask! Here’s our conversation:

Do the side effects of medication differ across solo sex, hetero partnered sex and queer sex? Or, if someone’s feeling a loss of libido or inorgasmic, that’s likely to be happening in all areas of their life?

JEN: Generally, I’ve seen a lot of it functioning like a light switch – it’s there or it’s not. There are, of course, exceptions. People who reported that during a certain episode (because remember depression differs person to person and episode to episode) they found themselves with no desire for people of one gender but comforted by people of another. There was also a noteworthy moment at a conference when I was sharing some of the survey numbers and it came up that there was a general trend away from using sex toys during bouts of depression among the respondents. Some sex writers in the audience tweeted about finding that to be untrue for themselves and it started a lively discussion among a group of sex writers about how depression (so many of us are affected by it) affects our toy use.

So, short answer: as far as I’ve seen not really except for the times when they do.

If you can dream up an ideal health professional, how would the conversation around potential sexual side effects of medication go?

JEN: It’s hard… I started this work guns blazing about how doctors don’t talk to patients about sex and make it hard and scary due largely to their lack of sex education and personal discomfort. Now I see the situation is a bit more nuanced than that. Do doctors need more sex education and to get over their own hang ups? Yes. Have people had horrible experiences with doctors shaming or dismissing them? Absolutely. However I’ve also come to see, through my participant’s responses that a big part of the problem is that EVERYONE is afraid to talk about sex – patients included.

I think it needs to start at intake with establishing that your sexual health is seen as part of your health, establishing that foundation, knowing that their office is a place where you can talk about both your headaches and your libido, your flu and your orgasms, positions you well to deal with things like sexual side effects.

In this scenario the topic of sexual side effects would be broached when discussing possible medications side effects (in the 2014 survey less than 25 percent of the people who experienced sexual side effects felt that they had been adequately prepared for the possibility by their doctor) and then as regular follow up appointments continue it would be asked about the same way we are asked about sleep, appetite etc.

Psychotherapist Stephen Biggs is quoted in one of your articles about how having sex while experiencing or coming out of depression might be a totally new type of sex, and to think of it as a second teenagehood. I think this is true for different phases in our lives, yet I feel that we tend to hold tightly onto the type of sex and arousal patterns that are familiar. Has this come up in your conversations and research?

JEN: I also love that quote! You are correct though, this is a hard one for people. I always say that people get tripped up by wanting the road back to sex to be a short, straight path full of stuff they already recognize and more than likely it’s going to be long, twisty and have a bunch of new things along the way. Something that has come up repeatedly is the struggle folks have with not “just doing it the ‘normal’ way” (meaning the way they always have) – sometimes this is coming from partners and sometimes it’s coming from folks with depression themselves.

No one wants to have depression and it can be frustrating to have to change your sex life because of it but this is why I love what Stephen says about it – rather than seeing it as the end of one thing it frames it as an opportunity to try new fun things! The interviewees spoke a lot about communication, staying open minded, and being patient. Also, a couple of them mentioned one of my favorite pieces of sexual advice- read Emily Nagoski’s Come As You Are [CH – I 100% endorse this book too! It is so great].

If you’d like to know more about this, Jo Ellen’s website is FULL of information (and the best sex toy reviews I know). Her book, aptly titled The Monster Under The Bed is underway, and if you’d like a sneak peek, support her on Patreon!

This article was originally published in AUT University Students’ Association Debate Magazine, Issue 14, October 8 2017.

Update January 2021: Jo Ellen’s book was published in 2020! Amazing. Check it out.