Sex and Depression: A #GirlBoner Chat with JoEllen Notte

August:

“The world tells us that depression, by its nature, will kill our sex lives and destroy our relationships. And taking this as the gospel truth lets a lot of folks off the hook for having uncomfortable conversations, while hanging folks coping with depression out to dry. The truth is, we are not alone.”

I love this excerpt from The Monster under the Bed: Sex, Depression, and the Conversations We Aren’t Having, a new book by JoEllen Notte, a writer, speaker, researcher, and mental health advocate who writes about sex, mental health and how none of us are broken on her award-winning site, The Redhead Bedhead, as well as for Glamour, the BBC, Bitch, Psych Central, and more.

JoEllen believes that too often we are ill-equipped to cope with depression in our relationships, and that the myth that one, sex and desire should come naturally, and, two, that sex isn’t important enough to worry about in the midst of dealing with depression, lead to so many avoidable problems. We need to understand that depression can make relationships different, she asserts, but it does not have to destroy them.

I loved chatting with JoEllen in the studio earlier this year, and I’m thrilled that her book is now available.

If you appreciate the episode, I hope you’ll consider sharing it with friends and loved ones. Whether you live with depression or not, chances are someone, if not many people, in your life do, and thanks to JoEllen, I really believe the conversation you’re about to hear can help.

For some spicy inspiration of a pleasure variety, head to thepleasurechest.com. It’ll prompt you to enter your email address to receive 20% off your first purchase. Sex toy sales have been on the upswing in light of the pandemic, and I think for good reason. You are worthy of pleasure, and I hope you’re finding it while staying as safe and healthy as possible. Toward that end, find special bonus content on the Girl Boner Instagram page: @GirlBonerMedia

August:

As you’ve shared before, sex and depression and mental health, these are all topics that there can be stigma around.

JoEllen: 

Yeah, and there’s a lot of preconceived notions. A lot of people just take it as fact that if you have depression, you don’t have sex and your relationship is going to die.

 August:

Yes, that’s such a common misperception. And when people don’t feel they can talk about either of those, that can happen. It’s almost like a self-fulfilling thing where you feel like you’re not supposed to have a great sex life. So then why try? Which is sad.

JoEllen:

Yeah. A lot of people talked to me in the surveys and the interviews I did about the feeling that people gave them that “Like, really? You’re gonna worry about sex at a time like this? Don’t you have more important things to worry about?”

August:

Yes. Like it’s an ice cream cone or something. Just a little add-on. Like, “Oh, that’s a fun, frivolous little thing.”

JoEllen:

Exactly. Yeah, the word frivolity came up a lot.

August:

Which you know from your own journey, how impactful these types of intersections can be. Would you share a bit about your own decision to explore sex and depression and mental health? What was going on in your life?

JoEllen:

So in 2011 I was married, living in Boston, working as a personal trainer, and I woke up one day and said, “This isn’t my life. I’m in the wrong life.”  And so I got divorced, and I looked at what I wanted to do next. One night sitting around with a friend talking about boys we liked, I said to her, “You know, I wish I could sit here and talk to you about sex all night, but I have to go figure out what to do with my life.”

And the next morning, in the middle of a personal training session, I thought, “Oh my god, I want to learn about sex and I want to write what I learned and I want to call my website the Redhead Bedhead.”

And that was it. The next day was the 4th of July. I scrapped my plans, stayed in, built a website and we were off. Now, while all of this was going on, my father passed away. And so we got into the fall after I started the site, and it was the anniversary of that, my divorce was being finalized and my house was overrun with mice. And depression came back. I had battled depression badly in my 20s. And I kind of thought, now that I had gone off in pursuit of this life I wanted and I was talking about sex, and I was excited that that part was over. Sex was my new life, depression was my old life, and never the twain shall meet.

It’s not how depression works. So it came back, and I noticed I couldn’t have an orgasm on the meds I was taking. I also noticed I was like a zombie, but the orgasm thing, as a newly minted sex writer, I wanted to talk about that. I wanted to fix it. I marched into my doctor’s office and was like, “This is unacceptable.” I wrote a piece about that that fall. And it was the first time I realized people who weren’t my mom were reading my website. I got emails, I got private messages. And I got all this encouragement to keep talking about this, which I didn’t do for like another year, I got kind of freaked out.

But as I noticed this topic coming up more and more, I got some advice from an educator who said, “You know what, this could be a book.” When I said, “I am a sex writer with a theater degree, how do I write a book about this?” They told me, “You know, do some surveys, get some answers from people. Find out what they want to talk about, what’s going on for them.” That’s kind of how the whole thing snowballed into this book.

August: 

That’s so fascinating that the seeds for the book were planted very early, which I relate to. Publishing is an interesting business and you can’t always choose the timing… Could you share the most common thing you hear from people who are struggling in this department?

JoEllen:

I hear a lot of people saying their doctors don’t believe them. Or they’re told that that’s not a side effect of that drug; that can’t happen that way. Or they get told like “Of course, you don’t want to have sex. You have depression.” And those aren’t helpful answers, and so they end up feeling alone and like there’s nothing they can do.

August: 

Is that something that you heard?

JoEllen: 

Yeah. “That’s not a side effect of this medication” was a big thing that I heard. And what really kind of woke me up to that was when I marched into that doctor’s office, and I said to him, “I can’t have an orgasm. And this is unacceptable.” And he said to me, “You know, thank you. Nobody tells us these things. And so the big book I take out, and I tell you, ‘oh, this says that that’s not a side effect.’ That comes about from doctors reporting what their patients experience, and if our patients aren’t telling us” – or  what I learned in the course of the research of the book – if the doctor is not taking that on board as an important thing to report, it doesn’t make it into the big book that tells you what’s a side effect.

August:

So it’s probably more prevalent than anyone realizes.

 JoEllen: 

There’s a John Hopkins survey that said that between 15 and 75% of people on antidepressant medications, depending on the medication.

August:

Did you say 15 to 75?

JoEllen:

Right, which is basically like, “It could be everybody, maybe it’s no one; who knows?” But depending on the medication, 15 to 75% of the people had sexual side effects.

August:

Wow. And doctors are often not terribly comfortable asking about it. And then if the patient is not comfortable bringing it up, or if they bring it up, and the doctor does not respond in a way that seems that they are comfortable, or if they belittle the problem, I imagine that just can compound these issues and feeling more self-conscious and fester shame, which is which is really devastating when you’re already struggling.

JoEllen:

Some of the most surprising moments I had in this process – I’ve had a Patreon for like two years now, and one of the first supporters was so gung-ho and into this book. I shared a preview of the book that mentioned talking to your doctors. And this guy had always been like, “Yes, we need to talk about this.” He jumped in and he said, “I don’t need my doctor poking around my sex life.”

And I thought, whoa. This is the big disconnect we  have. We need to be able to talk to doctors, if we’re having medical things stand in the way of our sex lives.

August:

So I know depression and medications affect people differently. Certainly, it sounds like one of the most common potential side effects may be a drop in desire for sex. What are some of the other effects?

JoEllen:

So the polar opposite, which I didn’t leave any space in my surveys for. I found out through the interviews, a whole bunch of people reported having more sex. Some of it was a side effect of medication. Some people were looking for validation, looking for comfort. And for some people, it was part of not feeling in control. So that’s not talked about a lot, but it’s a thing. The big ones we hear about a lot are what I call the arousal ones: difficulty with lubrication, difficulty with an erection; the orgasm ones: which are anorgasmia, the inability to orgasm; or delayed orgasm, where it takes a long time; or my personal favorite, strange orgasm.

There’s not anything acknowledging it, but it came up over and over again, in the survey in the interviews. One of the guys described it as when you’re driving a standard transmission, and it doesn’t quite go into gear right. You’re driving and you know you’re in the gear, but it’s just not quite right. Unsatisfying, was the other term people used for the orgasms.

August:

Interesting. So there was like a disconnect in being able to fully be present in it.

 JoEllen: 

Yeah. Somebody said she felt in her head but not her body. Or it might have been the other way around.

August:

Those are really insightful responses. I mean, every doctor should read your book to get that information, because when you read a list of side effects or you hear “sexual side effects,” what does that even mean? And to know that you’re not the only person having this “strange orgasm.” That it’s something that may happen.

JoEllen:

The other thing that we talked about in the book that I think doesn’t get enough airplay is sexual impulses, but no desire to act on them. So it gets lumped in with low libido, but it’s really that depression can make everything feel way harder. It’s like I always say, when I’m depressed, brushing my teeth is harder than college. So that feeling of, “Oh, sex could be nice, but I don’t want to take off my pants and I have to make the bed” and then it just feels like another demand and too much. And so that’s a big piece of the puzzle too. And when we lump that in with low libido, it just goes along with people saying, “Well, I have depression, so I don’t have sex.”

August: 

Ah, yeah. And it’s so fascinating how we as a society tend to react to those happenings, because of the ways that we were taught that sex should look and feel like.

I’ve jokingly called it the Grey’s effect, because I love Grey’s Anatomy. And certainly, if a whole sex scene were part of the show, it would be most of the show. I get it. But there’s like a 20-second sex scene where two people experience orgasm in perfect synchronicity. So, if we think that that’s supposed to happen, but it’s not feeling like that, I imagine it could kind of put a wall up and we might not try to cultivate pleasure.

JoEllen:

As a society, we love the idea of things coming naturally. So, especially with sex, people get this thing that like, well, if I’m with a good partner who I care about, and we have the chemistry, it’ll all just come naturally. And even under the best circumstances where nobody has depression and everybody’s physically happy and healthy, we should be talking about our sex. People get this image from the media that electric sex just happens and it’s fabulous. And if it’s not fabulous, what are you doing wrong?

August:

Completely. Would you speak to the myth of sexual desire as a drive?

JoEllen:

My book, at least one portion of it, is largely informed by Emily Nagoski’s Come as You Are. We talk a lot about sex. This is not a drive; it’s not an inherent need we have like eating or sleep or thirst. We like to talk about it like it is. And I think, for a long time, that’s been a step in kind of shutting down sex-negative rhetoric like, “Oh, this is a natural thing that we all need.” What’s more true is that we’re complicated. There could be different things impacting your desire or your interest – and we need to acknowledge that, because when we expect it to be a natural drive, when it’s not there, we think we’re broken and something’s wrong with us.

August:

Which is really huge, especially in the context of mental health challenges, because so many people find sex to be healing and helpful once they engage in it. But they don’t take the steps to prioritize it in a way that they can, because they think they are broken.

JoEllen: 

There’s the idea of the sexual accelerator and sexual brake, that we have those in our minds, and in some people, one is more sensitive than the other. My depression, because I’m really fortunate and I really go big when I do things, comes with raging anxiety, too. I always feel like that sexual brake is getting pressed by a million different issues all at once. And it’s all just stress. I have to take a step back and look at that and see that that’s impacting my desire and talk to my partner about how that’s what’s going on.

August:

It sounds like when you started really speaking out about these issues, you were early in your own self-discovery around it. What do you remember learning early on? What were some of the first helpful messages you started to embrace or ideas you challenged, that ended up helping you experience more pleasure?

JoEllen:

I noticed early on that when people talked about this topic, and it started getting more attention around 2014 right when I was just doing the surveys, because, of all things, Robin Williams passed away, and people started writing about depression. I started seeing more things addressing sex and depression. And so many of them told people, “You know what? Just do it, just have sex, because you’ll find you want to have sex and that will just get through that barrier. Just do it.” And that made me livid.

So that was one of the earliest things I looked at and said, “We can’t be telling people this. This is not responsible.” That led me down the whole trail that eventually led to what is, I would say, one of the main points of my book, which is that depression doesn’t ruin our relationships and our sex lives. Resentment does. We don’t know how to cope with mental illness entering our relationships. It’s not a thing we’re prepared for, and so we’re not good at it. And then we end up resenting each other. And then of course, we don’t want to have sex anymore.

August: 

What an important point.

JoEllen:

I feel like my friends and family are just kind of done with me and my resentment talk, but it’s been at the core of my work for the last two years.

August:

I think it could be such a freeing message for people to learn about, because if you are the person who has depression, or any other mental illness or mental health issue, and you think that that is what is causing all the problems, all the onus feels like it’s on you. It shouldn’t be, but it feels like it’s on you and to say, “It’s actually how we are maneuvering around this and with this…” What do you say to somebody when they come to you and they say, “My relationship is like this. My depression is breaking my relationship or ruining our sex life.” Where do you go with that?

JoEllen:

Something I talk about a lot and gets a lot of enthusiastic nodding is this relationship dynamic I call “broken and lucky.” That those of us with mental illnesses, chronic illnesses, end up feeling like we are broken, something is wrong with us. And we are so lucky that someone would want to be with us in spite of that. And not only is that a recipe for raging resentment, because when one of you is broken then the other one is the de facto leader, they are right all the time. You’re just going to build up all of that resentment. It also screws with your consent dynamic. Because can you ever really say ‘yes’ or ‘no’ if you feel like you owe them so much, because you’re so lucky they’re there, or you feel like you don’t want to press that luck because luck runs out, right? There are so many unhealthy ways that can go and so many of us fall directly into that dynamic.

August: 

Wow. Also, I imagine it can impact your standards, the value you have for yourself: “Oh, this person is interested in me. Oh, wow, I’m so lucky!” When that person might be really not a good fit for you, or worse, harmful.

JoEllen: 

One of the things I, over the last couple years, started telling some friends when they talked about dating, and this is like for everybody in general, but it’s applicable here, is that a lot of folks, especially women, act like when we date, we are auditioning to see if someone else will accept us. And we don’t give enough credit to the fact that we’re trying to see if we have any interest in spending time with them, too.

August: 

I’m looking back at my life and going, “oh, wow.” You just described so many pages of many people’s diaries.

JoEllen: 

Oh yeah, that was my 20s… And so when we start to look at it like that, and depression doesn’t change that, illness doesn’t change that, you’re still auditioning people to see if you want them to be part of your life.

August:

When you first said lucky I almost thought that you might go into.. I don’t know if this is even an appropriate thing to say in this context, but the idea that navigating mental health issues can be a gift. Is that a good message? I mean, I would never say to someone, “Oh, you have depression? Well, don’t worry. Here’s the bright side.” There’s a lot of mental health issues in my family, and I’ve struggled myself, and I don’t think that’s helpful, but I do think that people I know who go through mental health challenges tend to have such enormous hearts and gifts that are so profound. I don’t know if I’m making any sense.

JoEllen: 

You absolutely are. I would separate that from the “broken and lucky” type of issue we were talking about before. And I look at it, because I’ve had my share of getting angry at people who are like, “well, look how much character you’ll build,” or “something amazing will come of this.” But I’ve had years and years of depression, I’ve had multiple spinal injuries that have kept me off my feet for a year at a time. I feel like all of that has helped me cultivate empathy.The idea that you never know what someone else is going through, the idea that you’re telling yourself a story about what other people are saying. Go read Brene Brown, everybody.

August: 

And watch her special. Best thing I’ve ever watched on TV.

JoEllen: 

I’ve watched that ripple out from me. My partner is more empathetic. My family just had this big, sit-down summit over stuff that they refused to talk about for years because they’re now all looking around and seeing what other people might be experiencing. And I think that is the gift that depression has given me.

August:

And that’s an enormous one. Empathy is so powerful and that it is sprinkling through your community is a huge testament to how you have chosen to go through all of this and then to help people with what you’re learning as well.

What are some of the myths that get to you? I know that you’re also very passionate about myth-debunking about who gets to be sexual.

JoEllen:

Basically, I feel like we as a society say that slender, heterosexual, typically white, conventionally attractive, people who are mentally and physically healthy – they get to be sexual. And I don’t know if I know anybody who literally checks all of those boxes, but those are the boxes.

August:

Barbie and Ken.

JoEllen:

Right. And that leaves out most of the world. So, it’s been encouraging over the last couple of years to see so much talk about sex and disability. Because we live in a world that says, “If you have any kind of physical mental health issue, you’re just out of the sexy pool.” And it’s just not true. It might look like a different pool. But yeah, you’re still there. 

August:

Yeah, you’re still there to be recognized as valuable and valid and just as sexually worthy as anybody.

JoEllen:

Yes, anybody. Absolutely.

August: 

There are so many paths to having a happy and healthy sex life and we can enjoy wonderful sex during some really dark times, which I think can be really cathartic. How often do you hear from people that they are having or getting to a place where they can enjoy maybe even the best sex while they’re going through some of these challenges?

JoEllen: 

I have heard some of that. I will say I am largely someone people reach out to when stuff is not going well. So I think that is the search for validation and for other people who feel this way. But a thing that came up in the interviews specifically was the couples [who] talked about everything; they understood. The partner who didn’t have depression learned about it. They worked together. Those were the people that I would hear, “We have a sex life. It is very satisfying. And you know, it might not look like what we had before. But we’re happy.” And I think that that is no coincidence. The people who are communicating, who feel seen and heard, who feel validated, they still want to have sex with their partners.

August: 

Yes. And the communication piece is so challenging for so many people. And as you said, when you’re struggling with a bout of depression or chronic depression, when brushing your teeth is challenging, bringing up a topic that brings up so many concerns – we hear things like, “I’m afraid that they will feel rejected if they find out that my orgasms aren’t what they used to be” — can just add to their shame and the negative things they’ve learned and the positive things they haven’t learned. 

What are some of the steps that someone in that place can take to have the first conversation?

JoEllen: 

My big thing for partners is to get on each other’s team. You should be on the same team. We tend to set it up like there’s a depressed partner and their depression on one team, and the other partner against them. If they all get on the same team, it just makes all of the next steps so much easier. And for me that involves, I say, you learn a new language. I taught my partner about something called Spoon Theory, which was written by a woman with chronic illness, and it explains the physical and mental capacity we have to get through any day. And that has worked for my partner and I.

I send people to play Depression Quest. It’s an online video game, and you basically roleplay inside the life of someone with depression. So it gets everybody on the same page, so you’re not having that thing where one of you is explaining their depression, and the other’s like, “Yeah, but I read depression’s fake.”  You get together and that’s like step one.

August:

That sounds incredible.

JoEllen: 

It’s amazing. Also, I would advise people not to play it when they are in depressive episodes. I did that once. And it was like super depression. Yeah, it was not good.

 August: 

Oh, wow. So, it’s really good for people who are trying to understand what it’s like. Which is really, really important because you just mentioned one huge myth, which is, “It’s not a thing.”

I have ADHD and I can’t even tell you… I am very comfortable talking about the things that I struggle with, but a lot of people will say, “that’s not a diagnosis in Europe,” or “have you tried this herb?” or “how about yoga?” And we’ve absorbed those messages. It can be detrimental, the point of maybe stepping away from treatment that’s saving your life.

JoEllen: 

And in a world that’s on social media as much as our world is, I feel like you kind of never know where that messaging is going to come from. Every time there’s another mass shooting, I hide from social media for a bit because it got too painful to watch people I know and love be like, “Well, clearly it was a mentally ill person.”

I think our partners really need to be our safe space from that. Something I talked about a couple of times in the book, that I feel like sounds a little harsh and a little tough love, is not everybody can be in a relationship that contains depression. And really before you set out, you need to ask yourself the question: can you be on board for that? And if not, get out, because you have such a capacity to do more harm to your partner.

August: 

Yeah, that’s really powerful. Do you recommend or – again this is different for everyone, I’m sure – but maybe in your own experience, bringing up depression pretty early on when you’re dating someone?

JoEllen: 

I do it because I tend to chronically overshare.

August:

I love love love that about you, by the way. Never stop.

JoEllen:

Conveniently, I’ve built it into my brand identity. So…yeah. I really wish this was not this hot button issue. I feel like if you go on a date with somebody and you tell them “you know, by the way, I have asthma,” they say “okay, cool,” and go back to their appetizer. But if you say, “I suffer from depression,” people expect you to start crying or think they’re going to have to stage an intervention for your suicide attempt or something. And I would love to see us move past that point. Because I do hear from people who are like, “I’m four dates and with this guy, I don’t want to ruin it. But I have chronic depression.”

August:

It’s so true. And I love that example. Because we don’t have that same stigma around medication either. If you have diabetes and you take insulin, people will be like, “Don’t miss your insulin.”  But if you said, “Oh, I missed my anti-psychotic,” or “I missed my antidepressant” or whatever it is, people have such a different view. I would love to see that change as well.

Could we talk about medications for a moment? I feel like that’s such an important topic that is so misunderstood.

JoEllen:

And I catch a lot of grief. The thing people will most likely write to me about, kind of annoyed, is, “Why are you so pro-medication? There are natural ways to treat it.” I’m not pro-medication, I’m pro-everybody having the treatment that they need, whatever works best for them. And medication’s a huge part of the sex and depression conversation because of sexual side effects.

August: 

It’s interesting that people perceive if you aren’t focused only on natural remedies and lifestyle, then you must be pro-medication and pro-Big Pharma. I think we could talk about the problems with Big Pharma, and be very accepting of medications and respecting what people need to do for themselves. If you take medication that you need…and it’s part of your care plan, it’s never the only thing, but people think that you’re somehow medicating instead.

JoEllen: 

And that once you get the medication, it’s super easy. We don’t talk about the four shots at different medications that you took before you got to this one and the effect on your body and the effect on your mind. It’s like they think it’s like a happy pill. And…no.

A question I get a lot is, “In your book, do you talk about natural treatment methods?” And I think a thing to be aware of is I don’t talk about any treatment methods because I’m not a doctor. That’s not the point.

August: 

It’s so big and it is so heated. I think one thing a lot of people…if they had a negative experience with a medication, it’s very easy to then jump to, “Medications are bad.” And I understand and have empathy for people who—I’ll use myself an example because I can talk about me publicly—I was misdiagnosed with multiple things before ADHD and antidepressants made my symptoms worse…so I just thought, oh. Medications don’t work for me. That’s what you think when you’re a kid and you’re like, well, I tried that.

Years later, once I was properly diagnosed and found, thankfully, a medication that is so helpful to me, it erased any semblance of doubt. When you finally do find something that helps you, it’s incredible how life-changing that is, and not in a “happy pill” way but in a way of, “I can be okay, I can be a human. ” When you’re struggling that much, and you finally find something that addresses the thing that is needing help, just like if your blood sugar is off.  Have you had those experiences, like you mentioned how sometimes you have to go through many medications to find the right one?

JoEllen:

So unfortunately, I feel like I have really yet to have that moment where a medication really hits. The last couple of years have been kind of brutal and awful because I’ve just been on the wrong medications. I spent a brief period misdiagnosed by a doctor who had never heard of anxiety and depression coexisting, so declared that I had bipolar disorder and treated it as such. But that was not the appropriate treatment plan. So now I’ve gone back to the medication I was taking for the time in my life when I felt the best, and we’re going to see how that goes.

As I mentioned earlier, I had back injuries. And both the best and the worst medication experiences of my life came through that. Once I had to go to an urgent care and I was in so much pain and they gave me, of all things, a steroid drug of some sort. It’s something you shouldn’t take more than a week worth of. I don’t know why; I felt incredible. I woke up one day and said, “This is how people feel,” and went about my work…it was wild. And I knew it was only going to last a week. But it opened my eyes to the fact that there is some path to normal or a happier me.

August:

It was addressing something that needed to be addressed.

JoEllen: 

And on the flip side, I was once prescribed a muscle relaxant and I became suicidal within 24 hours. What this taught me is that every medication interacts on all of us differently. So when I tell the muscle relaxant story, everybody’s like, “I need to know what it is.” And it’s such an uncommon reaction that it feels wrong to scare people away from something that might relieve their pain.

August:

Yeah, it can get really complicated, and knowing what the potential side effects are so key to being able to care for yourself, because when something makes you feel suicidal, that is, wow. Were you able to reach out for support? Was it something you were like, “Okay, this is from the medication?” 

JoEllen:

I didn’t know. I was staying with my partner and I was a mess and he was taking care of me. And then we happened to fall asleep really early on Saturday night and I didn’t take the medication. And the next day, I noticed I was feeling a bit better, but my head was still kind of there. So to be really honest—I want to warn everybody I’m going to mention suicide stuff right now—I looked up the medication to see if it was something I could use in the process of committing suicide. And the first article that came up was, “This medication can cause suicidal ideation in vulnerable populations,” and told the story of a man who was on it for a couple of days and his life ended and that was the moment it clicked for me and I knew what was going on. Because before that it just felt like the most natural thought in the world. Like, I was stressed out and I just went, “Maybe I’m done. Maybe that’s it.”

August: 

Because no one spoke to you about that as a possibility.

JoEllen: 

The doctors and the pharmacists, when I told them, none of them had heard of it as a possibility. And in my research, a huge percentage of people who experienced, for example, sexual side effects, said that they had had no preparation for that. They had had no warning. Nobody told them it could happen.

August: 

I see the parallel there hugely. Because again, you might not know why.

JoEllen: 

Exactly. Especially when you’re coping with depression that tends to sit there in our minds and tell us we’re terrible and we suck. And if you don’t know that the medication is causing this to happen for you, you just look at it as more evidence that you’re terrible and the worst and broken.

August: 

As I understand it, for at least some people, sexual side effects can be temporary. Is that right? You might start a medication, experience maybe vaginal dryness or low desire or something, but if the medication is helping you, sometimes it’s a matter of time.

JoEllen: 

I’ve found that with a lot of side effects, just in general, when you start something, sometimes you have the side effects for a little bit. And sometimes it can be a question of tweaking the dose or giving it some time. I get hesitant to tell people too much to give things time, because I know I would listen to that and you’d be like nine months later, because I was like, “I’m supposed to give it time.”

In addition to that, I have dealt with a lot of people who found a medication that worked and were so happy it worked that they were willing to take on the sexual side effects, which is a completely valid choice. And I’m not here to tell you you have to have all the depression orgasms. But it’s what sent me about figuring out strategies for working around some of the side effects, so that you could still have some pleasure while you’re on the med that works.

August:

That makes a lot of sense, because if a medication is that helpful to you in that, you’re like “I can make it through a day now,” then sex may not be the thing. It might be the give and take that you perceive as okay. Or it’s something that you’re like, “I’m willing to work around that in another way,” which I know you talk about quite a bit.

JoEllen:

I do. I want people to understand that it’s valid to choose to stay on something that’s compromising your sexual function, but also depression is not some kind of like Faustian bargain, where you trade away your sex life for a shot at happiness. There are ways we can work around all that.

August: 

Could you give a few examples that might work for some people?

JoEllen:

So I realized the sexual side effect I didn’t mention earlier: something called genital numbness. It’s not numbness in that pins and needles way. I once said it was like bubble wrap is over your genitals, like things that usually work don’t quite register. You’re just not feeling that. So in terms of that, and anorgasmia and delayed orgasm, I tend to recommend that every household where someone has depression has a high-powered wand vibrator in it. Because it sounds so silly, but they’re so powerful and the heads tend to be so big, that it can start stimulating parts you hadn’t thought you need to stimulate, or it can give that vibration to a huge large area, and it for a lot of people is a lot more than they’re used to. And it can help get around that numbness, or that delayed orgasm, which can be satisfying for people.

Additionally, for penis stimulation, I found a couple of things that actually can help stimulate someone to orgasm without an erection. One of them is the Pulse by a company called Hot Octopuss. It uses oscillation and it’s very cool. One of the big selling points is that it does not require an erection. 

Going back to my big giant wand fixation, there’s an attachment you can put on a giant wand that just looks like a tube. I think the Hummingbird attachment is a name it goes by frequently. And people in my research reported that they were able to have great orgasms without an erection with that attachment. And I just think that’s fun stuff that we never think of.

August: 

Imagine if you talked to your doctor and they could recommend some of these things or send them to your book.

 JoEllen: 

Well, a big thing with the changes in lubrication so many people experience… I just feel like in general, doctors need a better relationship with lube. And that would help so many people because again, we think of lube as some kind of unnatural interloper into our sex lives and we don’t want to use it and, “I don’t need that.” I don’t care if you actually need it or not. It just makes everything better. I keep a buffet of five lubes on my nightstand.

August:

I love that visual so much.

JoEllen:

And it’s because dry things touching genitals does not feel great. So I keep a water-based, silicone, oil-based, a hybrid and a flavored lube on my nightstand at all times, because that’s just a great path to things feeling better, whether your lubrication is compromised or not.

August: 

Would you share more about your book? Tell us a little bit about what you hope people get from it, the format, what the experience will be like using it.

JoEllen:

This book originally started out as just a way for me to say to people, “See other people are experiencing this.” And then they could feel better and move on. Over time, it evolved into almost like a guidebook. So, I say the first half identifies the monster under the bed. It tells us what’s going on for people, lots of survey results there.

The second half is more like applicable solutions, things you can try: products, books,…how to navigate the rest of the world stuff, so that we can have a step-by-step. I feel the book is Part One and Part Two. If you’re not interested in the history of how all of this happened, you can actually jump into Part Two and get some answers. And that’s kind of my favorite thing about the book.

August McLaughlin: 

Beautiful. Would you leave us with one piece of advice for anyone who might be struggling in the area of sex and depression?

JoEllen: 

Don’t be afraid to make conscious decisions when it comes to sex. A lot of us say “I have depression, so sex goes away.” And on the other side, we have that “Just do it” thing I don’t like. I like checking in, seeing how you feel about sex today… Do you want it, but it sounds like a lot of work? Do you not want it at all? Whatever it is, identify it. And then you have something you can talk to your partner about, and you get to stay on the same page.

For more on this topic, check out JoEllen Notte’s book here! To hear our full chat plus Dr. Megan Fleming‘s thoughts for a listener who misses her orgasms since starting antidepressants plus ways to cultivate pleasure amid the pandemic, stream the episode up above or on your favorite podcast app.