Can Antidepressants Accidentally Make You Lonely?

Love is pretty much the greatest thing ever. People who don't understand evolution think sex is the most important thing ever -- but without love, our species wouldn't exist. It doesn't matter how many women you can knock up if no one loves or cares for anyone and all the babies die.

As such, we evolved to be acutely sensitive to loneliness (and other negative emotions, like jealousy). And we evolved to love love. 

That's why anthropologists, psychologists, sociologists, and neuroscientists have all tried so hard to understand and define it.

There are still a lot of grey areas, but most scientists agree that there are three main components of love: lust, love and deep attachment. 

Anyone who's been in love can probably agree that it's, like, the most incredible thing ever.

And why wouldn't it be? When you're in love, you have increased activity in the ventral tegmental area (VTA) of the brain. 

The VTA is essentially a tiny dopamine factory. It is a very powerful part of the brain's reward system. It regulates wanting, motivation, craving, pleasure -- even cocaine addiction. ​​

And, in many ways, love is like an addiction. I wish I could remember where, but I remember reading that people who are in love think about their significant other up to 90% of the time. Is it perfectly accurate? I don't know.

But I do know what it's like to be in love, and don't think it can be that far off. 

Because this is how love starts -- with dopamine. With feelings of pleasure, craving and reward. With obsession. With motivation to do what it takes to make your partner happy -- both because you want them to love you, and because nothing makes you happier than seeing them happy.

For many people, there is also sexual component to falling in love. Lust motivates these people to try to find a partner. To them, sexual activity is an important part of the relationship. It is gratifying and helps promote bonding. (After all, as I wrote in The Orgasm Gap is Real, But Don't Blame It On The Patriarchy, from a neurochemical perspective, there is no such thing as "no strings attached" sex.)

So what do antidepressants have to do with this? A lot, actually. ​

Every year, doctors write over 239 million prescriptions for antidepressants, including selective serotonin reuptake inhibitors (SSRIs). SSRIs are believed to increase the extracellular level of serotonin in the brain by preventing neurons from absorbing it. ​

Doctors write these prescriptions without necessarily telling patients that the efficacy of SSRIs in patients with moderate depression is highly debatable.  And they write them without mentioning that SSRIs can prevent you from falling in love... and even cause you to fall out of love. 

Why? Medical research shows that increasing serotonin levels causes decreases in dopamine production.  Meaning SSRI patients don't get that obsession. They don't get that intense feeling of reward, longing and craving. 

Not to mention that somewhere between 17-41% of patients taking SSRIs experience sexual side effects, such as decreased libido and erectile dysfunction. So those people who are motivated by lust to find love... are no longer motivated. Sexual anxiety and fear of rejection may, in fact, disincentivize romantic partnerships for these people. For some, these side effects may not go away  -- even after discontinuation of SSRI treatment (Post-SSRI sexual dysfunction). 

Yet doctors and patients continue to see antidepressants as a quick and easy fix for sadness. Not depression, but sadness. I've heard of doctors prescribing SSRIs to grieving widows -- even though grief is not the same thing as depression, and even though antidepressants have been shown to have no effect on grief. ​

In fact, I was at the rock wall a few years ago with a friend who happens to be a doctor. Like, a family medicine type. I was telling him about a dangerous encounter I'd had with a psychostalker, and how I had bad dreams about it sometimes.

He suddenly got a strange look on his face and said, "If we were in my clinic, I'd have to cut you off now. I wouldn't have time to listen to the whole story -- I'd just write you a prescription."

"For what? An antidepressant? I don't have depression."

"I know," he answered. "But I wouldn't have time to talk to you more, so I'd just -- "

"What? Write me a prescription for something that could permanently affect my brain chemistry, without any good reason?"

He shrugged, and that was that. 

Long story short: just because a doctor prescribes it, doesn't mean it's good.

If you're going to start taking an antidepressant (or, in my opinion, an antibiotic you're not sure you need), make sure you fully understand the side effects. Make sure you fully understand why it's being prescribed and how you'll know if it is working. And, for the love of God, set up some therapy sessions. Studies show that drugs alone aren't nearly as powerful or lasting as talking to a good therapist (someone who uses CBT and calls you out on your bullshit -- not someone who still believes in "psychoanalysis", aka "self-masturbatory ruminating").

Or, if therapy's not for you, check out F*ck Feelings: One Shrink's Practical Advice for Managing All Life's Impossible Problems, by Michael Bennett, MD, and Sarah Bennett.

Or even their more recent, Fuck Love: One Shrink's Practical Advice for Finding a Lasting Relationship.

Because if you don't address the underlying behaviors, issues, and attitudes, the drugs won't change much. 

Also, important aside: before you get any stupid ideas, this is not the advice I'd give about things for which there is strong evidence and scientific consensus. Don't take "scientists don't understand how and why antidepressants work, or even what causes depression, so be careful about taking SSRIs" to mean something dumb, like "vaccines are all part of the conspiracy, and even though basically 100% of scientists agree that vaccines are important and safe, I'm going to be ruled by emotions and put my faith in one fraudulent paper that has long since been thoroughly debunked."

There's a huge difference between SSRIs, for which there is mixed and insufficient evidence, and vaccines, which ARE​ safe. Like, seriously, anti-vaxxers. What do you think is the difference between a vaccine and a "chicken pox party" -- other than one group of kids gets sick, and the other doesn't?

I really, truly hope you can understand the difference. (Want to know more? Check out I'm Not Arrogant, I'm Just Right -- The Trouble With Debating the Masses. Or download Just Stop: A Brief Guide to Rational Thought for the Modern Conspiracy Theorist.)

End side note.

Having had no direct experience with depression or antidepressants, I'm not here to tell people with depression what medical treatments they need. I know that some people literally need meds to get out of bed in the morning. 

​But I also know that many people would do just as well -- or better -- with talk therapy. (As long as it's not the stupid kind.)

The only think I think people should do, regardless of mental health status, is to practice mindfulness and take responsibility for your own health and recovery. Empower yourself. Do your research. Know what you're getting yourself into. Ask questions -- like, physically put yourself between your doctor and the door until all your questions are answered if you need to. That's what I did before my shoulder surgery.

Also, exercise. Date (people who say "you have to love yourself before you can expect other people to love you" are full of shit -- that's not how human survival and evolution work). Eat healthy.

And don't mindlessly trust your doctor to make important life decisions for you.