I’m coiled up in a ball, gripping at the duvet, holding it tightly so as to cover my naked body. A few minutes earlier, my nudity with a stranger hadn’t bothered me. But now, suddenly, it’s making me feel very vulnerable. We’ve been having sex for just over half an hour. I haven’t orgasmed. And I know there is no chance that I will at any point soon. It’s definitely time to call it a night. Yet, as much as I want to, I can’t ignore what has just happened. I have to say something. ‘Don’t worry about it,’ I add, the noise muffled by the pillow I’m hiding my face in. There’s more I could say, perhaps should say, but none of it lends itself to sexy bedroom talk. Certainly not on a one-night stand. It’s a lot easier
to just close my eyes, delve into a deluge of darkness,
When I was first prescribed antidepressants, I wasn’t thinking about my sex life. There were more important things to focus on. It was 2015, I was 19, and the Christmas holidays had just begun. I had also started to self-harm with anything I could get my hands on. Low mood, low energy, low interest in anything plagued me day and night. I listed my reality to my doctor in a monotone, telling him I’d tried counselling before—for OCD—and it hadn’t worked. I wanted medication. He handed me a prescription and off I went.
It was for citalopram, an SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant that’s widely used in the UK. I didn’t take anything in about the side effects—I only learned of them from a doctor back at university when I popped in to get a second opinion. Even then, they were mentioned casually. But looking back at the accompanying leaflets, it reads like a smorgasbord of robbed orgasms: coming too slowly, low sex drive or high sex drive, not being able to get an erection, numbness. The small print goes on...
I've not been feeling myself
My penis was numb within hours of taking that first pill. I was ready to expect emotional numbness. I also knew it would take at least four weeks before I felt any positive effects... But I didn’t expect to feel so much less down below.
The first time I had sex after taking the pills, it was as if I was wearing half a packet of condoms (I wasn’t even wearing one). The awesome high of physical touch dulled to almost nothing. I didn’t orgasm. I know that for women this isn’t unusual, that this suddenly being an issue for me seems a very particular, privileged type of complaint that could only come from a man.
But it had never happened before. All my life, I had an idea of who I should be and what sex should be—and the act not matching up to that terrified me.
Other side effects came quickly, too—from hands so clammy you could wring them like a damp flannel to gurning. These sensations gradually went away as my body got used to the drug. But the SSRI sexual dysfunction (SSD) has persisted ever since. I’ve taken around 1,000 citalopram tablets in that time, and the words ‘Sorry, I take a while’ have become a mainstay of my vocabulary. I still have some sensation, so there have been ways for me to slowly orgasm. At other times, no matter how hard I try, it just doesn’t happen. And the longer it takes, the more anxious I feel...and then the orgasm slowly fades away.
When Danish*, 25, speaks to me about citalopram, he does so in staccato sentences, as if he’s been suffering for so long, he’s tired of elaborating.
‘Weak, mute orgasms. Numbness. Trouble making erections,’ he says, listing his side effects on his fingers, before moving on to the emotional impact. ‘I felt suicidal,’ he says simply. ‘Angry. Confused. Broken. Less than a man.’ He’s managed to move from what he rates as 0/10 sex to 2/10 sex, but is crushingly anxious. ‘I’m nervous, but I’ve also largely accepted I’m a defect,’ he says, shrugging.
Online, men like Danish are easy to find. Disguising themselves under usernames like ‘Nogasm’, they flood onto forums such as Reddit, using the anonymity the keyboard provides to open up. I learn that having—and wanting—sex deems me ‘lucky’ in the eyes of others. Jai*, who, like me, began taking SSRIs while at university, has found his libido has vanished. ‘I never fantasise about sex,’ he tells me. ‘It doesn’t turn me on any more. It’s like that spark is totally lost from my brain; the rush of lust is gone completely.’
Others experience weaker erections or total erectile dysfunction, changes in the intensity of an orgasm, or less sensation. Just like the huge mixture of experiences reported online, sexual dysfunction associated with antidepressants varies considerably between studies, making it difficult to estimate the exact incidences or prevalence. That long leaflet I was given, says sexual side effects are ‘common’, happening to up to one in 10 people, but experts reckon it could be a lot more. One thing’s for sure, it is happening—to men, women, and non-binary people across the country. As to why, that’s not 100 percent clear either, as sex is more than just a physical act, it’s emotional, too.
The symptoms of SSD can have a lasting impact, even if someone comes off the drug. It turns out that there’s also PSSD: that’s post-SSRI sexual dysfunction. It’s exactly what it suggests: the same ill effects persisting after medication is stopped. It’s under-researched, and it affects Danish—he only took pills for a matter of days, but two years on, symptoms remain.
For some, these sexual issues could be down to the depression itself, with SSRIs merely exacerbating the problem. Dr Juliet McGrattan, a UK-based health expert and former GP, says, ‘When you’re depressed, there are chemical changes and imbalances in the brain that make you stop enjoying things in life, and that includes sex. Sometimes, patients would come to me concerned about a lack of sex drive, and after exploration, we would work out that depression was the underlying cause,’ she explains. To truly separate which symptoms are caused by depression itself and what’s a side effect from the drugs, a large study would need to be conducted on adults who don’t suffer from depression. Unfortunately, few of these have taken place. In addition, the effects and speed of the medication varies from person to person—so it could be positively impacting your mood, while still compromising your sexual function.
Coming off to come
There have been times when I have questioned why I’m still taking citalopram. The temptation to quit becomes all I can think about. But this would not be a good idea for me.
Taking citalopram didn’t just dramatically improve my life—it saved it. A period of depression had left me confined to my crumb-filled, sweat-stained bed, sleeping throughout the day and an insomniac during the night. Pleasures became pleasureless, emotional pain became self-harm. But finally, medication galvanised me. Although SSRIs have faced some fierce criticism that debates how helpful they actually are, and much is still unknown about their workings (and even about depression itself), it’s clear that they do work, in some way, for most people. In 2018, the largest-ever review of antidepressant trials showed that every single one of the 21 studied, including citalopram, worked better than a placebo.
And with sex, over time, I’ve found things that work, too. Without going into too much detail, there are other areas of my body that are just as sensitive, and sex doesn’t always have to be the traditional way that heterosexual society fixates on. It’s taken some adjusting, sure—not just for me, but for my current girlfriend and those before. I am aware that in the same way that my SSD impacts me, it has also impacted my partners. I’m less likely to initiate sex, which can be demoralising for them. Just as depression affects the people around you, SSD can cause collateral damage as well.
Dr Lori Beth Bisbey, a UK-based sex and intimacy coach, regularly sees couples who are experiencing SSD. Despite being happy in many others areas, they often feel the issue is ruining their relationship. It doesn’t have to be this way. Firstly, both partners need to understand this isn’t about their performance, or how attractive they are. Secondly, they must talk about it, and learn about the side effects in a compassionate way. Equally, the partner suffering from SSD should still find ways to be intimate and satisfy their other half. It’s a vital balance. And communication is key.
When it comes to sex, there are certain gender stereotypes lodged deep in the back of so many of our minds. That men want it all the time. That we orgasm within seconds. That sex has to end in an orgasm. These ideas—and more—have remained since high school, and are exacerbated by porn culture, so ingrained, it can be hard to shake ourselves out of them. For men like myself, Danish and Jai, these preconceptions weigh us down, making us feel ‘less than’ because we don’t fit into an ancient mould. And, in turn, our partners are told the same things, so when we don’t initiate sex or reach orgasm, it can make them feel that there’s something wrong with them.
Of course, my issue of not being able to orgasm through penetrative sex is not out the ordinary. Research by Durex showed that almost 75 percent of women studied do not orgasm during sex, compared to 28 percent of men. This orgasm gap has only really come into public consciousness because we’ve started to talk about it. And as soon as I started opening up about my SSD, things became easier. Every partner I told was kind, and we found a sex life that was enjoyable for all involved.
It also made me realise that somewhere along the way we’ve got it all wrong. Why do orgasms have to be the marker of successful sex? It was chasing them that made me anxious and afraid. But discussing it, and becoming able to enjoy sex in other ways has brought me hope—a hope that in the future I’ll be able to lie in bed, those painful memories of inadequacy as dim as mood lighting. One day, I’ll get there. Even if it does take me a while.”
Words like ‘Sorry, I take a while’ have become a mainstay of my vocabulary.
Pleasures became pleasureless, emotional pain became self-harm.