mental health

HOW VANITY CURED MY DEPRESSION

I wrote this for Harper’s Bazaar

Down the street from my cluttered Brooklyn apartment sits a high-end nail salon that helped to save my life. Filled with aspirational pink cushions and soft notes of jasmine, the salon’s manicurists would paint my short, round nails an O.P.I black onyx—or, if it were a cheerier day, a dark purple.

For two years, during 2013 and most of 2014, I was deeply depressed. After experiencing a sexual assault, a breakup, and my parents’ divorce, the structure of my world slowly began to give way. I was held captive by a distinct powerlessness that sucked me into a vortex of dark disappointment; and eventually, the cruelest depression I had ever experienced.

I sought out a psychiatrist and as expected, my blood was soon filled with sex drive-killing antidepressants. Though they helped, I quickly learned that what I really needed at the time, what I actually wanted, was slightly simpler—I wanted someone to take care of me.

It started with the manicurists at my nail salon. I learned that having appointments to show up to (especially those that included a massage while my nails dried) helped to get me out of bed. I dyed my hair an oxblood red that, coincidentally, needed several visits to the hair salon. Gradually, I began to put more effort into my appearance at home: I tried winged eyeliner and I discovered eye cream. Before I knew it I had found a bonafide beauty routine, which, rather than cover up what I was going through (although a YSL red lipstick is a terrific tool for camouflage), became a daily reminder that I was a living, breathing person who was worthy of being considered—worthy of being paid attention to. And apparently, I was onto something.

“Self-care is enormously helpful during depression,” explained Dr. Marlynn Wei, a New York-based psychiatrist and psychotherapist. “Depression often causes isolation and withdrawal from all the things that you normally do to take care of yourself and feelings of low self-worth, so making sure to focus on being kind to yourself to allow yourself to heal is so important during this time,” she continued. “Beauty routines, if done mindfully from a place of self-compassion, can also enhance your mind-body connection.”

In my experience with depression, the enemy is not unwanted thoughts dancing for attention (as with anxiety), or even daggers of self-hatred. What you’re fighting is a nothingness set on sucking your ambition, and in later stages, a will to live. It’s a faceless enemy that fights dirty. For me, the act of self-care was retaliation. It helped me to feel alive. It wasn’t so much about the discovery of night cream—or the lasting power of Kat Von D’s liquid lip liner—it was the “Hey, you! I know you want to die right now, but still you’re beautiful, and worthy of being taken care of.”

Today, in an age where women are shamed for their makeup routines and their want to look beautiful as much as they are for daring to appear disheveled, engaging in vanity was an act of triumph I didn’t know I was capable of. The maintenance required to obtain my red hair and perfectly-manicured hands might not be for everyone (for you it might be long hot showers, a new hairstyle, or wearing high heels again), but somewhere along the way, I began to see glimmers of my old, buried self. What’s more, I wasn’t choosing a beauty routine to please a perspective romantic partner, I was doing it for me.

During this period I moved out of my ex-partner’s apartment and into my own. I dove into writing. And, over manicures, I turned Twitter friendships to new, real-life friendships with fellow writers. Slowly, I got better. Through therapy I dealt with the sexual assault and the pains of the breakup, which faded and eventually morphed into a friendship. Now I live with a new partner who is not scared of my occasional depressive proclivities. And at one point, with the support of my doctor, I simply stopped taking my anti-depressants—and nothing happened. I didn’t need them anymore.

When I look back at the person sitting in that Brooklyn nail salon, I hardly recognize her. But I do thank her for teaching me how to properly apply a red lipstick and the value of a night cream. And while I still haven’t learned to do my own nails (I lack the dexterity), I finally found the important person I needed to take care of me: myself.

 

The Tough Choice Pregnant Women With Depression Have to Make

I wrote a new article for Mic. Image Mic/Getty.

Amy* is a blogger and teacher who lives in Ohio. She was also diagnosed with bipolar disorder in 2003. Since her diagnosis, she has become the mother of three children.

“[During] my second pregnancy I didn’t really have any problems, but when I got pregnant the third time … it wasn’t planned, [and] I was on Lamictal,” she told Mic. Lamictal is an anticonvulsant often used to treat epilepsy which has proven effective in treating bipolar.

During the first trimester of her third pregnancy, Amy was told to go off her medication. “Everyone [was] like, ‘Oh if you stay on it they’ll be hurt for life!'” she told Mic. She looked up Lamictal and found out it was a Category C drug, meaning the FDA determined that animal reproduction studies “have shown an adverse effect on the fetus,” causing potential health risks for pregnant women.

Amy wanted to stop taking the drug, but she wasn’t able to get in touch with her doctors. “My mood pretty much just plummeted,” she told Mic. Three weeks later and still in a state of despair, she finally got in touch with her psychiatrist’s office. “They said, ‘Well, you shouldn’t have gone off of that,'” she recounted, with palpable frustration.

Later in her pregnancy, Amy said she struggled with some of the more severe symptoms of her mental illness. “I was doing a lot of self injury, cutting,” she told Mic. After being turned away from one mental health facility, she ended up in the medical side of a psychiatric ward. “I still wasn’t good, but I was more stable,” she said.

Pregnant women living with mental illness face monumental struggles. According to the World Health Organization, approximately 10% of pregnant women experience a mental disorder during pregnancy, primarily depression. (In developing countries, that number is higher: about 15.6%.) For Amy and other mothers who fall in this category, pregnancy isn’t a picture-perfect experience of satiating ice cream cravings and emitting a radiant glow.

Although the symptoms of postpartum depression are well-understood, as the New York Times reported in May, “far less recognized is an equally troubling condition: antenatal depression, or depression suffered during pregnancy.” In addition to depression, researchers have found that 5 to 16% of women struggle with an anxiety disorder during their pregnancy.

Traditionally, many doctors have warned against patients taking antidepressants while pregnant. But the truth about whether it’s OK to take such medication during pregnancy is more complicated than we think. Pregnant women with mental illnesses must make critical decisions about treatment — not just for their own health but for their baby’s.

“I took fluoxetine for the whole pregnancy,” Jess*, a mom blogger living in New Zealand who has been diagnosed with panic disorder, told Mic. “I was very concerned about it and was willing to stop taking [the meds], but at the same time, the risks of me becoming extremely unwell were far too high. You need to weigh the risks and benefits.” Jess’ daughter was born healthy in 2013.

rappling with stigma: Women struggling with mental illness often experience extreme guilt and fear if they choose to take a medication during their pregnancy. And unfortunately, there aren’t many reproductive psychiatrists to help them make decisions about their treatment.

“It’s challenging because there are a lot of psychiatrists who are very uncomfortable treating pregnant patients, just because there isn’t a lot of training on that. And then there’s a lot of [obstetricians] who aren’t as comfortable treating mental health issues,” Dr. Anna Glezer, a psychiatrist in San Francisco who specializes in reproductive psychiatry, told Mic.

Glazer told Mic that the answer to whether a woman should take medication during pregnancy largely depends on the medication and the woman taking it. “I think it will be really hard for anyone to say that a particular medication, treatment, supplement, anything, is ‘absolutely safe’ in pregnancy. But there are definitely some that are safer than others,” she said.

Some medications, such as the selective serotonin reuptake inhibitor (SSRI) antidepressant Paxil, are shown to cause harm to a fetus. (That said, other SSRIs, such as Prozac and Celexa, are generally considered to be OK to take during pregnancy.) Other types of antidepressants, such as tricyclic antidepressants like Tofranil and serotonin-norepinephrine reuptake inhibitors like Cymbalta, have been determined to not have any serious effects on a fetus and can be safely used during pregnancy.

Yet, as Glezer explained, deciding which meds to take during pregnancy isn’t as simple as finding out what’s OK and what isn’t via a Google search. “I would say that apart from a couple of select medications, I don’t say that you absolutely can’t be on something. Otherwise, it’s absolutely a risk-benefit [analysis],” Glezer said.

This decision-making process is more complicated than people might think. In some instances, the mental illness itself poses more risks to a fetus’s health than the medication the mother might be taking.

“Depression in and of itself has consequences during pregnancy,” Glezer told Mic, citing increased risk of self-harm, as well as less serious conditions like sleep loss, as examples. “Furthermore, if you’re depressed and unmotivated while pregnant, you might not have the energy to do some of the things your doctors are recommending. Then there’s the illness of depression itself, and studies have found that[‘s] associated with things like smaller babies [low birth weight] or preterm deliveries.”

These days Amy is doing well, as is her daughter, who was born healthy in 2011. But the lack of information on psychiatric disorders and pregnancy is prompting professionals like Glezer and women like Amy and Jess to work to spread awareness.

“That was a big factor in me starting my blog,” Jess said. “I was so sick of having to act like nothing was wrong. I really hope that by sharing my experiences, maybe one person will benefit. Then it would all be worth it.”

Ultimately, some women with mental illness are going to want to live as pharma-free as possible during their pregnancies. But others are going to find that they benefit from medication, even in small doses. “I’ve actually found that pregnancy-related depression responds really well to even really low doses of medication,” Glezer said.

If taking even small doses seems too risky, Glezer recommends purely non-pharmaceutical approaches are available, such as psychotherapy, massage, light therapy, acupuncture and exercise. Prenatal yoga has been shown to help with anxiety and depression.

“Women who do yoga during pregnancy and postpartum are better able to fight anxiety and depression because yoga lowers the stress hormone cortisol and helps develops a stronger relaxation response,” Dr. Marlynn Wei — author of The Harvard Medical School Guide to Yogapsychiatrist and certified yoga teacher — told Mic.

Why Do So Many Women Feel Sad After Sex?

Repost of an article I originally wrote for Mic Connections. Photo courtesy of Mic/Getty Images.

The last time I cried after sex was during a summer fling I wasn’t totally into, about a year and a half ago. The sex was consensual, but all of a sudden, while he was on top of me, my flight-or-flight instinct kicked in. I had to ask him to stop before tears came.

This wasn’t a first-time experience. I live with post-traumatic stress disorder brought on by sexual assault, which means I sometimes have panic attacks during sex, which can sometimes end in tears. But according to a paper recently published in the journal Sexual Medicine, I’m not alone.

According to the study, nearly 46% of the more than 230 women polled have felt depressed after sex at some point during their lives. These women reported feeling symptoms of PCD, or postcoital dysphoria, which is marked by “tearfulness, anxiety, agitation, a sense of melancholy or depression or aggression,” according to the Independent. Of those women, 2% said they felt that way after every time they had sex. And although 20% of the women polled said they had experienced sexual abuse in the past, which led to them developing mental health issues down the road, many of those surveyed didn’t report having a preexisting condition like PTSD to explain their symptoms. 

Why the hell are so many women feeling sad after sex? The PCD study had some obvious flaws. For instance, the results were collected through an online survey, and the sample size included predominantly heterosexual women. But this is not the first time researchers have tried to link sex to sadness in women. A 2011 study published in the International Journal of Sexual Health found one-third of women said they felt depressed even after satisfactory sex.

Jerilyn, 27, is one of them. “Even when I was single, the post-sex depression morphed into a different shade of empty. I always attributed it to the fear of being abandoned,” she told Mic. “I started to wonder if something was being taken from me every time I had sex, even though I enjoyed the act itself.”

Researchers theorized this post-sex dysphoria was caused by hormonal shifts after orgasm. But according to sex and relationship expert Logan Levkoff, the reason might have less to do with biology and more to do with how women’s sexuality is viewed in modern society.

“I think it’s important to remember that if you grow up not feeling empowered by your body, if you feel guilt and shame about sex, if you’ve been taught that your needs are less important than a man’s needs … [it’s not a] surprise that some people wouldn’t feel great after sex,” Levkoff told Mic.

According to Levkoff, part of why women might feel down after getting laid is that their needs weren’t met in bed, a phenomenon linked to how our culture teaches women about their sexual desires. While many men believe that women can achieve orgasm via penetration alone, according to one study, about 75% of women need some form of clitoral stimulation to achieve orgasm.

If their partners aren’t interested in paying attention to their desires, it’s no surprise that women would feel frustrated or emotionally drained after sex. “I think that the take-home message has a lot to do with how we learned about sex [and] how we feel about our bodies,” Levkoff said.

Playing into stereotypes: Possible causes of PCD aside, it’s worth noting that the study could be interpreted as perpetuating the idea that women are more biologically predisposed than men to becoming emotionally attachedto their partners after sex. (That notion was quickly debunked by a study from Concordia University, which found men and women process both love and sexual attraction in pretty much the same way.)

The idea that women are more likely than men to become sad or depressed after sex also inherently endorses the stereotype that women just aren’t really into sex at all. While numerous publications have said otherwise — in fact, a fertility app survey from earlier this year determined that many women would prefer to be having more sex than they’re currently having — the stereotype of the sexless housewife in a frumpy nightgown snapping, “Not tonight, honey,” at her poor, neglected husband still persists.

For this reason, many women don’t buy into the PCD study, insisting that they feel just fine after sex. “The only time I ever feel negative emotions after sex is if it was a one-night stand and I didn’t practice safe sex,” Meredith*, 24, explained. “Maybe guilt the next day, but no, I’m never sad. I love sex.”

Ehris, 22, is also skeptical that women have a biological predisposition toward post-sex depression. “I’ve experienced [sadness after sex] before. But I don’t think that it needs to be pathologized as a problem experienced predominantly by women,” she explained. “I’ve had and heard of partners of both sexes and a variety of genders who have felt melancholic after sex.”

Ehris brings up an important point: PCD isn’t exclusive to women. Men too don’t always feel awesome after sex. “We certainly don’t talk about it as much,” Levkoff said of PCD in men. “And that’s the one thing — this study sort of stereotypes, ‘Yeah, women really aren’t interested in sex.’ I don’t want this to become a self-fulfilling prophecy. I think that’s a bad paradigm to put out there.”

hormonal quirk or a sign that something’s not quite right: An orgasm can be one of nature’s most powerful drugs. When you have sex, the release of hormones in your brain can cause some funny reactions, from making you want to snuggle into your partner’s armpit to making you cry uncontrollably for no apparent reason. The occasional bout of post-sex sadness might be a sign that something isn’t right in the relationship, but it might also just be an odd quirk of nature and nothing more than that.

That said, if you consistently feel sad and depressed after having sex, it’s worth asking yourself why and reevaluating your partner selection. While it might sound obvious, who you’re having sex with plays a major role in how you feel about it afterward. Levkoff said it’s wise to check in with yourself and make sure you are comfortable with your partner and that there are no unaddressed, underlying issues preventing you from enjoying the encounter to the fullest, even if you’re just looking for a one-night stand.

Ultimately, it’s important to have sex with someone with whom you feel safe, “and by safe I mean respected, trusted, cared for,” Levkoff said. “It might not even be a monogamous romantic relationship. If you feel like this is someone you are connected to and who respects you, that certainly impacts [your feelings afterward].”

Jerilyn experienced PCD for years before she started dating her current partner, a longtime friend of hers. They’ve been together five months, and Jerilyn said she is finally enjoying sex in the way she thought she was meant to.

“This is the first time in my life that I have not had some form of postcoital depression. The only reason I get sad is if he falls asleep and I want more,” she explained. “Sex is finally what it should be for me, which is primal and passionate, and no longer something that provokes that overhanging, ambiguous sensation that something isn’t right.”

I’ve dealt with a lot of my PTSD-related issues, and like Jerilyn, I am now with a partner with whom I feel safe. I no longer feel sadness or anxiety after sex. Instead, I feel a lovely, Ativan-esque sense of calmness.

*Some names have been changed and last names have been withheld to allow subjects to speak freely on private matters.

NEW FOR VICE – What Is It Like to Date When You Have Borderline Personality Disorder?

Originally published here.

Most people first encounter borderline personality disorder (BPD) on screen: It’s the condition behind Glenn Close’s character in Fatal Attraction. It’s what Winona Ryder’s character was diagnosed with in Girl: Interrupted. It’s what Jennifer Lawrence may have had in Silver Linings Playbook, in which her character’s specific mental health condition went unnamed. The largely unfair stereotype that has emerged of BPD—partially because of some Hollywood portrayal—is that of a crazed, manic, uncontrollable woman.

To learn more about the condition, I spoke to Dr. Barbara Greenberg, who treats BPD, Thomas*, a 32-year-old who dates someone with BPD, and Karla*, a 29-year-old recently diagnosed as borderline.

*Names and details have been changed

VICE: So what is BPD?
Dr. Barbara Greenberg: It’s a personality disorder that’s really all about having very intense moods, feeling very unstable in relationships, and seeing the world in black and white—things are either all good or all bad. People with borderline feel empty, and they are always trying to fight off what they perceive as rejection and abandonment, so they see abandonment and rejection where it doesn’t necessarily exist. They’re so afraid of being alone, abandoned, or left, or people breaking up with them, that they sense it where it doesn’t exist and they need tons of reassurance. I think it’s one of the hardest personality disorders to have. And what’s really unfortunate is that there are males with borderline personality disorder too, but it’s the women who tend to get the label more frequently. I’ve always had an issue with that.

Do more women actually have it? Or is it a cultural stereotype that leads to more women being diagnosed for their emotional behavior?
I think it’s both. I think it’s primarily that women get the diagnosis because when women are upset, they get sad, depressed, and worried. When men have intense feelings, they act it out. They act it out in terms of anger, or hitting a wall, or drinking, or smoking. Women are wonderful torturers of themselves.

How does the fear of abandonment affect their romantic relationships?
When they are in relationships they get very intensely involved way too quickly. Men or women, whatever their [sexual preference] is, tend to really like [people with BPD] at first, because they are very intense, and very passionate. Everything they do is very intense—who is not going to be attracted to that? But then what comes along with it, a couple of weeks later, is: “Why didn’t you call me back immediately?” “Are you out with somebody else?” So [people with BPD] get attached very quickly, give [the relationship] their all, but then get disappointed very quickly. They start out thinking, “I love this guy, he’s the greatest,” but if he does a minor thing that disappoints them, they get deeply disturbed. Everything is done with passion, but it goes from being very happy and passionate to very disappointed and rageful.

How can that behavior affect someone without BPD?
Terribly, because most people aren’t trained to deal with it. They don’t even know that it exists. So eventually [people with BPD] do get rejected by partners because they’re just too intense. And it’s very hard for their partners to focus on other things in their life if their relationship is so demanding.

“Everything is done with passion, but it goes from being very happy and passionate, to very disappointed and rageful.” —Dr. Barbara Greenberg

Is there treatment available for BPD?
Absolutely. There is treatment and usually the women [seek] treatment because of relationship problems leading to depression or maybe self-harm behaviors. Dialectical behavior therapy has a tremendous success rate in treating borderline personality disorders because it basically teaches them a set of skills for them to handle their emotions. [Those with] borderline somehow have the message that every feeling needs to have an accompanying behavior. If [non-BPDs] are mad, maybe they’ll keep it to themselves. We sit with it. But borderlines initially can’t sit with any emotion that is uncomfortable. They have to act on it. So that’s one of the things they learn [to manage]. They learn in DBT how to deal with and sit with negative emotions without acting on them. It’s a very Buddhist zen-like treatment. They’re also taught to “walk the middle path,” like don’t look at a person as all good or all bad, a person is shades of gray. Bad people have good qualities and good people have bad qualities.

What advice would you give to someone who is dating a borderline and wants it to work?
If they want it to work they need to either be prepared to give reassurance: “I’m not leaving you, you’re safe with me.” Or they have to suggest that that person gets some therapy before being in a relationship. Or if it’s too much for them they should get out of there sooner rather than later.

So do you think there’s any hope for the borderlines after therapy to have a successful relationship?
Oh yeah, oh yeah. I really, really do. I’ve seen a lot of them get so much better, I love working with borderlines. Because their emotion is all there, and acting that way is all they know, and then when you show them an easier way to be, and to act, they see how much easier life can be. Absolutely. There’s hope.

VICE: When did your girlfriend tell you she had BPD?
Thomas: My girlfriend didn’t receive an official, medical diagnosis for BPD until a number of months in to our relationship, and the scenario surrounding the diagnosis itself was particularly unpleasant—as had some events which occurred in the months prior to the diagnosis which, considering things now, led to the diagnosis in the first place.

Before you knew the diagnosis, was there behavior that made you wonder if something was amiss?
Before her diagnosis with BPD, I understood my girlfriend to have some form of depression as well as social anxiety, which I believe she still may have in some capacity in addition to her BPD. She had grown up in—and was still living in—a particularly volatile and negative family atmosphere where she was treated quite badly. Frankly, witnessing that firsthand, I believe that if my girlfriend didn’t have some mental illness as a result of it then she’d be a true anomaly. However, many of her mood swings (which of course I can now link and identify with her BPD) before the diagnosis were difficult for me to understand, and for the most part, I assumed it was something to do with me being difficult for her to be with. I didn’t know anything about BPD before my girlfriend was diagnosed with it and certainly had no awareness that my girlfriend had it. I had no real idea of what BPD was before then.

“I see Borderline Personality Disorder as an illness about pain, fear, and struggling to cope with all of that.” –Thomas

How have you educated yourself on BPD?
Since my girlfriend’s diagnosis, I have done some considerable research on BPD, mostly as a means to better understand and to protect her. I’ve done research on the internet and read various articles.

What do you find to be the biggest misconceptions about BPD?
I think BPD is entirely misunderstood (if people are even aware of it at all) and sufferers are seen as “crazy” more than anything else. As a personality disorder, I think it’s seen in much the same vein as Antisocial Personality Disorder or even sociopathy and the likes of that, where it really isn’t comparable to those. There are a lot of nuances, complexities, and lines to be read through with BPD, but mostly I see Borderline Personality Disorder as an illness about pain, fear, and struggling to cope with all of that. It’s almost like a wounded animal, as I see it. But the common conception is just [that they are] crazy, which is an extraordinarily damaging misconception to those who suffer from it. They aren’t crazy, they’re hurting.


VICE: How have romantic partners reacted when you’ve told them you have BPD?
Karla: I am a picky girl when it comes to romantic relationships. I usually only have flings here and there, so I did not deem it necessary to let them into my mental world. One, however, did stick around. During these years I had suffered BPD unknowingly, and then knowingly. We dated on and off for about four years. He knew about my anxiety and mood depression disorders, diagnosed back in 2013 into 2014. When I told my ex-boyfriend Aaron* about borderline, he had zero clue of what it meant, or what it means to live with it or be close to someone who suffers in it. He did hours of research on borderline. Even before this, a year or two ago he had researched anxiety disorders to get a better understanding. It was impressive that instead of him running away in fear, it shed light on many aspects of the not-so-great parts of our relationship. Aaron helped himself comprehend how difficult it must be, and reiterated multiple times that was is in full support of whatever I needed at the time, as long as I was open with him, which I always was—perhaps to a fault.

How do your BPD symptoms affect your relationships?
My BPD symptoms affect my relationships with family, friends, and lovers almost all the time. It would be impossible for me to explain all of the ways my symptoms do, so I’ll give an example. One of my friends was having a get-together before we went to our favorite pub. It was a small party of about four girls and six guys. When I feel as though someone is secretly attacking me, I will get on the defense, become overly emotional, moody, and dramatic, and perhaps will call them out on it. In reality, [they] may have just not been aware whatsoever. In this case, I acted on my symptoms. It was not so much of a big deal as it was an embarrassment for me, to me. I doubt my friend had any idea. Some people with BPD label people as “good” and “bad” friends (black vs. white) when one small thing happens. I have unfortunately done this in the past.

Are you in treatment? Is it helping with your relationships?
I am currently in DBT therapy treatment. When it comes to relationships, I have certainly seen progress, but I cannot wait to see and feel more.

If you suspect you or a loved one is suffering from Bordering Personality Disorder, learn more about treatment options here.

The Post-SSRI Orgasmic High

New for Broadly.

I have been on and off various forms of antidepressants since college. A class of antidepressants (Zoloft, Lexapro, and Prozac) called SSRIs (selective serotonin reuptake inhibitors) is often the first line of pharmaceutical treatment for depression and a safer and less addictive solution than benzodiazepines (Xanax, Ativan, and Klonopin) for anxiety and panic disorders. The problem is, as if trying to date while depressed or anxious isn’t shitty enough, taking SSRIs, which work by blocking serotonin receptors in the brain so that levels of the chemical in the brain stay higher, can basically cause chemical castration.

“The current thinking is that serotonin and dopamine are something like the brakes and the gas when it comes to sex,” explains Dr. Julie Holland, a psychiatrist and the author of Moody Bitches: The Truth About the Drugs You’re Taking. “Too much serotonin seems to make it hard to flip the switch over to orgasm. When women are in a lower serotonergic state, as when they are closer to their periods (PMS) or if they’ve taken MDMA the day before and are temporarily depleted, it’s easier to climax. When women take SSRIs, it’s not only harder to climax, but for many women, it’s harder to feel sexual pleasure or get horny. I have patients tell me they’re less interested in sex, their pelvis feels numb, or it’s nearly impossible to climax.” 

You get off the meds, and then you quite literally get off.

knew that during high school I would masturbate an average of three times a day, and while I had to use my hand to rub my clit sometimes, I also knew I had gotten off during oral, vaginal, and anal sex without using a vibrator. (There’s no shame in using a vibrator during sex; I think more women should. But what if you’re up against the fence at Williamsburg Waterfront and just don’t have it on you?) Yet when I was on Lexapro, a commonly prescribed SSRI, I did not know that girl. Sex became something I did because I knew I was supposed to, rather than because I felt my clit would explode if I didn’t have that hot man in me right this second. “I guess when you’re super depressed your sex life seems not that big of a deal, but when you’re a functioning human being and part of society again you’re like, ‘No, this is actually a pretty key thing that I’m missing out on,'” says Claire, a 29-year-old living in Brooklyn who has also experienced the SSRI chastity belt via Prozac. “I would have sex with the men I was dating because I thought, This is what you should do in a relationship, but it wasn’t really fulfilling. You kind of forget what sex is like. Then you go back [get off the meds] you’re like, ‘I remember!'” 

You get off the meds, and then you quite literally get off, which is exactly what happened to me when I finally weaned myself off Lexapro over the course of a month. Unfortunately, my sex drive came back just around the time my relationship was ending. My ex had often complained that he didn’t always feel we were on the same page sexually and he hated that he couldn’t get me off, so it was a shame he left just as my orgasms were coming back full force. 

“It would have been different. It definitely would have been different,” says Dr. Helen Fisher, a biological anthropologist from the Kinsey Institute, when I ask about whether going off Lexapro earlier might have changed our sexual chemistry. “Orgasm is really important for a relationship. It makes you like the person! It makes you trust the person; it makes you want to be with the person; it makes you feel warmth towards the person; it evolved for very obvious reasons, which is to make you want to do it again to be close to somebody and hold somebody. When you’re hugging somebody and holding somebody, oxytocin is going up in the brain. Oxytocin is associated with feelings of attachment and calm, and right before orgasms there is a spike of norepinephrine and dopamine that is going to give you feelings of optimism, and energy, and focus, and motivation, and then of course after orgasm there’s a real flood of oxytocin again and that gives you a feeling of deep attachment to a partner. So there’s a reason that men want women to have an orgasm,” explains Dr. Fisher. 

Ross, a 32-year-old New Yorker whose girlfriend took 20mg of Lexapro, agrees. “You can understand it’s science, but it [was] still hard not to take it personally when I couldn’t get her off,” he says. 

Before I regale you with the joy that is the second puberty experienced when flushing all those nasty orgasm police pills out of your system, it’s crucial to note that they do save lives; quitting cold turkey without discussing with your doctor is a no-no. “Some people really need these drugs,” says Dr. Fisher. “They need them to get out of bed in the morning, to make the effort to go find a sweetheart.” 

However, this is not always the case. “Data shows that 70 percent of people who are on these drugs don’t really need them,” Fisher says. “They [get] back on their feet, and they [keep taking them] because they have the feeling of calm and stability, so they stay on them long-term. [But] when you stay on them, you can jeopardize yourability to fall in love and stay in love.”

Yes–there’s more than sex at stake here. SSRIs could be screwing up what humans are already very bad at: finding and maintaining a loving relationship. “If you aren’t interested in having sex, or you’re having less pleasure when you do have sex, it’s going to affect your relationships, obviously. There is even some suggestion that it affects whether women make themselves available for sex when they’re dating, or whether it can affect that angsty/horny feeling when you fall in love with someone,” says Dr. Holland. “Human female subjects on antidepressants spend less time poring over faces of potential male dating partners than the women who are unmedicated.”

SSRIs could be screwing up what humans are already very bad at: finding and maintaining a loving relationship.

Over the course of the month that I quit Lexapro, it felt like a sexual re-awakening. “My patients who have weaned off their SSRIs are happy to report they can climax more easily,” says Dr. Holland. “It’s nice to be able to enjoy sex again, and to connect with your partner on that physical, and often spiritual, level.” Skylar, a 28-year-old from Richmond, knows what the doc is talking about. After giving Zoloft a shot for anxiety attacks, she stopped using it because she decided she’d rather be anxious and having orgasms. “Within a matter of a few weeks I was back to normal in the sex department,” says Skylar. 

Claire, the 29-year-old Brooklynite who was on Prozac, concurs. “I noticed [my sex drive return] more when I was just masturbating by myself, because I [was single] at the time. [I would be] watching porn and using my vibrator and being like, ‘This is amazing!”’ 

While most women return to orgasm-land with a vengeance after being on SSRIs, however, some never come the same again. Post-SSRI sexual dysfunction (PSSD) is a nightmare in reality, in which patients’ sex drives and functioning can take years to return to normal after being on SSRIs. Some patients never feel the same again.

“It’s frustrating that they haven’t found a pharmaceutical cocktail that can be so beneficial for anxiety without those side effects,” Skylar tells me. The good news is there is one antidepressant that can actually promote sexual desire and function: Wellbutrin. “Well, the makers of Wellbutrin don’t really cop to the mechanism of action of their antidepressant, only describing it as ‘non-serotonergic,'” says Dr. Holland, “but it seems as though [it has] an action that increases dopamine levels.

“For many of my patients, they are much happier with the effect of Wellbutrin on their sex lives, over the SSRIs,” Dr. Holland continues. “Wellbutrin can also help to cut appetite and improve focus and concentration. Where it’s weak is in treating anxiety, and especially treating obsessive symptoms. The SSRIs are much better for that.” Not to long after I stopped taking Lexapro, I tried Wellbutrin and had three orgasms during sex on my yoga mat–two clitoral, and one cervical, which until then I didn’t actually believed existed. (Thank you, makers of Wellbutrin.) I stopped Wellbutrin because, as Dr. Holland says, it sucks for anxiety, which is my main enemy at the moment.

After a fuck ton of therapy, quitting drinking, and developing a mindfulness practice (seriously), I’ve earned the bragging rights to say that now, sans SSRI or Wellbutrin, I’m just a little bit nuts. The renewed ability to orgasm is probably helping to keep me so fucking cheery, too. “Orgasms do create a bit of a ruckus with neurotransmitters and hormones,” Dr. Holland says. “In particular oxytocin and endorphins, though the endocannabinoid system may also be involved. They do help to relieve stress, obviously, which is likely therapeutic. And yes, there is a study showing that sperm, when deposited in the vagina, can have antidepressant effects. 

“Much of the brain even shuts down when you’re having an orgasm,” she continues. “It’s a very deep experience.”

My Shrink Broke Up With Me

Going back to the dark days in my latest for Broadly.

According to therapist-cum-speaker Dr. Julie Gurner, “A responsible psychologist will always make a referral if the client continues to need treatment elsewhere, but it is ultimately the client’s responsibility to follow through with that referral. An exception to the client taking responsibility for follow through might be if they are feeling unsafe (suicidal) or are compromised in some other way.”

Two years ago, on a hot New York Summer’s day, still drunk from the night before, I walked into my shrink’s office and told him I needed to quit drinking and wanted to kill myself. I’m not sure if it was as cohesively articulated as that, but rather a rambling about how high a sixth floor walk-up apartment is, various uses of a cleaver, and that Lenny Kravitz had jumped out of the audience to play drums at the show I attended the prior evening. Regardless of my exact words, my psychiatrist’s response was clear: “I am no longer qualified to treat you, and I must terminate this relationship.” My ex-shrink told me he would be in touch with names of doctors who would be a better fit, and I wandered into Washington Square Park, shielding the sun from my eyes.

The Summer of 2013 was brutal for me: a sexual assault, followed by an alcoholic bottom, a breakup, and my parent’s divorce–I was a suicidal nutcase. As it was August, my ex-shrink was going on vacation, so by the time he got around to calling me with those recommendations he promised, I was already in treatment with someone else, primarily because I was taking antidepressants and benzodiazepines, which were going to run out. Benzodiazepine withdrawal can involve seizures, so it’s something you don’t want to fuck with. “If the patient is taking medication, sometimes they will simply continue the medication under the supervision of the same psychiatrist, but their visits will be less frequent. This would all be an ongoing discussion with the patient,” says Amanda Itzkoff, MD.

I’m too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?

Being broken up with by your shrink can be a brutal blow to the ego–it has you thinking “I’m too crazy for a boyfriend right now, but am I too crazy for a psychiatrist?” Flipping through old diaries from that period feels like stepping into a horrific rape scene that I’ve seen in a movie–there’s a fearful recognition, but I can’t believe I ever actually lived it. Back then; even I didn’t want to be around myself, so I don’t blame the guy for ending the client/patient relationship. But I was curious: why do shrinks break up with patients? Are they even allowed to do that? 

“There are guiding principles you should follow, rather than an official set of protocol,” explains Dr. Gurner. “In graduate school, the act of separating with a client is referred to as “termination.” A fair amount of attention is paid to how you separate from a client…because how we say goodbye and end our relationships is so important.

Often, a psychologist or psychiatrist will terminate a relationship because the patient is exhibiting symptoms they don’t feel qualified to treat, as doctors typically have specialties. A common occurrence of this lies among patients diagnosed with Borderline Personality Disorder, as 10 percent of individuals with BPD successfully complete a suicide attempt. “Some disorders are certainly more difficult to treat, but I have not known of someone ending a patient relationship because of liability. The only reason I would see someone ending a patient relationship based on a diagnosis, is if they did not feel they could provide the specialty treatment required,” says Dr. Gurner. “Almost everyone I know has unfortunately had a client end their life, but none of them have ever faced legal action or fear that element of their practice.”

If the client is not committed to treatment, I would terminate our time together.

It may not happen often, but shrinks can be sued, which is maybe why my very handsome doctor felt I was out of his control. “Yes, therapists can get sued,” says Dr. Barbara Greenberg. “If the survivors feel that it was inadequate care. That’s why with all of your patients you have to access carefully for suicidality, or any predictors of violence, and you are responsible, and yes, you can be held liable,” said Dr. Greenberg. One of Dr. Greenberg’s specialties is treating BPD, so fear not Borderlines, there is indeed someone for everyone. “In my practice I get a lot of borderline personality disorders-I like people who are very energized who really need help; I find that stimulating. Substance abuse on the other hand, I might refer that person to see somebody else who had substance abuse as a specialty.” 

How many psychiatrists does it take to change a light bulb? One, but it has to really want to change it. An acquaintance of mine from high school was in treatment for alcohol abuse, and her doctor ended the relationship upon continuously catching her in lies about her drinking habits. “If the client is not committed to treatment, I would terminate our time together. People come to therapy for various reasons, but I would never accept a patient or keep someone as a client who was there at the wish of someone else,” says Dr. Gurner. 

If you’re suffering with substance abuse, please get some help. Find an AA meeting, or if you’re like me and don’t jive with the 12-steps, understand that there are other options. There’s the Buddhist recovery group Refuge Recovery, the science-based SMART Recoveryharm reductionayahuasca healingSatanism, honestly whatever helps you get your life together, I’m in support of.

Because we all really are different beautiful little fluffy fucking snowflakes, aren’t we? As with recovery, when seeing a shrink, it has to be the right fit, or it’s not going to work out. “There has to be chemistry. I call it the “relational bond.” If that bond doesn’t exist, you really can’t do good therapy,” says Dr. Greenberg. A cool thing for me about quitting drinking, is when I was drunk, I checked off all the boxes for probably dozens of diagnoses. When I stopped, it turned out I wasn’t insane; I’m just someone who absolutely does not mix well with alcohol. One spanking new fantastic shrink and two years later and I’m no longer drinking, and no longer suicidal. Maybe, if it continues to go well, the eventual breakup will be amicable. “The goal of any good therapy is separation, and that you’ve taught them how to manage their symptoms well enough that they don’t need you anymore. You hope for them every good thing,” says Dr. Gurner.