The Brain in Love: 12 Lessons to Enhance Your Love Life (27 page)

Antidepressants and Romantic Love

Depression inhibits romantic love. People who are depressed tend to be negative, socially isolated, and often have little interest in sex. They might also have suicidal feelings, which are usually a turnoff to potential partners. Treating depression is essential for people to have healthy relationships. Yet, the specific type of treatment can either enhance or hurt attraction in romantic love. In my imaging work I have discovered that depression is not one illness and that the treatment needs to be tailored individually. In general, however, bupropion (Wellbutrin) is prosexual and enhances sexual feelings and function. It enhances dopamine availability in the brain and increases attention and focus. It is useful to treat depressions associated with low energy. SSRIs, useful in treating depression associated with obsessive thinking, can jeopardize romantic love. Low serotonin levels help explain the obsessive thinking common in early romantic love. In a study by Helen Fisher, subjects reported that they thought about their loved one 95 percent of the day and couldn’t stop thinking about them. This kind of obsessive thinking is comparable to obsessive-compulsive disorder, also characterized by low serotonin levels. Serotonin-enhancing antidepressants blunt the emotions, including the elation of romance, and suppress obsessive thinking, a critical component of romance. “When you inhibit this brain system,” Dr. Fisher warns, “you can inhibit your patient’s well-being and possibly their genetic future.” These antidepressants also inhibit orgasm, clitoral stimulation, penile erection, and seminal fluid. From an anthropological perspective, Dr. Fisher concludes, “a
woman who can’t get an orgasm may fail to distinguish Mr. Right from Mr. Wrong.” As one woman on an SSRI told me, “I thought I no longer was attracted to my husband.” In a study, women on SSRIs rated male faces as more unattractive, a process called courtship blunting. Seminal fluid contains dopamine and norepinephrine, oxytocin and vasopressin, testosterone and estrogen. Without an orgasm, men may lose the ability to send courtship signals. These warnings should encourage us to look for alternative treatments in depression.

Anxiety Disorders

There are five common types of anxiety disorders that can affect people’s relationships, moods, and sexuality in a negative way: panic disorders, agoraphobia, obsessive-compulsive disorder, post-traumatic stress disorder, and performance anxiety. I’ll briefly discuss each of these and their treatments.

Panic Disorder

Healthy sexuality is usually enhanced by a sense of safety and peacefulness. But what if all of a sudden your heart starts to pound. You get this feeling of incredible dread. Your breathing rate goes faster. You start to sweat. Your muscles get tight, and your hands feel like ice. Your mind starts to race about every terrible thing that could possibly happen and you feel as though you’re going to lose your mind if you don’t get out of the current situation. You’ve just had a panic attack. Panic attacks are one of the most common brain disorders. It is estimated that 6 to 7 percent of adults will at some point in their lives suffer from recurrent panic attacks. They often begin in late adolescence or early adulthood but may spontaneously occur later in life. If a person has three attacks within a three-week period, doctors make a diagnosis of a panic disorder.

In a typical panic attack, a person has at least four of the
following twelve symptoms: shortness of breath, heart pounding, chest pain, choking or smothering feelings, dizziness, tingling of hands or feet, feeling unreal, hot or cold flashes, sweating, faintness, trembling or shaking, and a fear of dying or going crazy. When the panic attacks first start, many people end up in the emergency room because they think they’re having a heart attack. Some people even end up being admitted to the hospital.

Anticipation anxiety is one of the most difficult symptoms for a person who has a panic disorder. These people are often extremely skilled at predicting the worst in situations. In fact, it is often the anticipation of a bad event that brings on a panic attack. For example, you are in the grocery store and worry that you’re going to have an anxiety attack and pass out on the floor. Then, you predict, everyone in the store will look at you and laugh. Pretty quickly the symptoms begin. Sometimes a panic disorder can become so severe that a person begins to avoid almost any situation outside of home—a condition called agoraphobia.

Panic attacks can occur for a variety of different reasons. Sometimes they are caused by medical illnesses, such as hyperthyroidism, which is why it’s always important to have a physical examination and screening blood work. Sometimes panic attacks can be brought on by excessive caffeine intake or alcohol withdrawal. Hormonal changes also seem to play a role. Panic attacks in women are seen more frequently at the end of their menstrual cycle, after having a baby, or during menopause. Traumatic events from the past that somehow get unconsciously triggered can also precipitate a series of attacks. Commonly, there is a family history of panic attacks, alcohol abuse, or other mental illnesses.

On SPECT scans we often see hyperactivity in the basal ganglia, or sometimes temporal lobe problems. Psychotherapy is my preferred treatment for this disorder and in some studies has been shown to calm basal ganglia activity. Sometimes supplements or medications can also be helpful. Unfortunately the most helpful medications are also addictive, so care is needed.

Agoraphobia

The name
agoraphobia
comes from a Greek word that means “fear of the marketplace.” In behavioral terms it means the fear of being alone in public places. The underlying worry is that the person will lose control or become incapacitated and no one will be there to help. People afflicted with this phobia begin to avoid being in crowds, in stores, or on busy streets. They’re often afraid of being in tunnels, on bridges, in elevators, or on public transportation. They usually insist that a family member or a friend accompany them when they leave home. If the fear establishes a foothold in the person, it may affect his or her whole life. Normal activities become increasingly restricted as the fears or avoidance behaviors dominate their life.

Agoraphobic symptoms often begin in the late teen years or early twenties, but I’ve seen them start when a person is in their fifties or sixties. Often, without knowing what is wrong, people will try to medicate themselves with excessive amounts of alcohol or drugs. This illness occurs more frequently in women and many who have it experienced significant separation anxiety as children. Additionally, there may be a history of excessive anxiety, panic attacks, depression, or alcohol abuse in relatives.

Agoraphobia often evolves out of panic attacks that seem to occur “out of the blue,” for no apparent reason. These attacks are so frightening that the person begins to avoid any situation that may be in any way associated with the fear. I think these initial panic attacks are often triggered by unconscious events or anxieties from the past. For example, I once treated a patient who had been raped as a teenager in a park late at night. When she was twenty-eight, she had her first panic attack while walking late at night in a park with her husband. It was the park setting late at night that she associated with the fear of being raped and which triggered the panic attack. Agoraphobia is a very frightening illness to the patient and his or her family. With effective, early intervention, however, there is significant hope for recovery. The scan findings
and treatment are similar to those for people with panic disorder. The one difference is that people with agoraphobia often have increased anterior cingulate gyrus activity and get stuck in their fear of having more panic attacks. Getting stuck in the fear often prevents them from leaving home. Using medications, such as Prozac and Lexapro, or supplements, such as 5-HTP and St. John’s wort, to increase serotonin and calm this part of the brain is often helpful.

Obsessive-Compulsive Disorder (see Lesson Eight)

Posttraumatic Stress Disorder

Joanne, a thirty-four-year-old travel agent, was held up in her office at gunpoint by two men. Four or five times during the robbery, one of the men held a gun to her head and said he was going to kill her. She graphically imagined her brain being splattered with blood against the wall. Near the end of this fifteen-minute ordeal, they made her take off all her clothes. She pictured herself being brutally raped by them. They left without touching her, but locked her in a closet.

Since that time her life had been thrown into turmoil. She felt tense, and was plagued with flashbacks and nightmares of the robbery. Her stomach was in knots and she had a constant headache. Whenever she went out, she felt panicky. She was frustrated that she could not calm her body: her heart raced, she was short of breath, and her hands were constantly cold and sweaty. She hated how she felt and she was angry about how her nice life had turned into a nightmare. What was most upsetting to her were the ways that the robbery affected her marriage and her child. Her baby picked up the tension and was very fussy. Every time she tried to make love with her husband, she began to cry and get images of the men raping her. Joanne had posttraumatic stress disorder (PTSD), a brain reaction to severe traumatic events such as a robbery, rape, car accident, earthquake, tornado, or even a volcanic
eruption. Her symptoms are classic for PTSD, especially the flashbacks and nightmares of the event.

The worst symptoms came from the horrible thoughts about what never happened, such as seeing her brain splattered against the wall and being raped. These thoughts were registered in her subconscious as fact, and until she entered treatment she was not able to recognize how much damage they had been doing. For example, when she imagined that she was being raped, a part of her began to believe that she actually was raped. The first time she had her period after the robbery, she began to cry with relief that she was not impregnated by the robbers, even though they never touched her. A part of her even believed she was dead because she had so vividly pictured her own death. A significant portion of her treatment was geared to counteract these erroneous subconscious conclusions.

Without treatment, PTSD can literally ruin a person’s life. The most effective treatment is usually psychotherapy. One type of psychotherapy that I think works especially well for PTSD is called eye movement desensitization and reprocessing (EMDR). You can learn more about this technique in my book
Healing Anxiety and Depression
or visiting
www.emdria.org
. Depending on the severity of PTSD, certain types of medications and supplements can also be helpful.

Performance Anxiety

Feeling anxious or nervous before speaking or performing in front of a group is one of the most common fears of human beings. Many people hate feeling judged, scrutinized, or “on the spot.” As anxiety levels go up in the brain, thoughtfulness usually goes down. This is particularly true with sexual performance. It is very common for lovers, especially new lovers, to want to please their partners. They feel anxious and their nerves tend to get in the way of sexual play and enjoyment. Often this type of anxiety is associated with what I call Fortune Telling ANTs. ANT stands for
automatic negative thoughts. These are the thoughts that go through your head automatically and ruin your day. Fortune-telling ANTs are the thoughts that predict a bad turnout, even though there is no evidence for the idea. Examples include, “He will not like my body.” “She will think I have a small penis.” “I will come too quickly.” “I have to fake an orgasm, or he will not be happy with me.” The problem with fortune-telling ANTs is that your brain makes happen what it sees. If you predict failure, you are more likely to fail. For example, when you see yourself not pleasing your partner, the subsequent anxiety will interfere with your feeling relaxed and present, in the moment; then you will not read his or her body language and end up missing important clues to making it a special sexual time. Learning how to calm performance anxiety, through correcting negative thoughts, deep breathing, and meditation, is essential for great sex.

Attention Deficit Disorder

In my lectures I often ask, “How many people are married? Raise your hands.” Usually, a good portion of the audience raises their hands. “Is it helpful,” I ask next, “to say everything you think in your marriage?” Everyone laughs. “Of course not,” I continue, “relationships require tact, they require thoughtfulness. Saying everything you think is usually a disaster in relationships.” Unfortunately, you need healthy PFC activity to suppress the sneaky thoughts that just creep through your brain. Attention-deficit/hyperactivity disorder (ADHD) is usually associated with low PFC activity and people are more likely to blurt out, without forethought.

Do you often feel restless? Have trouble concentrating? Have trouble with impulsiveness, either doing or saying things you wish you hadn’t? Do you fail to finish many projects you start? Are you easily bored or quick to anger? If the answer to most of these questions is yes, you might have attention deficit disorder (ADD).

ADD is the most common brain problem in children and
adults, affecting 8 to 10 percent of the United States population. The main symptoms of ADD are a short attention span, distractibility, disorganization, procrastination, and poor internal supervision. It is often, but not always, associated with impulsive behavior and hyperactivity or restlessness. Until recently, most people thought that children outgrew this disorder during their teenage years. For many, this is false. While it is true that the hyperactivity lessens over time, the other symptoms of impulsivity, distractibility, and a short attention span remain for most sufferers into adulthood. Current research shows that 60 to 80 percent of ADD children never fully outgrow this disorder.

Common symptoms of the adult form of ADD include poor organization and planning, procrastination, trouble listening carefully to directions, distractibility, short attention span, relationship problems, and excessive traffic violations. Additionally, people with adult ADD are often late for appointments, frequently misplace things, may be quick to anger, and have poor follow-through. There may also be frequent impulsive job or relationship changes and poor financial management. Substance abuse, especially alcohol or amphetamines and cocaine, and low self-esteem are also common.