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mental health mondays :: crazy sex

welcome back! clearly, i've taken a few days off, plus mhm has been away for the summer, so it's a double return with a slightly racy theme. well, not x-rated or anything, but today we are talking about the crossroads of mental health and getting busy.

there were a lot of recent headlines about the approval of a new drug dubbed the "female viagra" in the united states. flibanserin, sold under the brand name "addyi" is supposed to give women the renewed sexual vigour that viagra gives to men. equal opportunity crazy sex! but the little pink pill [get it? pink for girls and blue for boys? get it???] has created something of a backlash because of how it works and the condition it's supposed to treat. and as it turns out, it has a lot more to do with what's happening in your head than in your loins.

first, let's get one thing straight: flibanserin is in no way female viagra. viagra treats a physical disorder that prevents men from achieving an erection or acting on sexual desire. it works by increasing blood flow to the penis, which makes it easier for a man to get and maintain an erection. to truly be a "female viagra", a drug would have to treat something like a muscle spasm that caused women's vaginas to squeeze shut, but since that doesn't happen, there can be no equivalent medication for women.

instead, flibanserin is a completely different kind of drug that works on a completely different problem. it's prescribed to treat a condition called hypoactive sexual desire disorder, where the patient feels unable to become aroused. this is a particular issue for women approaching menopause, as hormone levels start to shift, so that even if a woman wants to have sex in theory, she rarely feels like having sex in reality. flibanserin works by modulating the neurotransmitters in the brain, maximizing the availability of those that help in an excitatory sexual response and minimizing those that provoke an inhibitory sexual response.

it turns out that the same neurotransmitters implicated in mood are the ones that affect our level of sexual desire. flibanserin started life as a prospective antidepressant, but despite repeated tests, it wasn't effective enough to cut it. while testing it out, however, the drug's makers [sprout pharmaceuticals] noticed that while it didn't make people happy, it did make them horny and thus was a new target market acquired.

flibanserin helps raise the levels of norepinephrine and dopamine in the brain, two neurotransmitters that tend to make us feel energetic and randy, while limiting the amount of available serotonin, something which makes us feel more calm and cuddly, but usually not sexy. as a result, women are more likely to become aroused and responsive more often. [and, as you've probably guessed, this explains why many people of both genders complain that antidepressants- which mostly increase serotonin levels in the brain- make them lose their interest in sex.] the idea is that by juicing the brain with sexy stuff and mopping up the substance that makes us a little more blasé, we'll be creating the conditions for a perfect sexual storm.

the drug claims that it will increase the incidence of "satisfying sexual encounters" for women and although the extent of the before/ after difference is subject to some debate, patients involved in testing did report an increased number of satisfying sexual encounters as a result of their improved libido. unfortunately, the drug also comes with some significant down sides: it can cause drops in blood pressure, especially when combined with alcohol [even a glass of wine is a big no-no]; it can cause both somnolence [i feel sleepy] and insomnia [i can't sleep], which is just a peach of a combo; and of course, it can interact with a lot of different drugs including antidepressants like ssrsi's and benzodiazepines.

it makes sense that taking two drugs that affect serotonin levels would be a no-no. although the actions of the two drugs would seem to offset each other, the antidepressants tend to amplify flibanserin's effects on the central nervous system- the drop in blood pressure that can lead to fainting or worse. given that a large number of premenopausal women [the largest target market for flibanserin] seek treatment for depression and anxiety occasioned by hormonal shifts, it's bound to be a bit frustrating that they'll be forced to choose which condition they'd rather treat, but such is life. what's interesting, however, is that no one's backed that argument up to its logical origin: if lady viagra plays around with the chemical soup that is your brain, what effect will it have on someone whose soup is a little too spicy to begin with?

for the people i just lost with that metaphor, i'll rephrase: it's fine to say that medications for depression can't be taken with this new drug, but what about depression itself? is this safe to take if you're suffering from or have been prone to depressions? although there have been some questions recently, research still suggests that people who are depressed have difficulty accessing the serotonin their bodies produce. so if a patient is already struggling with inadequate levels of serotonin, would it be dangerous for them to even start taking the flibanserin? there's nothing to stop their doctor from prescribing it, provided they aren't already taking drugs for depression. and since one of the frequent effects of depression is a loss of interest in sex, there's a lot of potential for chicken and egg confusion over what should actually be treated.

since flibanserin is being marketed as a libido aid, a sort of "sexual liberation drug" for women, questions about its effect on mental health aren't being asked. but the marketing masks the truth: flibanserin is a psychiatric medication. like all "crazy meds" it needs to be taken daily in order to be effective [unlike viagra, which can be taken as necessary]. like most antidepressants, it takes about a month to become effective. and like psychiatric meds, it modulates the neurotransmitters serotonin, norepinephrine and dopamine. the federal drug administration in america has already given its cautious approval after a massive campaign by the drug manufacturer [aided by a number of women's groups] that positioned flibanserin as being akin to birth control pills in its importance to women's control over their sexuality. i hope that when the manufacturer seeks approbation to sell in canada [coming soon] and in other countries, that they'll evaluate the drug based on what it is rather than how it's being sold.

p.s. :: at least one study has pointed to the possibility that there is already a female viagra, and it's viagra. women in the study reported it made them feel more aroused, increased lubrication and made it easier to achieve orgasm. in short, it offers a solution to the physical issues that can impede women's ability to enjoy sex.

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