Love, Lust & Lexapro

There's a lot we don't feel like doing. But can you hear me out that once we started doing it, we're glad we did. Like, I don't think anyone's ever been like, fuck, why'd I have that orgasm last night? Why'd I have sex last night? So if you have to do little things to push yourself and to keep going, like with masturbation or toys, start getting you in the mood and get you going, I think you're gonna find that your orgasm is going to come back. Maybe it'll even come back stronger.

You're listening to Sex with Emily. I'm Dr. Emily and I'm here to help you prioritize your pleasure and liber the conversation around sex. Let's talk mental health and sexual desire. Do you really have to choose between one or the other? While antidepressants like Lexapro can be life saving, all too often they deflate our sex drive. But conversely, it's hard to get aroused if your depression goes untreated. So is there any way out of this predicament? Like you have to be really depressed in that one sex or you take a pill and you feel better, but then you have a side effect. What to do? Well, on today's show, I'll answer how to overcome this struggle that is way more common than you think. You'll hear from some of our listeners and I'll also share alternative treatments to hacks around timing and dosage. I'll help you keep pleasure in your life without compromising your mental health. Health. We can have really strong mental health and a lot of pleasure, I promise. All right, intentions with Emily. I want to start off by setting an intention for the show and I encourage you to do the same. Well, my intention is to alleviate any sense of hopelessness you may have around mental health and your sex life. Whether it's you or a partner. Supporting your mental health doesn't mean saying goodbye to your sex life. Please rate and review Sex with Emily Wherever you listen to this show, it really helps us. I appreciate you all. My new sexiest gift guide ever. Emily's picks for 2022 holidays is up@sexwithemily.com Check out my YouTube channel, Social Media and TikTok. It's all Sex with Emily for more sex tips and advice. If you want to ask me questions, leave me your questions or message me at sex with emily.com askemily or call my hotline 559-talk-sex or 559-825-5739. Just include your name, your age, where you live, and how you listen to the show. And you can totally change your name or choose to remain anonymous. All right, everyone, enjoy the show.

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All right, I'm going to do things a little differently and I'm going to start off with an email because it really illustrates the main issue. We've heard a lot from you when it comes to to your mental health and treatments. Okay. This is from Sarah, 22, in Georgia. Hey, Dr. Emily. I'm a longtime listener of the show and I was reaching out because recently I've had some sexual troubles. I'm on antidepressants for my anxiety and it's helping out in so many ways, except sexually. I know it's a side effect of my medication, but my sex drive is so low, I no longer crave sex most of the time. And I've stopped masturbating as a result. Reaching orgasm was normally easy for me, but it's now difficult to almost impossible. My boyfriend and I have been dating for three years and we usually rip each other's clothes off. Well, I don't want to stop taking my medication, but also don't want to give up my sex life. Any suggestions? Sarah, you just painted this very common conundrum. Do we have to choose? Can you be on a medication that's helping your symptoms and still want to have sex. Well, let me clarify one thing here. You have been with your partner now for a few years. And so I want to normalize that after a few years, the honeymoon phase starts to wane. We're just not going to want to rip our partner's clothes off with the same verb and intensity that we did before the honeymoon phase or when we were still in the honeymoon phase. Okay? So just normalize that. It guess we have to put a little bit more effort in. And I'll share more of this in a few minutes. But sex drive is lower. That is a side effect of taking an antidepressant, especially an ssri. So just know that once you do get going sexually, meaning you can get over this lack of just spontaneous desire of just instantly wanting your partner the second they walk in the room and ripping the clothes off. Like, that's not going to happen. It's not going to happen in longer term relationships. And it's definitely doesn't help to be an antidepressant. I get it's not going to happen spontaneously. But understand what you need to get in the mood for sex. Once you can get yourself going in the mood, you're going to want to keep going. I often liken it to like going to the gym. You know, sometimes you just don't want to go to work out and the hardest part is getting on your shoes and getting out the door. But once you get out the door and you got your workout clothes on, it's a lot easier. So think of your sex life this way. Like, okay, so maybe you're not having that really strong desire, but you need to do things that are to get you there. Maybe it's sending your partner a sexy text and saying, I can't wait to see you tonight and I look forward to doing these different things with you. Maybe you guys make out in the morning and you start sending each other sexy texts throughout the day, building the anticipation for when you see each other later. So it's sort of hacking this typical arousal that you used to feel in desire. And remember, desire and arousal are often used interchangeably, but technically they mean something different. But it's also okay if you conflate them. Desire is the mental, it's the wanting, it's the desire for sex. It's that thinking about sex. It's that knowing I want to have sex right now. And what I'm asking you is think about other ways you can get yourself in the mood so that desire will come. It's not as spontaneous as it might have Been in the past, it might be more responsive. Arousal is actually the physical symptoms. Arousal is when your body is showing signs of arousal. Maybe you're getting wetter, there's an erection, your breath is quickening, your face is flushing. That's the arousal symptoms. But either way, we tend to use them interchangeably. So all I'm saying is here we got to figure out your desire, arousal, and what's going to get you in the mood. Because once we get going with sex, once we start to say, like, I'm going to start making out or doing foreplay, you'll find that you will get into the mood with your partner and you will want to have the sex and finish the sex. And you'll be so grateful that you did. Much like going to the gym where we don't want to. And then once we get out the door and get to the gym, we're always glad we did. And I. And I'm here to say I think we're always glad once we get to the sex as well. In fact, I don't think anyone's ever like, why'd I have sex last night? Why did I have that orgasm last night? That was terrible. No, we want to do it. What this medication is making us do, it's making us work a little bit harder, a little bit smarter, and sort of hacking our system so we can get to that point of being ready for sex. Okay, so, Sarah, you are so not alone. And we're going to get into. Now, how do you balance taking an antidepressants with a healthy sex life? Why is this a common challenge right now? Well, for starters, let me just lay down the facts for you. More people are feeling anxious and depressed than ever before. In fact, the prevalence of anxiety and depression have increased by 25% worldwide in the first year of the COVID pandemic. How crazy is that? So think about it this way. Pre pandemic among adults, about 8 to 9% of adults were saying they were feeling depressed. During the pandemic. That number climbed to 32%. That is a massive jump. Which means that 1 in 3, 1 in every 3 of Americans are experiencing some depression. And as far as anxiety, more than 4 in 10Americans say they were more anxious than the year prior to in May 2021. Also, more people are suffering from social anxiety after emerging from the social isolations we all experienced during the pandemic, which makes sense. We were not around as many people. We got very comfortable at home, and it got a lot harder to get out there and to Start talking to people again. So we have to all go easy on ourselves. And remember this, your sexual well being is directly impacted by your mental health. If you're not feeling mentally well, well, you're not going to feel as sexually tuned in and turned on. A study in 2022 found there's a decrease in sexual activity and higher rates of sexual dysfunction during the pandemic, largely due to higher rates of anxiety, depression and fear and an uptick in antidepressant and anti anxiety bed usage. So there's less sex happening, more dysfunction, and they're attributing it to people on antidepressants. But, but listen, it wasn't just the pandemic. We also saw before the pandemic that sexual dysfunction was prevalent in 62% of depressed men. And then we look at women and this stat has been around for a long time that 21% of Volvo owners will experience depression at some point. My belief is that penis owners or men experience depression just as frequently as vulva owners. But maybe they're not as in touch with what it means to be depressed. So I want to normalize that as well. We all know that men are not socialized, talk about their emotions as much. At least they weren't 20, 30 years ago. Hopefully men of today were raised in homes more open and a lot more support around expressing emotions. But again, this study's been around forever that twice as many women are depressed than men. And again, I think that it's equal opportunity. We all get depressed. We are in a conundrum because now that we're treating our depression with antidepressants, we are having the side effects. So why, why are antidepressants causing a low sex drive? Well, the most common is that we're taking these antidepressants, which are SSRIs and SNRIs. But the SSRIs are the ones that are most common, that initially they're saying they increases the levels of serotonin in the brain. Because low serotonin, which is a hormone, is what's influencing happiness, learning and memory. And so we have to maintain serotonin levels, which is why SSRIs can be helpful. And when I say SSRIs, it's like all the common ones that you hear of. It's like Cymbalta and Prozac and Zoloft and Lexapro. Those are the main culprits. Those are the ones that are the most commonly prescribed and the most common ones that are going to cause sexual side effects. Then there's also SNRIs, a serotonin and noneperphrin reuptake inhibitor. So these also work on levels of like non EP prefer to the brain. Just to break this down, that's like Effexor, that's Sibolta. Basically they're the same. Basically, if you're an SNRI or an ssri, the ones that you are most commonly prescribed, you're going to have a sexual side effect. Now listen, the reasons are not totally understood since depression itself can cause sexual side effects. So how do you know? Is it the medication or is it just that I'm feeling depressed? What we do know is that these medications are in place to release serotonin to help with users that are feeling depressed and anxious. And some studies have shown that too much serotonin inhibits a person's sex drive, which is why you're making harder experience pleasure. So what we're saying is you've low serotonin, so you gotta take a pill that's gonna increase serotonin. But when we increase serotonin, you're gonna feel happier, but it's going to impact your sex drive. Another theory is that as your serotonin is increasing, as is these medications, then your levels of dopamine are decreasing. And then since dopamine is the chemical we need to feel stimulated sexually, our sex drive is going to decrease. So there's all this stuff happening with your hormones. We want to get this happy hormone in place. It's going to decrease the sex hormone, which I got to be honest, seems like this really cruel trick in a way. It's like I'm so depressed, can't get out of bed. The last thing on my mind is sex. Taking an antidepressant that makes you feel alive and happy and social and like you wanna have sex, but now you can't because of the side effects, which to me just a huge freaking bummer. It's a huge bummer that like we need dopamine to feel stimulated and then it's gonna be decreased. A few months ago there was a groundbreaking study that came out because what we've been told for many, many years, so 30 years, since the 90s, since Prozac and all these other antidepressants came out, we were told that somebody who's depress depressed as having a chemical imbalance and this chemical imbalance needs to be treated by an anti depressant. Well, these studies that have came out showed that it's actually not true. There isn't a chemical imbalance that depression is not caused by low serotonin. But the truth is, is that we have to remember this is that they're not really sure why. And I actually did a big deep dive on this study. They're showing that, well, that might be true. What's also true is that antidepressants do help treat depression and symptoms of depression, anxiety, ocd, eating disorders, and they can be life saving. So I am in no way saying go off your antidepressants. And I don't think the studies say that either. It's just saying, you know what? The culprit might not be this elusive chemical imbalance. The culprit might be life of trauma, someone from ptsd, someone who had a really unstable childhood with more trauma than usual. Because, side note, we all have little messed up things that happen in our childhood. So it could just be your own experiences in life. Which is why there's also been so much talk lately about trauma and treating trauma through a lot of your nervous system treatments, which is like heat therapy, cold therapy, acupuncture, exercise, nutrition, therapies like emdr, eye movement desensitization, reprocessing. There's a lot of great trauma therapies out there and different kinds of trauma therapies that work in the body to release trauma and to release stuff that's stored in the body in addition to in conjunction with antidepressants. So you're on an antidepressant. So what are these side effects everyone talks about? Let me break it down for you, V. Owners, 72% had problems with sexual desire, which we already talked about is the psychological part of wanting to have sex. That's the part of you that says, I am so horny, I'm so turned on, I can't wait to just rip my partner's clothes off. 72% had increased problems with that. 83% of all owners had problems with arousal. That's physical. That means they weren't getting as lubricated as normal, their breath wasn't quickening, they weren't having as many physical symptoms of arousal. And for Vulva owners on SSRIs, 42% had problems with having an orgasm. But let's go to penis owners. Penis owners. Their most common sexual side effects from using an SSRI is they also reported higher rates of problems with sexual desire and having an orgasm, but lower rates and problems with sexual arousal. Which means that men were getting erections, but they weren't necessarily desiring sex or having orgasms. So they were walking around erect, but not ejaculating. Is what I'm hearing from this. But also because arousal for men, I think could be more mental. Like, you can get an erection, right, but the desire wasn't there. But once you got your desire going, you got aroused, but the orgasm wasn't happening. And I've heard this from many. They're like, I'm doing all the things, I'm having sex with that partner and I'm not coming. Okay, so the antidepressants that are most causing these sexual side effects are the ssri, which is like Prozac, Zoloft, Effexor, Sebalta, Paxil, nfxr, xr. So, okay, I've laid the land out for you. Now you're realizing that you are not alone. But does this mean that your sex life is over? Does it mean you have to go off of the antidepressants? No, I'm not saying that. Here's some things that you can do. Okay, first off, well, listen, even if you are suffering from depression or anxiety, I think this goes for everybody, that the more you can do, more holy holistic healing practices like acupuncture, breathing, moving your body through exercise, working on healthy nutrition, taking supplements, meditation, yoga, all of these practices absolutely help calm the nervous system. They help you're helping moving your body and they can be a great supplement to any other thing that you're doing. For to treat your depression and anxiety. You definitely have to consult it with your doctor about all this stuff. Because SSRIs are notorious for killing sex drive. You have to remember that only 20% of doctors who prescribe them are even going to tell you about it, which is why a lot of you are not clear. You're like, what happened? I was wanting to have sex all the time and now I don't. So I just want you to understand that your doctor might not be telling you this. So in conjunction to taking a med, try to make sure that you have. You are practicing a healthy lifestyle overall. Here's some things that you can do. Always consult with your doctors. You can try switching medications. There's a handful of non SSRIs out there that have fewer sexual side effects, like Wellbutrin or Remeron. Those are really common that those are common alternatives to SSRIs to treat depression and anxiety. They don't work for everybody, but you could definitely talk to your doctor about trying another one of these medications. There's also some supplements that have been reported to help with sexual dysfunction. Saffron. That's been one that's derived from a flower and that can help with aphrodisiac effects in animals and humans. And some evidence that inhibits serotonin reuptake and can sort of help with achieving erection and orgasm in others. Another one is 5 HTP. This has been around for a long time. That's another supplement that can be as effective, some say, as SSRIs. Now, again, try it out. You gotta talk to your doctor about this. I think you have to be really regular with these doses and also try some of the other holistic approaches I talked about for these supplements to work. Okay, but here's some other hacks. If you're staying on the antidepressants and you're like, but what else can I do? I don't want to go off the beds. Which I totally understand. Here's a few hacks. Timing. So a lot of patients have noticed that there's stronger side effects right after they take their antidepressant. So if you know you're going to be having sex, take your SSRI first thing in the morning. So when you're having sex later that night, the side effects might be decreased. Another one is reducing alcohol. Many, many, many people are quick to blame their SSRI for a lower sex drive, when alcohol may actually be the culprit. There was a study that found that 34% of women experienced symptoms of sexual dysfunction, especially lack of desire and difficulty with orgasm, when they were on an antidepressant and also having a high level of alcohol consumption. They clearly warn you on these antidepressants not to drink alcohol. And I'll be honest, very few people read that or adhere to that. But it might not be your antidepressant, it might be your alcohol intake. So as always, just pay attention to that and reduce your alcohol consumption. Marijuana. Lot of studies lately about marijuana, cannabis and sex drive, but it is limited. A lot of these studies, but it seems that at low doses seems to help with sex drive, which I've heard from many anecdotally and in research that a low dose of marijuana, whether it's like an edible or, you know, another form, can sort of help with sex drive. You're kind of decreasing inhibitions and it can help you get more in the mood. Studies show that more than 200 women and men who use cannabis found that nearly 60% said that cannabis increased their desire for sex, which is a great thing. Again, I think it decreases your inhibitions and it allows you to be more in your body and maybe you're less in your head. The Flip side of that is that cannabis can lead some to be more anxious and paranoid, which is not a news flash here. But if you're feeling a lot more anxious and paranoid from cannabis, you're definitely not going to be as much in the mood. And also people experience problems with less motivation for sex, erectile dysfunction, trouble reaching orgasms or premature ejaculation. Well, it looks like vulva owners seem to benefit the most from cannabis because in a study they show that there was a definitive link between cannabis and improved orgasms for vulva owners. So perhaps just using your cannabis in the bedroom when you know you're going to have sex might be the sweet spot for many. But again, check out the side effects, talk to a doctor, try it out, maybe in small doses and see how it goes. I'm also excited to share with you some alternative treatments for depression and anxiety that I've been really fascinated with. And I've had some friends and colleagues who've tried it out. And one is called TMS therapy or transcranial magnetic stimulation. What I love is that it's FDA approved as a safe and effective treatment for a major depressive order. Maybe people who weren't responding antidepressants or just have been depressed for a long time. And essentially what it does is you go to see a doctor. I think some of these clinics you go once a day for 40 days. You go and they deliver these electromagnetic micropulses to your scalp. So essentially you're wearing like you lay down on a machine and you're essentially wearing like a, a scalp mask, a scalp helmet with a lot of different pulses on it. And what it's doing is it's activating regions of your brain affected by depression. So it's a non invasive form of brain stimulation. And what the cool thing is it operates completely outside of the body and it's affecting the central nervous system activity by again just applying these powerful magnetic fields to specific areas of the brain. It is shown that this can be more effective for many individuals than antidepressants. And it does not lead to sexual dysfunction. It's painless, it's non invasive, doesn't require anesthesia, it just requires a lot of time. Another thing people are asked about with this like, oh, is that like shock therapy, which has been used for many, many years. Shock therapy is still being used. ECT or electroconvulsive therapy. TMS offers lower low intensity magnetic pulses. ECT is like shock therapy. You probably heard about this like in the 50s too. Like it is literally shocking your brain because nothing else has worked. So your brain is actually seizing, but with this seizing, it's sort of resetting your brain. And it can help patients with severe major depression. I don't know many people who use it, but it can be used for people with very, very severe cases of depression. All right, Another thing, hallucinogens, AKA psychedelics. Now, there's been a lot of great research in recent years that's super, super promising for the treatment of anxiety and depression and PTSD with hallucinogenics, psychedelics. So one is ketamine. Ketamine is a dissociative anesthetic, and that has been used in small doses. According to a 2022 study in the Journal of Clinical Psychiatry, 72% of patients saw improvement in their mood. 38% were depression symptom free after 10 infusions. 85% saw decrease in suicidal ideations after only 15 infusions of ketamine. And they didn't have to go back on antidepressants. Or maybe antidepressants weren't even working. So I think this stuff is really, really promising. Mdma, also, AKA Molly or Ecstasy. There was a study that showed that 67% of patients no longer met the diagnostic criteria for PTSD 18 weeks after starting treatment. And then there's psilocybin, which is magic mushrooms. Studies have shown that again, 71% of people who took psilocybin for major depressive disorder showed a 50% reduction in symptoms after only four weeks. I think this stuff is really, really promising. But let me just tell you this. There is a disclaimer, and there's definitely downsides, like, everything. First, if you find a clinician, please only consult clinicians who are credited by maps, which is a multidisciplinary association for psychedelic studies. This is one of the only places that I think that are the most reputable if you want to find someone who's worked with maps. Things to know. Insurance doesn't cover these type of treatments yet. Hopefully they will. And in fact, maybe in some states they do, but many of them don't. Access is limited. You have to go to a clinic, enroll in a study, or do it from home. And again, you guys, I've had friends who had some bad experiences. I'm going to be honest. They found Academy Clinic, like, in their area, and it was just not what they wanted to be. So I just can't emphasize enough that you want to be with a practitioner and maybe you could talk to some of their clients, do some research on them, make sure you are working with somebody who is accredited. And again, the risk is that in some instances, hallucinogens can evoke a long lasting psychotic reaction, especially if you have a family history of psychosis. Okay, so really, I just wanted to lay out for you everything that's happening in the space of mental health and wellness and treatments for it. So hopefully that explanation of why antidepressants can can affect your sex drive and then some solutions to address the side effect were helpful for you. And please just let me know any questions you have, any clarifications. And if you'd like me to do more episodes on this topic, I would love to. Okay, so you let me know what you need here. All right, after the break, I'll be answering your questions all about antidepressants, sex drive, and arousal. So don't go anywhere.

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This is from L40 and she's in Los Angeles. Hey, Dr. Emily. I know the difficulty achieving orgasm is a common side effect of antidepressants, especially SNRIs and SSRIs. I've experimented with different antidepressant meds, and the only ones that help my depression are SNRIs, and they make it much more difficult for me to achieve orgasm. Never had a problem orgasming prior to meds, and when I switched off the SNRIS to Wellbutrin, I had no issues achieving orgasm. But Wellbutrin didn't help my depression. Side note, I've heard this is very, very common. A lot of people get switched to Wellbutrin. I would say for half people it really works, but for half people, it doesn't work. Okay, is there anything I can do to help counteract this horrible side effect of my SSRIs and regain my normal ability to orgasm? I appreciate any advice you can give. All right, so, yes, I want to help you here, and I want to say a few things. First, the side effects of SSRIs tend to subside over time. They're really intense in the beginning, but for many people, after a few months, they can subside. And a lot of it is mental, too. We are like, oh, am I going to be able to orgasm? I get turned on. The last few months, I haven't been turned on and aroused. And we continue to perpetuate this, you know, belief. So I think just knowing that you can figure out a way to break through it is going to help you. You could also try some of the hacks I mentioned above. Switching up your dose, making sure that you are healthy, that you're exercising, that you're moving your body, that you're eating healthy foods. You know, maybe trying a little bit of marijuana has been helpful for some, the timing of the dosage. Like I said, trying different timing of your dosage could be helpful. Masturbation, you guys, listen, you might not be hit over your head with this desire. You might not want to masturbate. You might be feeling like, I don't want to have sex. But sex begets sex. The more you start, like, trying to work on your desire and hack your desire. So maybe you start to masturbate so you remember what it feels like to orgasm, even if you don't feel like it. Okay, just like you don't feel like going to the gym, you don't feel like taking your medicated medicines, or there's a lot we don't feel like doing. But can you hear me out? That once we started doing it, we're glad we did. Like, I don't think anyone's ever been like, fuck, why did I have that orgasm last night? Why'd I have sex last night? So if you have to do little things to push yourself and to keep going, like with masturbation or toys, start getting you in the mood and get you going, I think you're going to find that your orgasm is going to come back. Maybe it'll even come back stronger. So be willing to do some workarounds and some supplemental activities that will help you reach orgasm and more pleasure. Okay? Thank you for your question. I really appreciate you. This is from Gemma. She's 28 in London. Hey, Dr. Emily, I need your help. I've been with my partner for a couple years and we're both on SSRIs, antidepressants, mines for anxiety, his for OCD. This has taken a huge toll in our sex life as neither of us had a sex drive since taking them. But they make our mental health so much better. There are so many societal norms on how often we should be having sex, but it's on average happening once a month that feels that we're doing it just because we should. We love each other dearly, but if this carries on, I worry we will only become friends. Is there someone out there that will make me want to have sex? Or is this how it's supposed to be? All right, well, thank you for your question here. And, Gemma, I get it. It is not easy when you're noticing the sudden plummet and change in your sex drive. But the good news here is that your partner's coming right along with you. He's also not feeling it. So how can you guys work together together to say, you know what, once a month doesn't quite feel right for both of us. And I kind of agree with you that if you're only having sex once a month with a long term partner, I feel like we probably need to be doing a little bit more than that. Unless you're both totally fine with it. But I'm not hearing that. What I'm hearing is that this is a great opportunity for you guys to tackle it together, work together as a couple. I don't think that you're going to find a brighter, shinier person out there that's going to help you want to have sex again in a way that you want to be having sex because you still love your partner, right? What might be interesting is to find your desire style. What do you need to feel aroused and in the mood? We have an article 5 arousal styles and we'll put that in the show notes. We also have a podcast that explains what your arousal type and some things in this article. Thinking again, you guys, like I said earlier, desire and arousal are very closely linked. I don't think we have to get caught up in it. But knowing where your arousal slash desire, it's thinking about if desire is like your motivation to have sex. Like where mentally like am I in the mood for sex and how am I going to get aroused to it? Like what actually happens so arousal can happen. Like how do you get to the point of your desire and arousal is through? Maybe you could find out I need conversation. Maybe you know, you know this that when you have long conversations with your partner about your hopes and your dreams and you know, maybe you're more of a sapiosexual, meaning that you need more of an intellectual conversation to turn you on, that's when you get aroused. Well, maybe you need to build in more of those conversations. Or maybe you find that you get aroused more through touch. The way your partner grazes your thigh gives you a sensual massage. That's what you need to be in the mood for sex. Or maybe you need visuals. Maybe you need your partner to send you sexy nudes or you want to watch porn together. Or maybe you want to share some fantasies or maybe you need to play, you know, maybe like talking about and planning your future, like I can't wait to talk dirty with you or to get dressed up or to do some kinkier things with you is really going to be the thing that'll get you guys on the same page. Or maybe you need Physical adventure. Maybe the two of you, when you work out together, you go hiking or you're like, you get the adrenaline going together. Well, couples who get the adrenaline and their heart pounding finds that they're releasing feel good chemicals in the body, which is prompting them to feel sexual. So you sort of leverage this physical arousal and then enhance the intimacy between both of you. So really this is about truly just understanding and sort of it's a hack for both of you, like knowing that you're both out in the mood. Look at this arousal style inventory. We'll put it in the show notes and just figure out what do we both need to get there? And then start to work around it so you can both find the pleasure and the desire and the sex that you both need in the relationship. The other thing that you could do, and this is a really interesting study, is that you can prioritize emotional intimacy. Again.

Emotional intimacy is a prerequisite for physical intimacy for many, many couples. And there's more couple counselors that are utilizing the 36 questions. There's a study that I find fascinating that's proven to increase closeness in couples. So each partner goes back and forth answering questions, and you can do them over a single session or stretch them out over time. And studies have found that when couples do these 36 questions, they've found to enhance intimacy and arousal and their frequency of sex. So some example of these questions are, for what in your life do you feel most grateful? Take four minutes to tell your partner your life story. As much detail as possible. Another question is, is there something that you've dreamed of doing for a long time, and why haven't you done it? Another question is, what roles do love and affection play in your sex life? So they found that when couples sit and ground in these 36 questions, that it increases their closeness, it melts away resentments. And couples have found more connected, more intimate, and more ready for sexual intimacy as well. Because again, antidepressants might be wreaking havoc on your body in ways that are negatively impacting your sex drive and your sex life. But all these tools here might help you override the side effects, so you could really work towards closeness and intimacy. Last question is from Courtney. She's 48 in Michigan. Hey, Dr. Emily. I'm 48 years old, and I recently started taking Wellbutrin and Lexapro for symptoms of depression, anxiety, fatigue, lack of arousal energy, brain fog. From 2010 to 2017, I took Zoloft. When I went off Zoloft in 2017, my sex drive life was reignited. Everything awoke from a slumber I didn't even realize it was in. It was amazing. This experience made me very reluctant to go back on any meds, but my symptoms were worsening rapidly despite the use of alternative treatments. As feared, the meds have affected every aspect of my sex life. And it's so frustrating that you have to choose between mental health and have an enjoyable sex life. Any thoughts, suggestions or help would be appreciated. Thanks for the work you do. All right, Courtney, I hear you. This is a bummer. So it sounds like you went off of all of your meds and initially you felt really aroused, turned on, like you were rediscovering your sex life. But those pesky symptoms were coming back, which sucks. Sounds like you started feeling anxiety, you started feeling anxious and depressed again and you went back on the meds. So what to do? Well, first I just want to say that you're 48 years old now, that there could be other things going on. And I would definitely find a doctor who specializes in hormone treatment therapy, especially for women's sexual health, and see if there's something going on with their hormones. Because at age 48, I would guess that you're in perimenopause. Perimenopause can last a women anywhere between like 8 and 10 years. Where your body's making the transition to menopause, which is menopause is simply like a day. Like menopause is when it's a year without a menstrual period. Perimenopause is this treatment that lasts forever. It seems like it's forever in women age 10 years. And in that period you're, you're all your sex hormones are decreased, decreasing. And unfortunately when you've got estrogen that's taking decrease and testosterone and you got to play with your progesterone, what happens is you're start to have symptoms that are related to anxiety and depression, but it's not in the same way you were having before. So in conjunction to going back on your meds, you might also want to get on some hormone replacement therapy, but again, only if you find somebody in your area that specializes in it. Because there's a lot of people who think they do or there's a lot of different opinions about it. A lot of times our western doctors, like gynecologists, are not necessarily up on the latest treatments. I'm a fan of bioidentical hormone replacement therapy, so I would look to that as well. And another thing I haven't mentioned is nutrition, I don't think as much, but there's a lot of great information lately. Aviva Ram, R O M wrote a great book on hormones, and that kind of talks about, like, it's a multidisciplinary approach. We have to, like, there's certain foods we should be avoiding, different, you know, supplements we could be taking. There's just a lot to understand about hormones as it relates to your sexual health and your sex drive. And so just becoming an expert in your own sex life and your own challenges right now is really important. I mean, sometimes we have to become our own very best advocates. Because I'm telling you, in my journey, I've probably gone to five or six different doctors and I've gotten all this different advice, and I really had to pick and pull what worked for me. And I can do another show where I talk about that. But, you know, menopause can start to women around age 40 to 44, and you're 48 years old. So I'm sorry to say this, Courtney, because it seems like you've been through a lot in all these years. But I would also just add getting successful hormone panels done with a doctor that you trust and working in nutrition and maybe some hormone replacement therapy as well. And so maybe you'll find that you won't need as much of the antidepressants as you need to supplement some other treatments. All right, thank you so much, everybody. Thank you for your questions, your emails, and we'll talk soon.

That's it for today's episode. See you on Tuesday. Thanks for listening to Sex with Emily. Be sure to, like, subscribe and give us a review wherever you listen to the podcast and share this with a friend or partner. You can find me on YouTube, Instagram, Facebook, and Twitter at Sex with Emily. Oh, I've been told I give really good email, so sign up at sex with emily.com and while you're there, check out my free guides and articles for more ways to prioritize your pleasure. If you'd like to ask me about your your sex life, dating or relationships, call my hotline 559-talk-SEX. That's 559-825-5739 or go to sexwithemily.com askemily Special thanks to Acast for powering the Sex with Emily podcast. Was it good for you? Email me feedbackexwithemily.com.

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