There's a Pill for That

For Prozac Nation, is dosage dictating desire?

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One pill makes you taller, another makes you small. Or put more prosaically: Have we reached the point where our most intimate activities are governed not by our emotions but by the contents of our medicine cabinets?

With recent surveys indicating that more than half of those taking Prozac and its relatives, Paxil and Zoloft, lack interest in sex, have difficulty reaching orgasm, and are unable to maintain an erection, depressed Americans are reaching for antidotes to their antidotes, causing some observers to question our new commitment to pharmacological sexuality.

“We want the quick pill. This is America,” says Dr. Domeena Renshaw, author of Seven Weeks to Better Sex (Random House, 1995) and director of Loyola University's Sexual Dysfunction Clinic in Chicago. But the problem doesn't stop at our borders. It exists in all industrialized nations, where the clock and calendar have become tyrants, she says. In our hurry-up society, sex becomes a low priority. So we search for a quick, convenient, synthetic stimulant to give us performance on demand. Women are even taking their partners' Viagra, she notes.

When Prozac hit the market back in 1987, it spelled salvation for millions of Americans battling clinical depression. Psychiatrist Peter D. Kramer in his best-seller Listening to Prozac (Viking, 1993) called the little pill a restorer of self; it bestows feelings of greater self-worth, boosts confidence, and improves job productivity. Today, Prozac is among the top five prescribed drugs in the country.

But just as Prozac, Paxil, and Zoloft may make shy people more comfortable in the boardroom, these selective serotonin reuptake inhibitors (SSRIs) may have an altogether different effect in the bedroom.

“When Prozac first came on the market, the medical profession didn't have a clue about how vital serotonin was to sexual pleasure and responsiveness,” writes Dr. Valerie Davis Raskin in Family Therapy Networker (March/April 1999). As she explains it, anti-depressants target neurotransmitters like serotonin inside and outside the brain, and may reduce genital sensation as a mild anesthetic would do. “What used to feel great feels good, what used to feel good feels OK, and what used to feel OK doesn't even register now.” Remedies for these side effects include Viagra, Wellbutrin, and gingko, she notes. And if that doesn't do it, there's always Asian ginseng, oats, or wild yam, as Michael Castleman points out in Herbs for Health (March/April 1999).

“I definitely think we're on the edge of sexual pharmacology,” says Davis Raskin, associate professor of psychiatry at the University of Chicago and author of When Words Are Not Enough: The Women's Prescription for Depression and Anxiety (Broadway, 1997)—especially with regard to Viagra, which, like Prozac, is being widely used to fine-tune sexual response rather than address chronic ills. Still, painting a picture of a soma-crazed brave new world doesn't give consumers enough credit. “I don't think middle America is that gullible,” she says. There's always a flurry of interest in a new drug, she explains, but it typically dies down when people realize there are no quick fixes.

“We're backing off of Prozac,” she adds, and predicts the same will happen with Viagra, because people don't do well with taking drugs long-term. “They're expensive. They forget them. You get a flurry. There's a pill for erectile dysfunction. Everybody tries it,” she says. “We're a long way from reducing human suffering or human sexual relationships to a pill.”

Ann B. Tracy, director of the International Coalition for Drug Awareness in Salt Lake City, is less sanguine. “We are in the middle of the worst drug problem this world's ever seen,” says Tracy, author of Prozac: Panacea or Pandora? (Cassia Publications, 1994). “For anything that ails us, we reach for another drug.”

Tracy, who tracks disturbing cases in which individuals have become suicidal or homicidal on prescription drugs, insists that we could do away with medications if only we took better care of ourselves. “We don't want to do everything we're supposed to do to be healthy,” she says. “We need to learn to rest. We need to learn to quit pushing ourselves.”

And, adds Davis Raskin, sometimes we need to understand that sex has as much to do with the mind as with the mechanics. Talking openly about our needs and fears can be every bit as powerful as the latest pharmaceutical or herbal antidote to sexual malaise, she says. “That takes a lot more openness and trust than taking a pill together.”