TW: mention of sexual abuse, eating disorders and suicide.
The number of people taking medication for their mental health increases in the UK – and worldwide – every year.
SSRIs (standing for selective serotonin reuptake inhibitors used to treat disorders such as depression, anxiety, PTSD, and OCD) are the most commonly used medication amongst 16–24-year-olds. 19.6 million antidepressants were prescribed by the NHS between July and September 2020 alone. In total, 17% of the adult population take anti-depressants. That is a lot of statistics and a lot of people. But in my experience – and the experience of the wonderful people I chatted to for this piece – the side effects of psychiatric mediation are very rarely discussed. Partner that with the shame surrounding discussions about our sex lives, the effects of mental health medication on a person’s sex drive seems to be the best kept secret since the
location of the clitoris.
I interviewed five people in their early 20s: Jack (21), Katherine (24), Jen (23) and Meg
(23), and Maja (22) all of which either currently take SSRIs, or have done so in the past. We had candid and raw conservations about how their medication has affected not only their sex drives but their senses of self, identity, body image, relationships and what they would tell their younger, non-medicated selves if they could. The conversations that followed were incredibly enlightening, and I can’t thank them for their honesty and
willingness to share their most intimate experiences with me.
How long have you been taking mental health medication for, and what do you take?
Jen: I’ve been taking sertraline for one and half years now, and take it for complex PTSD.
Katherine: I’ve been on sertraline since I was 16 and I'm now 24. I've been through different cycles of it. The highest I've been on has been 200mg during my A levels, and then I dropped down again when I started university. Currently, I’m on 100mg.
Meg: I’ve been on sertraline for nearly three years now.
Maja: I have been taking citalopram for about 2 years now, it helps a lot with my anxiety and low mood.
Jack: I took citalopram for one and a half years, but I stopped taking it a few months ago.
How do you think your medication has affected your sex drive?
Jen: I tend to get side effects when I’m increasing the dose, and when I first started on sertraline. I get this real burst of energy and anxiety, but it’s not too negative. It’s the only medication I’ve had that has positive side effects overall. Regarding sex drive, that decreases before my body gets used to the higher dose. When this
happens, I can still get horny, expect it means that I can’t get over the edge with an orgasm which is frustrating – I could be so close to the edge and just give up. This happens more when I’m masturbating because I think I'm more self-aware of my body when I'm orgasming alone. I don't really remember if I had sex when I was
ever increasing the doses so I can't compare it to that, but I don't think it would have helped. It would probably have been even harder to orgasm with a partner than by myself. It gets better for me within three weeks of increasing a dose. When I was suffering quite severely with PTSD symptoms before I started taking sertraline, I
was too anxious to really have or enjoy sex. Then once I started taking it, I can now have sex pretty happily again.
Katherine: So, I was a bit of a late bloomer in terms of sex. I didn't have a serious boyfriend until I was 19 and didn’t lose my virginity until then (by that point I’d been on the meds for two years). I think one of the reasons I didn't have a boyfriend until that point was due to my mental health. I was just convinced that no boy liked me. I also felt a lot of pressure to be sexual – all my friends were having sex and I wasn’t. I think the trouble is because I went onto the meds at 16 it’s such a pivotal age when your hormones are kicking in. I went onto them before I started my period so it's hard to know whether your sex drive is natural, or whether it’s placated by the meds.
Meg: I think it’s affected my sex drive in waves. I think most of all its affected how I enjoy sex as opposed to how often I want it. I find it a lot harder to enjoy myself in the moment. I’ve noticed a difference in general in trying to orgasm both by myself and with a partner.
Maja: When I first started medication, I didn’t really notice a change in my sex drive, as I had been previously been depressed so my libido wasn’t great to begin with. After starting higher doses of the medication, I noticed that I couldn’t orgasm sometimes, and when I did it would take significantly longer than it would have before starting the meds. The weirdest part is that now that I am on the highest dose available of citalopram, my libido has gone back to normal, which was unexpected but definitely a welcome change.
Jack: In the early stages on lower doses, it didn’t affect my sex drive much. But when I was on a fuller dose, I noticed less of a drive which I didn’t expect at all, and I wasn't really warned about it by my doctor or anything. Then when you notice it, it's in your head and so it probably made it even worse because you get stressed about it. I also had difficulty reaching climax. Then within days of coming off my medication I had no issues at all.
Has this in any way changed your sense of self, identity, or body image?
Jen: At first, I was worried to take sertraline even though it was recommended, and I did try other drugs. I chose fluoxetine instead of sertraline because I feared gaining weight due to a past eating disorder, which kind of has remanence now that comes up. When I did try sertraline, I ended up gaining weight - except not by accident. So, I was really stressed out about that initially. Sertraline really just relieved my symptoms of stress,
anxiety and insomnia, and I gained weight because of being healthier and not using restriction or exercise as much as a coping mechanism. So, it wasn't actually scary in the end. I have a much better relationship with myself overall now.
Katherine: Yeah. I thought okay, 7/10 of my friends have a boyfriend or have “done it”. I would always fucking dread never have I ever. I would always have to lie, and I hated that. I just felt like why haven't I done sexual things and then I felt I had to justify it to people. In my head it was like, well, you haven't done it because no one wants to do it with you. So yeah, it affected me, but I wouldn't say that it affected my sense of self
necessarily. It was more when I was in a situation where people would bring up sexual stuff. It wasn't a major priority to me. If anything, I felt more pressure from other people.
Meg: Yeah, probably. I've never found it easy to orgasm. I've always been insecure about that, because I've never wanted it to reflect on my partner and to make them feel insecure about it, or for them not to feel like I'm having a good time. So, the fact that it's gotten harder means I just get more in my head and more stressed, and makes it a less enjoyable experience all round.
Maja: It did make me slightly self-conscious when I first noticed it. I felt my body had changed from something I knew intimately to something I couldn’t recognise and had to learn all over again. Sometimes, I would even get angry at myself or my body for not being able to perform as well as I wanted it to, which made me hate myself even more. Over time though, I’ve been able to appreciate my body for what it can do, and forgive
myself for not living up to society’s expectations, as well as learn how everything works all over again, which has been quite exciting.
Jack: Yeah, my sense of self a bit for sure. Because I wasn't told about the side effects at first, I thought there must be something wrong with me. That definitely affected my sense of self. Also, the lack of climaxing puts a bit of a grey cloud over the whole experience of sex. It didn’t happen all the time, but when it did, I was immediately hit with an anxiety like, oh shit, something's wrong with me. It just makes you feel a bit rubbish about yourself. I think with toxic masculinity there is such a shagging mentality and it all links back to why men feel ashamed to talk about these sorts of issues. That’s then linked to a lower sense of self, because if you hear all these blokes saying I shagged so and so all the time you’re like, oh shit. And you just get more in your head.
Has your changed sex drive in any way affected your relationships?
Jen: It hasn’t been an issue with a partner as I don't think I had a partner at the time when I was increasing the doses. But now it's the other way round and it’s kind of a blessing because I can have sex without much anxiety involved at all. I can enjoy it with sexual partners or by myself.
Katherine: It has definitely affected them. More so that when you're feeling awful in yourself the last thing you want to do is be sexual and strip off for someone. Before I spoke to anyone else who was on meds, I was just convinced that it was just me and not the meds. I thought maybe I'm just asexual and that freaked me out. But then I realised no I do have a sex drive, it’s just not on the same level as everyone else as it was being
dampened by the meds for sure. Also when you get close to someone at aged 16/17 it’s a question of when do you turn around to a boy or girl and go, so by the way, I'm on medication and I'm in treatment for mental health issues. And when do you say oh, by the way, those scars are self-inflicted. At the time I was self-harming and if I had a boyfriend, I didn't want to get undressed for them to see that. I kept people at arm’s length. I went on holiday with an ex-boyfriend, and he kept reminding me to take my meds and I felt quite comfortable around him being honest about how I was feeling. But then as it ended, it was almost used against me in a way. So, it can be really hard to know whether or not you can trust someone in either a friendship or romantic
partnership as to whether you can tell them about your experiences. But as I've grown older, I've realized when you find your people, they are not going to judge you. None of my current friends who know that I'm on medication would ever judge me or think it’s a bad thing.
Meg: Yeah - when I started taking meds I was in a long-term relationship. It was quite easy to communicate about it because they knew everything that was going on with me and they were with me on that journey. Since, I think it's a little difficult because you don't want to be on a date and have to say oh, by the way I’m on meds. It’s just an awkward thing to have to consider when you're already considering everything else about someone like do I like this person? Do I want to hook up with them? When do I bring this up?
Maja: Yes, it has. I dated a girl last year who was on the same medication as me, but had slightly different side effects. She was on a higher dose than I was at the time, and whenever we would engage in sexual activities, neither of us would be able to orgasm, which made for quite interesting experiences. It helped me to learn to appreciate sex for the journey and not just for the destination. However, whenever I drank alcohol, my libido
would come back and I would be able to enjoy myself and orgasm, whilst hers would disappear completely after drinking. It became a bit of a problem as we were never on the same page after going out for drinks together, and our differences did lead to the end of the relationship.
Jack: Not in my friendships because I didn't speak to anyone about it. In terms of relationships not really either because I kind of sorted it by coming off the meds before I was even seeing anyone. But I can imagine it would have massively affected a relationship if I was in one.
Other than the effects on your sex drive, how do you think your medication has affected you?
Jen: I think I have more clarity of mind. The medication allowed me to get to a point where I could actually do therapy in a fruitful way because the condition was very disabling before. NHS therapy has been amazing. It's helped me build my sense of self and understand that I can say no to things. I feel empowered in general. I would say something as well related to eating disorders, my ED started off as anorexia and went to bulimia and back and forth. And I struggled with that since I was 13 (I'm 23 now). This is the most recovery I've had in the past two years, I'd say, because I've started medication. So, I'm not really using anorexia or bulimia as a coping mechanism anymore. I'm the most confident I have ever been including sexually at my highest weight
ever, which was like the scariest thing for me. I couldn't even imagine that before. And I used to think I needed to be skinny, or I won't go on a date or meet a guy because my body's not in a good enough state. Whereas now I feel so confident I've had just a massive ego boost recently. With PTSD and sex, sometimes if I get triggered, even since I've been on medication, I have to set boundaries. For example, I watched a Jeffrey
Epstein documentary recently (which was probably a bad idea) and the girls mentioned some things which reminded me of my own sexual trauma. So, I had to say to my partner, okay, we can have sex, but you can't touch this part of my body. And it was quite difficult to communicate, but I think that it's just a matter of being very open and choosing someone who understands you - they should be empathetic if they're your partner.
Meg: At one point when I was on a really high dose, I felt like I was numb to everything. I couldn't cry anymore, even when I wanted to. Then there's obviously all the other side effects that come with it. Even now three years down the line I have no temperature control anymore. It also really affected my appetite when I first started taking it.
Maja: I think the biggest way that medication has affected me is that my mental health is so much better at the moment and it doesn’t impede my everyday life as much as it used to. I used to not be able to get out of bed some days, or even weeks, and was in a very dark place before starting medication. Things improved somewhat at the beginning of my journey with medication, but it hadn’t been until recently that I’ve really noticed the difference. I used to be able to relate a lot to my brother, who struggles with clinical depression to this day, despite having tried every combination of antidepressants available, but now I realise I am in a completely different situation to him and it’s honestly quite strange. I feel like I can enjoy the little things now, and take joy in planning my future, whereas before I couldn’t even picture what the future would look like
because I didn’t think that I would be a part of it.
Jack: Positively, my medication stopped me feeling shit when I needed it too. I was never on a super high dose of anything, so I was very fortunate in not feeling too many side effects. The reason I came off them was because I realized in my circumstances my lifestyle was the more important factor in my mental health. I thought to myself that I don't want to be on these pills forever and sex drive was a factor. I kind of experimented a bit and went off them without consulting my doctor, which was a bit silly, but luckily it worked for me.
Sex is so important, and having to compromise your libido for your mental health is a hard sacrifice to make – has this ever frustrated you?
Jen: For me it's, it's been fine really. It's just been frustrating if I'm horny and I can't get over the edge of an orgasm.
Katherine: Yes, I felt that in my first relationship, I would have sex because I felt it was my job as a girlfriend, not because I was turned on. There were definitely times when I thought I don't want to lose him, so I’ll match his sex drive.
Meg: Yeah, literally I say this to my friends all the time. I'm like what's the point in not wanting to kill myself if I can’t have sex! I want to enjoy my life and have a good time. And it feels like the cost of feeling stable is sacrificing the things that make life worth living. It’s like Sophie’s choice!
Maja: My lack of libido due to my medication has frustrated me so much over the past two years, to the point where I’ve even contemplated giving up on medication just to get it back, despite my mental health declining rapidly every time I was without it. I used to sometimes skip doses so that I could get it back for a day or two before going back, even dealing with withdrawal symptoms, so I could feel normal again. Now, I realise those weren’t the best decisions I could have made, and taking the meds every day consistently really helps improve my mental health a lot, and I wouldn’t give that up for anything, even an orgasm.
Jack: I think it's very hard because obviously sex and mental health are two very important parts of life. Your sex drive is obviously important in terms of relationships, and mental health affects all aspects of life. When I really needed medication, I think it was worth it 100%. In the Venn-diagram of life, mental health affects everything. When I realized that there were other ways of improving my mental health, the medication
became less important.
Is there anything you wish you could tell your younger self, before you started your medication?
Jen: I would say don't fear the medication and its side effects and go with the one initially recommended or at least try it. Sertraline was initially recommended for me but due to fear I ended up trying all sorts of medication which had even worse side effects. It shouldn’t be stigmatized as well because my family stigmatized medication to an extent of thinking we shouldn't put you on that, but ultimately it was the best thing for my mental health. In combination with therapy as well, it's been so helpful. Also, just having both of those things have helped me to have healthiest sexual relationships with partners and myself. So, I feel less shame whether it's by myself or with a partner. I'm a bit more aware now about consent and boundaries and how to say no, whether it's just to sex or within a sexual context.
Katherine: I hate this phrase, but it's very true: trust the process. I went on them at quite young age and when you're young you’re struggling with so many insecurities and I still struggle. I don't go out with a massive badge that says “I take meds”, although I don't really care anymore. I would encourage anyone who is going to get help for their mental health, just fucking own it. By owning it, you then have the power over it, and no one can
leverage it against you, and no one can make you feel bad about it. By doing that, it can either improve your relationships or it can reveal the ones that are fair weather friends. Also, don't read all the side effects because you will freak yourself the fuck out.
Meg: I'm grateful for the medication because when I started it, it really did save my life. I was so low, and I needed that. Three years down the line, I would tell myself that just because I needed it then doesn't mean that I will always need to be medicated. It’s much more important to try and take care of the other things that impact my mental health, rather than just thinking I'l take a pill and it'll make it better. Also, I struggled to tell people that I was depressed, or I had depression until I went on medication. I didn't feel like it was legit until I started my medication. I then thought if they medicate me for it, then I can confidently tell people I have depression. So, I would just tell myself to stop holding that up as a marker for how ill I was. As women, we must trust ourselves and the way that we feel. Six or seven months back, I told my doctor that I wanted to
start bringing my prescription down because I was on 150mg. They told me “we don't usually start taking prescriptions down in the winter”. But I knew that the medication was more adversely affecting me than was helping me. I went down to 100mg then 50mg. I feel so much better and I'm just glad that I trusted myself and my instincts. We're living in these bodies and we know how we feel and what we want to do with them.
Obviously, you need to listen to medical professionals and take their advice, but no one else lives in your body except for you.
Maja: I wish I could tell my younger self that she didn’t have to be so afraid of medication, and that taking it wasn’t a sign of weakness. I also wish I could tell her that opening up to your family about mental health isn’t as scary as it seems and your mum will not disown you for having the same mental illness that she has struggled with in the past, and that she should go to the doctor sooner and not wait until university when things got really bad, then maybe she could have avoided the massive mental breakdown during first year that lead to dropping out of uni.
Jack: Yeah, you're not going to suddenly be cured. I kind of learned by experience - for me anyway, it was the drinking probably a bit too much and my lifestyle. Medication isn't going to make everything else go away. So, I would just tell myself that, it's part of the solution but not the whole solution. I would also tell myself that
medication affects more things than you think. Definitely research the side effects for yourself. It would be nice if guys spoke about their mental health more to each other too.