Certain antidepressants, claim Fisher and her collaborator, Andy Thomson, a psychiatrist at the University of Virginia Elson Student Health Center, can actually deaden some of the most basic human instincts associated with love like, say, blushing—or crushing. "The main characteristic of romantic love is obsessive thinking—you can’t stop thinking about your sweetheart," says Fisher. "These drugs numb emotions and reduce obsessive thinking. That kills romantic love."
The drugs in their crosshairs are a popular category called SSRIs, or Selective Serotonin Reuptake Inhibitors, which include oft-prescribed Zoloft, Paxil, and Prozac, among others. They work by building up levels of the brain chemical serotonin, which helps alleviate anxiety and depression, leaving us more content and more relaxed. The rub, says Fisher, is that basic neuroscience tells us that when serotonin skyrockets, dopamine plummets.
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And dopamine, the "wanting" chemical, is what makes us yearn for a piece of chocolate or a promotion at work, and, as Fisher learned in her study (published in 2005), which examined brain scans of 30 people in love, it's also the driving force behind budding desire—the stage when you're anxiously awaiting a call or an email from someone you can't stop thinking about. "When you take SSRIs and drive up serotonin, it stands to reason that you not only suppress dopamine but also romantic love," she says.
And then there's the randier half of the equation: Some studies show that as many as 70 percent of people taking antidepressants have some sexual dysfunction, according to Anita Clayton, a psychiatrist with the University of Virginia Health System and a leading researcher on these drugs’ sexual side effects. A study she led last year found that women on SSRIs are most likely to experience arousal problems—they can’t get in the mood for sex, either mentally or through vaginal lubrication, and she adds, "they may also have trouble achieving orgasm."
The reasons are twofold: SSRIs lower the levels of testosterone and dopamine in the body, and can also alter vaginal sensation, leaving users without much feeling—or so sensitive that sex is painful. The side effects may go away in time. Often doctors add a new drug to the mix to alleviate them, switch up medications, or, less frequently, recommend a short "vacation." But patients are often reluctant to mess with a formula that’s working—despite the drawbacks.
"I'm totally disinterested in sex," says Daniela Vellotti, 33, of Alpharetta, Georgia, who used to enjoy occasional twice-a-day romps with her long-term boyfriend before going on Zoloft in May. "I've only been able to orgasm twice since going on the drugs, and it wasn't even that good."
The bigger problem, says Fisher, is that unfulfilling sex is more than just a relationship inconvenience—science shows couples need to orgasm to stay in love. Sexual stimulation drives up dopamine, helping fan the fires of romantic love, and orgasm brings a flood of oxytocin, the brain chemical associated with attachment. The bottom line: "Sex drive, romantic love, and attachment are connected," says Fisher, who passionately believes that antidepressants are capable of tampering with that delicate love triangle.
Not everyone is convinced. "Our capacity to love is very strong," says Clayton, author of Satisfaction: Women, Sex and the Quest for Intimacy. "I just haven't seen people on SSRIs not be able to fall in love, and there's no good systematic data to suggest that." The very nature of depression places stress on relationships, she says. The last thing a depressed woman is thinking about is falling in love or having sex: "They're focused on their own suffering." By and large, the drug companies also dispute the claims.
"Antidepressants allow most people to experience more normal emotions again," says Dr. John M. Plewes, medical adviser for Eli Lilly, maker of Prozac, though, he concedes, "Certainly some people may have more difficulty than others." Even Vellotti says that while she wants a solution to her sex problems, overall, she credits her much happier relationship to her antidepressant. Before Zoloft, she felt short-fused, resentful—and nearly broke things off with her boyfriend. "Now, I’m hopeful about a future with him," Vellotti says. "It's not an option to go back to how I was. It would be horrible."
Fisher, too, makes a distinction between "people who literally couldn't get out of bed in the morning and need the drugs in order to find love" and those who hit a trouble spot but may stay on the drug indefinitely. They’re the ones she believes may be at risk for what she points to as the true danger: “emotional blunting.”
Blunting is an effect described in a recent study by University of Arizona researchers, who found that SSRIs can make it harder for people to cry, worry, or feel anger, surprise, or compassion. Thomson has heard these same complaints from patients. "People describe it like this: 'I just don't have the same range of feelings, and stuff that used to upset me doesn't upset me anymore,'" he says. But, on the flip side: What used to make them really happy now barely moves the needle—they feel indifferent. To most everything.
Maybe even someone they once loved? For Ticas, that was the case. She and Julio even considered divorce: At one point he packed a bag and left—but returned the same night. They resolved to stick it out and now, four years later, Ticas is off antidepressants and treating her depression by different means (a pacemaker-like device that sends short bursts of electrical energy to her brain every few minutes). "When you're depressed, you're in a darkness," Ticas says. "Taking antidepressants takes you to a kind of dawn. There's light, but it's not bright."
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While pills work wonders for some, for her, being off her medication means the light is brighter. The romance is back. And when the lights go out, and she's cuddling with Julio in the darkness, there’s no place she'd rather be.