Follow Dan

Facebook    Twitter    Instagram    YouTube
Savage Lovecast
Dan Savage's Hump
It Gets Better Project

Savage Love Podcast

Got a question for Dan Savage?
Call the Savage Love Podcast at 206-201-2720
or email Dan at mail@savagelove.net.

Savage Love Archives

More in the Archives »

More from Dan Savage

More in the Archives »

Books by Dan Savage

Want a Second Opinion?

Contact Dan Savage

Savage on YouTube

Loading...

Just Out

June 27, 2012

My younger brother and I are close. He came out of the closet last year, although it wasn't much of a surprise because everyone knew he was gay since forever. Everyone is happy he's out because it kind of takes the elephant out of the room, and our immediate and extended family are all really supportive. But for the last six to nine months or so, he's been really depressed about not ever having had a boyfriend. He's 21 and he's always talking about how he wants to find a boy to be with in a relationship and not just for sex, but he says it's impossible for him to meet said boy.

Me being straight, the only advice I've ever been able to give him is to just try new things and that way you'll meet new people, as really that's the only advice you can give someone who's looking to meet a potential partner. My brother, however, framed his issue to me in a way I've never really thought of—which is that only a small fraction of the population is gay, and an even smaller fraction of that may be compatible with him, so meeting new people for a gay guy is actually a lot harder than it is for straight people.

He's been on the whole online dating thing for a while, but said it's really difficult to meet anyone who he feels a connection with. I've never done online dating, but I have heard the same points from others who've tried it. I asked him if he ever goes to gay bars, because that would obviously change the ratios around, but apparently it's a little insensitive for a straight guy to say that, and he said he's not really into that scene. Anyway, I just wish I could give him some good advice without being unintentionally offensive (the gay bar suggestion). I'd still like to offer him any advice I can for him to meet a guy he feels strongly about.

Seeking Advice For Family

There are 3.5 billion men on the planet.

Even if we accept the lowest educated guesstimate of the percentage of the population that's gay—1.7 percent—that means your brother has nearly 60 million potential romantic partners to choose from worldwide; he has 2.5 million potential romantic partners in the United States alone. Other informed guesstimates of the percentage of the population that's gay are much, much higher—seven or eight times higher—so your brother's odds of finding a partner are probably much better. But let's put that 1.7 percent figure in perspective: Jews represent just 1.7 percent of the population of the United States. So even if the percentage of the population that's gay is "just" 1.7 percent, your brother has the, um, same cross to bear—and the same odds of success—as an American Jew who wants to marry another American Jew.

It sounds like your brother is going through a common if rarely discussed stage of the coming-out process: Wallow in Self Pity and Bite the Head Off Anyone Who Tries to Help. That's why he was offended by your perfectly reasonable, not at all offensive suggestion that he get out there and hit some gay bars. Yes, the bars aren't for everyone. But if you're single and want to meet people—gay or straight—you need to be moving on all fronts: online dating, hitting bars and clubs, volunteering, and just generally getting out of the fucking house.

Your brother is 21 years old and he just came out, SAFF, and his frustration is understandable. He's been watching his straight peers (and his straight brothers) hook up and fall in love since middle school and he feels anxious to make up for lost time. But he won't find that first boyfriend if he isn't willing to put himself out there—and that means giving the guys he meets online a chance, giving the bars a chance, and giving the people who are trying to help him out a break.


My girlfriend of two and a half years and I are ready to move in together. Finally! I am so excited to take this next step, and so is she. The problem is that I work third shift four to five nights a week and she works a regular day job. I can't help but feel that we aren't going to get the full experience of living together with our work situations being what they are. I won't be waking up every morning to her saying, "Good morning, beautiful," etc. What can we do to make this a better situation and take advantage of the next step? Thanks.

The Next Step

Here's a tip, TNS: Don't spend too much time comparing your actual relationship, which will always be shaped by circumstances not fully in your control (like your work schedules), to your idealized notions about what a romantic relationship should look like. That only ensures constant disappointment. Don't get me wrong: Once you move in with your girlfriend, there will be days that begin with her rolling over and saying, "Good morning, beautiful." But there will also be days that begin with your girlfriend rolling over and farting. The trick to loving your LTR is to fully appreciate the moments that rise to the level of your romantic ideals ("Good morning, beautiful") without obsessing about those moments that disappoint (split shifts, ripped farts). Good luck!


I'm a guy. I've been with my girlfriend for almost two years. I love her, but in the last year, sex has been an issue. I feel attracted to her, but I find myself easily distracted these days, kind of worried during sex, which has resulted in me either coming super fast or losing my erection altogether. As a result, she does not orgasm at all. It's gotten to the point where I'm afraid to be intimate with her for fear of letting her down. I have gone to see doctors to try to understand if my medical conditions—severe sleep apnea, elevated blood pressure—might have something to do with it. I'm in treatment for these things and I've started going to a therapist, too. I am thinking of buying some sex toys to use while I work to overcome my problems. My girlfriend doesn't own any, and she says she doesn't masturbate because she tried it once and never came. How do I approach her with the idea of using sex toys during sex? Should I? I just want her to experience an orgasm, even if I need to get some extra help from a vibrator.

Devil In The Details

Incorporating some adult toys—vibrators and dildos—into your sex life isn't just a great way to maintain your sexual connection while you work on your physical and mental issues, DITD, it's also a great way to take the pressure off your dick. Performance anxiety and worries about leaving your partner unsatisfied can combine to create a hugely destructive, dick-deflating negative feedback loop. As for your girlfriend...

A woman who doesn't masturbate—because she tried it once and it didn't work—has hang-ups, DITD. And a woman with hang-ups is much likelier to forgive a partner for having purchased some sex toys than she is to give a partner her advance permission to go and purchase some sex toys. So find a good local or online sex-toy store and buy whatever you think looks like fun.


Find the Savage Lovecast (my weekly podcast) every Tuesday at thestranger.com/savage.

mail@savagelove.net

@fakedansavage on Twitter

 

Comments (234) RSS

Oldest First Unregistered On Registered On Add a comment
1
I'm trying a new game where I form my answer to the letters before reading Dan's.

For the first, Dan and I are in agreement. The numbers on how hard it is to find someone compatible and getting depressed over it are 2 different things. It looks like SAFF makes a suggestion, and his brother shoots him down. SAFF feels horrible for offending, and we're off to the races. Here's my advice to SAFF. Say to your brother "gee, that really sucks. I wish I could say something that would make you feel better." And then stop! Don't say anything else after expressing your sympathy. Your brother knows that possibilities are out there, but he's enjoying letting everyone else feel bad for him more than he does making the effort. I have little patience for manipulation like that. (If the brother had written, I'd have this idea for a line to use in gay bars. You find someone who looks attractive and say "The bar scene isn't really my thing. Would you like a cup of coffee in cafe across the street?")

For the 2nd letter, I agree with Dan as well. I was thinking split shifts ARE the living together experience. So is arguing over dishes left in the sink and hair in the bathroom sink. Welcome to the real world.

But for DITD, Dan, good guy though he is and hard as he tries on the questions regarding women's orgasms, he always seems to miss the mark. How do you approach her with the idea of using sex toys? You don't! Instead, you go to her and say how grateful you are to her for being patient and supportive while you struggle with your mental and physical medical problems. You ask her if there's anything you can do for her, and you listen! Maybe all she wants is to be cuddled right now. Maybe she'd like to watch some porn with you. Maybe she's curious about you going down on her. Hell, I don't know, but she might have some ideas. Ask her.
More...
Posted by Crinoline on June 26, 2012 at 5:00 PM · Report this
GoodOmens 2
Letter 3 just seems like a whole host of problems. The gf obviously has hang ups. The bf doesn't sound like a real winner either.
Posted by GoodOmens on June 26, 2012 at 5:23 PM · Report this
evamoon 3
I wouldn't give up just yet on letter 3. I agree with #1. Toys are great - and kudos to him for considering them - but another way to take pressure off his dick is to rely on fingers, tongue, lips. Hard dicks are great, but they are often not quite as essential as men would like to believe they are.

BTW, Dan, I wrote a DTMFA song inspired by you and your legions of letter writers. You rock. http://evamoon.net/blog/2012/06/15/dtmfa…
Posted by evamoon http://evamoon.net on June 26, 2012 at 5:46 PM · Report this
4
#3, listen to Crin @1. Ask her, don't tell her. Maybe she has some ideas.

And I say we give the girlfriend a pass on not masturbating. People are allowed to be into and out of different things. Masturbating works for most people, but it's also often characterized as a way to get rid of sexual tension when we don't want it. It's not like partnered sex in a lot of ways. She didn't even reject it pre-emptively. She heard it was supposed to work, she tried, it did nothing for her. If she'd done the same for a sexual position--one to which her bf was completely neutral, just wanting her to enjoy herself--and it didn't do anything pleasant for her we'd say "Hey, there's a lot of other stuff you can do." Not "Get back in reverse cowgirl and work it! Work it! No sex life is complete if you cannot climax, or at least find intense sexual pleasure, from reverse cowgirl! Cow! Girl! Cow! Girl! Give me a C...!"

So like Crin advised, ask her what she wants. Finger? Tongue? Toys? Cuddling? If you're distracted and can't concentrate during sex, she's probably feeling rejected. Lots of cuddling and romance might come across a lot better than "Look honey, a penile replacement!" Or "Look honey, a penile replacement you can use without me even there! Like I've felt emotionally absent, now I can be physically absent." This might not go well. Ask first. You and Dan are both focused on the orgasm rather than the emotional closeness.
Posted by IPJ on June 26, 2012 at 5:56 PM · Report this
5
@3: Hard dicks are great, but they are often not quite as essential as men would like to believe they are.

------
I bet if we took a poll of the straight women in this thread--Should a shaky dick be replaced with a a) hard dick substitute; b) tongue--(a) would not win.
Posted by IPJ on June 26, 2012 at 6:00 PM · Report this
6
Sage advice again, Dan! Kudos!

@1 Crinoline & @4 IPJ: Good job! You both nailed it!

@5: I think you're right.
Posted by auntie grizelda on June 26, 2012 at 6:19 PM · Report this
7
Hm, a very young adult is depressed about something and shoots down all suggestions using some lame excuse? Not too rare. The question is what to do about it. My advice would be to leave the brother alone about it for a while and then pretend not to notice when feels better enough to head to gay bars. (As in pretend not to notice that he's doing what he was advised to do.)

Of course, it's also possible that the younger brother just really doesn't like bars. After all, all one really knows about bars is that the people there probably like to drink. If he's not into that, then bars are just waiting rooms where it's too loud to talk to anyone without shouting.
Posted by DRF on June 26, 2012 at 7:05 PM · Report this
mydriasis 8
@3

"Hard dicks are great, but they are often not quite as essential as men would like to believe they are."

Depends on the woman. It's extremely essential in my life. But I know I'm an anomaly among my gender.
Posted by mydriasis on June 26, 2012 at 7:17 PM · Report this
9
@3

I'm with 8 on this one; I'm totally a g-spot girl and a hard dick is my favorite way of stimulating that. I've never found a good substitute for the real thing.
Posted by magc on June 26, 2012 at 7:27 PM · Report this
10
ROTFL!! My husband frequently wakes up to a ripped fart and still finds it in his heart to reply with "Good morning, beautiful"... only SOMETIMES with a touch of sarcasm...
Posted by auntielarrie on June 26, 2012 at 7:51 PM · Report this
11
@2: Having issues and hangups is not a crime, and trying to get your gf off, even when you can't, is the sign of a hero. There need to be more men like that.

Not being into masturbating means one thing to me- not having tried a good vibrator. I, like the gf in #3, used to not be into masturbating (tried it, got nothing from it, etc), until my bf bought me a little bullet vibrator. I used it a few months after we broke up. Not only did it make me realize what I'd been missing, but I felt complete: didn't need someone else to control my orgasms. I've introduced a few girlfriends to vibes, I always start with little, not scary, silver bullets, and the most common response: I need more batteries!
Get your gf a silver bullet before you move to something cock-like. Ease her into vibes, there was (is it still there?) a nice $15 silver little vibe at babeland. It's the one I start all my friends out on. Eventually we all move on to bigger and better toys, but that is the one to start with.

Posted by lemonrose on June 26, 2012 at 8:27 PM · Report this
12
@5 - Not me! Hard dick substitute for the win!
Posted by sanguisuga on June 26, 2012 at 8:37 PM · Report this
Free Busch On Tuesday 13
Severe sleep apnea and elevated blood pressure?

Psst

Lose 40 lbs, fatty.
Posted by Free Busch On Tuesday on June 26, 2012 at 9:34 PM · Report this
14
I am sad for every woman who doesn't masturbate and who relies on others for orgasms. SAD. I have the BEST orgasms from masturbation. Also, I choose tongue over hard dick substitute any time. Huge fan of a hard dick... because it is a hard dick. A piece of plastic (or rubber or cucumber or whatever) is only as sexy as the one who wields it.
Posted by bodhirungus on June 26, 2012 at 9:41 PM · Report this
evamoon 15
Ain't diversity wonderful? I like a hard dick too, but when push comes to shove, call me clit girl. I vote tongue, but I'm happy for the dicksters.
Posted by evamoon http://evamoon.net on June 26, 2012 at 10:31 PM · Report this
16
I'm also delighted for the term "dicksters".
Posted by SpaceGirl on June 26, 2012 at 10:45 PM · Report this
Write or Wrong 17
She tried masturbating one time and gave up because she didn't come? I've never had an orgasm from masturbating, but I still do it because *it still feels good.*
Posted by Write or Wrong on June 26, 2012 at 10:46 PM · Report this
Corylea 18
LW #1, where is your brother? If he's in college, most universities have at least one -- and sometimes many -- gay organizations. These organizations usually have discussion groups or meetings or dances or some other events, so it's an alternative to the bar scene.

Does he live in or near a major city? Most major cities have a large number of gay groups, from gay bowling leagues to gay square dancers. Lots of people don't like bars, but there are many other places to meet gay people.

Tell him to do a google search on "gay yellow pages" for his area, and he'll find a lot of listings of places to go to meet people.
Posted by Corylea http://corylea.com/ on June 26, 2012 at 10:53 PM · Report this
nocutename 19
Sounds like a scrimmage: the Clitsters against the Dickstirs.
Posted by nocutename on June 26, 2012 at 10:54 PM · Report this
20
@5 Poll, Poll, Poll!
Posted by TheOtherWoman on June 26, 2012 at 11:08 PM · Report this
21
@4 The gf only tried masturbating once and gave up? One time? I agree with 14, that is kind of a shame. I think of masturbation as a basic life skill. Rejecting it would be one thing, but she hasn't mastered it yet to reject it. Agree that asking her what she wants and/or needs is good, but I'd also encourage the purchase of the bullet vibrator. No, not the same as intimacy, but release of physical/sexual tension is not to be discounted either. Both matter. Sounds like he is genuinely working to make things better for himself and their relationship. Hope she's willing to be patient and receptive to his efforts.
Posted by kait on June 26, 2012 at 11:09 PM · Report this
shurenka 22
For letter 3, I'd bet good money GF has never masturbated to orgasm that she hasn't come from sex either. For the love of god, buy her a vibrator. After she possibly gets mad over the gift, she'll hopefully be curious enough to try it.
Posted by shurenka on June 26, 2012 at 11:12 PM · Report this
23
There's nothing really wrong with the first answer, but I think Mr Savage, who is very much a Bar Person, might tend to assume that everybody else is too, or can be. There's nothing wrong with bars as a general suggestion, but this was a particular suggestion that might not have been a good fit to the suggestee (although Mr Savage's conclusion is perfectly plausible). Would it mean that he'd have to go alone into an atmposphere he wouldn't think congenial where he wouldn't meet the sort of people he'd be inclined to like? I never went to a bar until I'd been out a good deal longer than the subject of L1, and I've still never been to one alone, though I don't find them particularly uncongenial.

While getting out of the house is key, the suggestion of bars, though Mr Savage is probably right about wallowing, might have a One Size Fits All feeling or seem to imply that All Gays Drink Lots if one hasn't examined particulars. What's available? What's affordable? What sort of person does the brother like (at 21, if his tastes run younger and aren't that flexible, then bars aren't a likely winner, and note that the word "boy" was used)? What sort of social situation is likely to suit him best?

I'm also curious about whether the lack of boyfriend is the whole problem, or if it's just what the brother is presenting when really he could use friends and a more gay life in general. My suggestion for the LW would be to look into what might be a promising social option for the brother in particular, not just any crabby, generic Johnny-Come-Out-Lately. Pick one or two and, if at all palatable, offer to accompany him once or twice to help him get started. If he's a little maladroit, that might be - after he rejects the idea the first time but appreciates it later - worthwhile. Be prepared with a second head in case he bites one off, but leave the offer open if he changes his mind.

Again, this is just a 2 a.m. guess, as the letter, naturally enough, isn't comprehensive. I am getting a glimmer that perhaps the brothers aren't quite so close as the LW thinks, but that could just be the hour.
More...
Posted by vennominon on June 26, 2012 at 11:17 PM · Report this
sissoucat 24
@5 Tongue for the beginning, oh yes, much much more appreciated than any dick around.

But when the tongue has done its amazing job to multi-orgasmic results, then slowly arises the deep and strong need of the hard dick, and no amount of tongue can satisfy that urge, arrgh.
Posted by sissoucat on June 26, 2012 at 11:29 PM · Report this
sissoucat 25
@14 I'm unlucky in the masturbation area ; I can't have conscious orgasms that way - either the sexual tension reaches a plateau and then declines without orgasms, or I fall fast asleep and any orgasm happens in my dreams. Shame, right, since I then experiment them through a haze.

I've tried various techniques with the same disappointing end result. But I know I'm not alone in my case - other women fall asleep just like me. Masturbation doesn't work for every woman, folks.

I'm thinking of buying a vibrator, to have conscious orgasms by muself - what kind would posters recommand, who have the same tastes as me (tongue first, then deep hard dick) ?
Posted by sissoucat on June 26, 2012 at 11:44 PM · Report this
26
Oh heavens, SAFF. Suggest that your brother visit the Society for Creative Anachronism. Suggest that he visit an origami convention. Suggest that he visit Burning Man, or the Oregon County Fair. Suggest that he visit a Dresden Dolls concert, or a science fiction convention, or a community theater, or San Francisco. No offense to anyone, but there are lots and lots of gay people in the world who don't go to the bars. And so they go to *other places*.

If your brother has any interests at all, he can find gay guys who share those interests. (There's a meetup group here in NYC for GLBT folks who like to discuss Hegel!) He might even make some gay friends along the way, who may not be dating material for him for whatever reason but who can and will help him find dates.

I don't blame you for suggesting the bars, and I don't blame him for not wanting to hit the bars, and neither will the gazillions of gay guys who feel the same way.
Posted by mouseandclown on June 27, 2012 at 12:04 AM · Report this
27
@20 TheOtherWoman, and @24 & @25 sissoucat: My vote goes for tongue
first (I need it in the beginning, too)!
Posted by auntie grizelda on June 27, 2012 at 12:09 AM · Report this
28
@14 I am sad for every woman who doesn't have a 400 pound man sitting on her as two midgets take turns pleasuring her. SAD. *I* have the BEST orgasms from having a 400 pound man sitting on me as two midgets take turns pleasuring me.

Did you see that? That's how ridiculous you read to women who, like me, simply don't orgasm from masturbation. Human contact FTW.
Posted by mynameisvagina on June 27, 2012 at 12:50 AM · Report this
29
SAFFS brother needs to focus on meeting people in general. He will improve his chances of meeting someone he could form a connection with, he will make more friends who, as @26 said, can help him find dates, and he may be scaring off potential partners by being so focused on a relationship that he is not giving himself or them time to figure out whether they even like each other, let alone want to have a relationship.Plus, everything Mr. Vennominon said @23.
Posted by tachycardia on June 27, 2012 at 12:59 AM · Report this
30
@8 Mydriasis, I have been reading this column for awhile, and I don't think you are an anomaly. I will let a guy do oral on me if he really wants to, for the same reason I like foot rubs and flannel nightgowns:they feel good, but don't do a damn thing for me sexually. Hard dick is pretty essential to me too.
Posted by tachycardia on June 27, 2012 at 1:07 AM · Report this
31
@5 can't we have both? the first time my BF went down on me and used a vibe at the same time I damn near fainted!
Posted by UK girlie on June 27, 2012 at 2:43 AM · Report this
32
Agreed with 22. A woman who isn't tapped into her own pleasure enough to get herself off won't know how to get there during sex either, no matter how skilled her partner. The women I've known who were too hung up to masturbate didn't really know what a full-fledged orgasm felt like until they learned to, or got themselves a good vibe. Her taking some of the responsibility for her own pleasure also takes the pressure off DITD, too. All the focus on PIV sex puts way too much emphasis on his performance only, so all you end up with is a "headfuck."
Posted by M1A on June 27, 2012 at 2:44 AM · Report this
33
@13: Fat people are allowed to have a sex life too you know. The guys mentions that he is taking care of his issues, that might also involve working out.

I hate it when sex life seems reserved for a perticular size, age, gender, etc.
Posted by The monogamish on June 27, 2012 at 2:45 AM · Report this
34
Agreed with 22. A woman who isn't tapped into her own pleasure enough to get herself off won't know how to get there during sex either, no matter how skilled her partner. The women I've known who were too hung up to masturbate didn't really know what a full-fledged orgasm felt like until they learned to, or got themselves a good vibe. Her taking some of the responsibility for her own pleasure also takes the pressure off DITD, too. All the focus on PIV sex puts way too much emphasis on only his performance, so of course all they end up with is a "headfuck."
Posted by M1A on June 27, 2012 at 2:47 AM · Report this
35
@5:
Neither nor for me.
I'd prefer him to hug me, rub my ass, touch my boobs, etc while I masturbated.

Intimacy plus orgasm.
Posted by migrationist on June 27, 2012 at 4:14 AM · Report this
MythicFox 36
I really like @1's suggestion of the "Cup of coffee across the street" line for people who resort to gay bars but aren't 'into' them. Just sayin'.
Posted by MythicFox on June 27, 2012 at 4:32 AM · Report this
37
LW 3 should say he doesn't mind at all if she comes or not, he just wants to explore different ways of giving her more fun and pleasure. And for a while, try lots of things that don't involve dicks at all - unless or until she begs...

But keep at it for ages if it's going well - my first orgasm took hours to arrive and the poor guy ended up with a very sore arm and tongue (as well as a big smile all over his face).

Posted by misspiggy on June 27, 2012 at 6:22 AM · Report this
38
If you're not into bars, there are still many other options, depending on where SAFF's brother lives: gay biking clubs, hiking clubs, gaming clubs, etc. etc.

As for not finding a connection right away, welcome to the club. I dated until I was almost 30 before meeting "the one"

Another thing that Dan didn't mention is DON'T COME ACROSS AS DESPERATE. To me, and I'm sure to others, there's nothing that's a bigger turnoff than someone who seems clingy and desperate to be in a relationship with me. I'm not saying to be an aloof a-hole. If you find someone intersting, by all means show them interest, just don't smother them or they'll view you as a controlling, smothering person and leave.
Posted by sfguy on June 27, 2012 at 6:54 AM · Report this
39
"A woman who doesn't masturbate-- because she tried it once and it didn't work-- has hang-ups."

No! No! and no! A woman who doesn't masturbate and complains like crazy and blames her boyfriend has hang-ups. A woman who doesn't masturbate and is content either in the short term while her boyfriend gets treatment for sleep apnea, high blood pressure, and anxiety or over the long term because that's who she is is fine, a gem, someone to treasured for her understanding and self-knowledge.

Look at how fast this turned out to be about her. A guy writes in about his limp dick and self-contributing medical troubles. (Somewhere out there there's thin man who exercises, eats right, keeps his weight under control, and still has sleep apnea and high blood pressure, but the chances are in favor of this being a guy who has let himself go.) (Come to think of it, the odds are in favor of this being a guy who smokes.) He's the one who's distracted, worried, and has pre-mature ejaculation, but she's the one with the "hang-ups."

I'm supposed to feel sympathy for this guy because he so considerately offered his girlfriend sex toys? It sounds more like he's pressuring her to do something she doesn't want because it will feed his ego and assuage his guilt. The motivation isn't concern for her. This is about him.

I've probably mentioned in this column a boyfriend from 30 years ago. His pre-mature ejaculation was extreme, but he didn't acknowledge it, looked baffled when I brought it up (admittedly I wasn't as direct as I might have been), and yet he was all soft concern about my lack of orgasms. He even asked about my orgasms after we'd broken up. After all this time (and I'm still friends with the guy), I can get angry (both at him and at my youthful stupidity).

I guess this is a sore spot with me. I acknowledge that a woman has to be responsible for her own orgasms, but that doesn't mean man gets to demand that she have them for his sake.
More...
Posted by Crinoline on June 27, 2012 at 6:57 AM · Report this
40
WTF is offensive about suggesting going to gay bars?? I didn't understand that at all!
Posted by wayne on June 27, 2012 at 7:03 AM · Report this
41
@39:
"I acknowledge that a woman has to be responsible for her own orgasms, but that doesn't mean man gets to demand that she have them for his sake."

Very well put!

Or maybe even: "...that means man doesn't get to demand that she have them for his sake."
Posted by migrationist on June 27, 2012 at 7:05 AM · Report this
GymGoth 42
Commenters seem too keen on dismissing bars as a good suggestion for meeting people. Unfortunately even in gay "meccas" bars tend to be the place to meet people. But then they can lead to friendships and other non-bar activities.

A better question would be what kind of bar scenes does the brother find appealing? There are dance bars, video bars, sports bars, country-western bars, and leather bars. Some are bars/restaurants. Some offer activities beyond drinking like darts, pool, or air hockey.

I've been out for over 20 years and still find bars a more natural place to meet than online. Online seems to attract either (1) sex pigs who want to hook up immediately for sex or (2) socially awkward misfits who are unable to carry on a decent conversation in person. I'm sure you can meet a few there but it seems a lot harder and a big waste of time.

Posted by GymGoth on June 27, 2012 at 7:42 AM · Report this
43
You don't have to be overweight to have sleep apnea, though it is the most common reason. My husband is 6'4" and not overweight at all. When I met him he snored horribly to the point it was scary. He said it ran in the family. I insisted he go to a doctor who diagnosed sleep apnea. Further medical investigation resulted in extensive surgery to restructure the back of his throat, nose, etc. which has helped almost eradicate the sleep apnea.

Also, if you have sleep apnea, it can lead to high blood pressure.
Posted by Bugnroolet on June 27, 2012 at 8:01 AM · Report this
44
Wait, I'm confused....Waking up to partner ripping off a good fart is a bad thing?
Posted by gonzo on June 27, 2012 at 8:02 AM · Report this
45
I second @26's recommendation. There's a group out there for everyone. Take a look at Meetup.com, it's a treasure trove of groups for just about everything under the sun. I belong to a sports meetup and we have several couples who've met there. Some have married, some are living together, some are dating and some didn't make it. We're a group of people who get together to watch hockey and, *surprise*, with the common interest to start things off, some people found romantic relationships.
Posted by moosefan on June 27, 2012 at 8:07 AM · Report this
mydriasis 46
@ 30

Haha, my lord. I feel the exact same way.
I also used to use tachycardia as my SN for quite a while before I settled on mydriasis.
I guess what I'm saying is: I think you're alternate universe me.

@ Gymgoth et all re: Bars

I agree that online is absolute piss when it comes to looking for anyone of value. Which isn't to say that there's 'no one' good online, but they are vastly drowned out by a lot of creepy and painfully awkward types.

But I am not a drinker and loathe 99% of bars.

I'm a big believer in networking. Everyone good I've been with, I've met through friends or even been reccomended. I also do the same for the people I know - I've definitely set up my friends before. I think that's really the best way to go.
Posted by mydriasis on June 27, 2012 at 8:09 AM · Report this
47
Hey, us painfully awkward people need love too...
Posted by Melissa Trible on June 27, 2012 at 8:30 AM · Report this
48
Maybe the brother's aversion to gay bars is based on experience. In my part of the country (New England) it is very difficult to actually meet people in gay bars. People go in cliques and loners are ignored. People who go alone are made to feel they have committed a crime against good taste.
Posted by cockyballsup on June 27, 2012 at 8:52 AM · Report this
49
@48, who said he had to go alone? It sounds like everyone is very accepting of his orientation - his brother is suggesting the bars, after all. Maybe he should ask people to come along. I have a straight friend who goes to gay bars with his friends semi-regularly. Because, ya know, they're his friends and sometimes they go places he wants to go. He even plays wingman for his friends from time to time.

This goes for any other group or activity he might want to try out. If he's not comfortable going by himself at first, or thinks going in a group will be more acceptable for any reason, he should ask his brother or some friends to tag along.

I don't think any of this will necessarily help. When people blow off well-meaning suggestions (and/or accuse people of being insensitive for their well-meaning suggestions) they're wallowing not truly seeking solutions.
Posted by moosefan on June 27, 2012 at 9:08 AM · Report this
50
I was in #3's situation for a long time. Extreme premature coming with my wife, every time. I did all the things people suggest, including the "stop and go" method I've seen Dan suggest here. My marriage broke up, I got depressed. I was prescribed citalopram, an antidepressant with a side effect of "delayed orgasms." I don't know if it's a placebo effect, the effect of being in a hot new relationship, and/or the side effect of the drug, but now I last forever and when I do come, my orgasms are explosively awesome. It's definitely helping me feel a lot better about myself, and my gorgeous girlfriend sure has no complaints. I'm interested to see what happens when I stop using the citalopram--does the problem come back, or have I trained myself physically so that it doesn't return? Hmmmm...
Posted by turtlemilk on June 27, 2012 at 9:10 AM · Report this
51
@13,39,43 Some research indicates that the sleep apnea contributes to weight gain.

For those who don't know, sleep apnea is a condition where breathing stops for more than 10 seconds during sleep. A host of problems are related, including fatigue, high blood pressure, depression, and a whole host of mental issues do to the difficulty of getting REM sleep.
Posted by I'm a chiropractor! I will use my skills negatively! on June 27, 2012 at 9:32 AM · Report this
52
@49, with or without friends, they still won't speak to someone they don't know. People here tend to go online to meet new people; bars don't have that function any more. If you are the kind of aggressive person who will barge into the middle of a clique of strangers, then maybe bars here will work for you. Otherwise not so much.
Posted by cockyballsup on June 27, 2012 at 9:44 AM · Report this
53
Anyone else think DIDT's GF has probably never had an orgasm ever? DIDT seems to be very concerned about the duration and hardness of his erection for sex. Very few women get orgasms due to simple penis-in-vag back and forth....and women who are too repressed or disinterested to maturbate or use toys seem hardly likely to be easily orgasmic. If he's doing more than PIV stimulation, his erection wouldn't matter so much. It's possible she's always faked it and is embarrassed to admit it. In which case, buying some toys and expanding the sexual repertoire would be good for more reasons than one!
Posted by strange observer on June 27, 2012 at 9:45 AM · Report this
54
For the gay little brother: maybe join a marriage equality activist group? "Doing good" can be helpful in alleviating depression, and certainly the odds of meeting other gay men would seem high...
Posted by Maryse42 on June 27, 2012 at 9:48 AM · Report this
Eva Hopkins 55
Dan's pretty much got the first LW covered & everyone else's input should help. Going to Pride events is not a bad place to meet people, & 'tis the season.

LW #2, TNS: try to learn to like your opposing schedules. Unless you live in a mansion with his & her wings, it's been my experience that working different shifts is not a bad thing, always. We as a culture tend to emphasize togetherness within a couple to the point where there's not much time left for us as individuals. If your live-in situation comes with a little time to read a book or work out or whatever on your own, might keep things fresh & interesting, rather than be a detriment.

Posted by Eva Hopkins http://www.lunamusestudios.com on June 27, 2012 at 9:49 AM · Report this
Eva Hopkins 56
DITD/LW #3! Glad he's taking care of his health issues (you can do it, if you're reading, DITDS, if yer readin' this far) - but a caveat to the vibe idea. Whatever "looks like fun" to a straight, first-time vibe buyer man, might not, in fact, be a good first vibrator for a woman. ;) When I first went looking at "adult toys", I thought the Silver Bullet looked like fun, & it was okay, but the toys that do the job best - for me - haven't been the flashiest. & if someone had tried to start me w/ a Hitachi Wand straight off the bat, it woulda been too much for me (very sensitive). A friend once bought me a vibe that was scary & jelly & red & useless. What toys would the women who use toys recommend to DITD, should he happen to be reading..?

I'd like to put in a good word for the Lelo Nea - (& a few of the Lelos are pretty awesome) http://en.lelo.com/index.php?collectionN…

& also the JimmyJane form 2 (ditto for their overall line, mostly good) - http://www.jimmyjane.com/form2/

& if yer local to Seattle, the folks @ Toys in Babeland are super helpful.

http://www.babeland.com/

Posted by Eva Hopkins http://www.lunamusestudios.com on June 27, 2012 at 9:52 AM · Report this
57
@39 Exactly. If she isn't complaining like crazy, then her preferences could be respected. One could even enquire about them, rather than react to his problems by attempting to fix her.

Thanks to Sissou for the example of someone who has orgasms in other ways but not masturbation. And re the person somewhere upthread who doesn't climax but masturbates because *it feels good*: I'm interpolating here but the evidence is it didn't feel good for her.

One of the great things about SL is discovering that the way arousal and such work for you personally aren't the way they work for the whole world.
Posted by IPJ on June 27, 2012 at 10:01 AM · Report this
58
@56 I second you. I'd get her something really simple to start, and not expensive, so there's no pressure to "have" to like it. JimmyJane's iconic smoothie is the kind of vibrator I started with. It's only $16.

And while we're talking JimmyJane vibrators, we just got the Form 3 and I am having every-time hands-free orgasms during penetration for the first time in my life. You can fit it between your bodies quite easily. I'd just like to take a moment to applaud the very good people at JimmyJane who made this possible. I never thought I'd have this experience. Testimonial over.
Posted by sfgurl on June 27, 2012 at 10:22 AM · Report this
59
I don't know if this matters, but comparing numbers of gay people to numbers of Jewish people doesn't quite work out correctly. Jews can, and often do, date and marry outside of our faith. LW1's brother doesn't have the equivalent (dating women) as a reasonable option.

I actually met the woman who I would eventually marry in Israel, so maybe that's an argument for going places where the odds are in your favor.

But right now, LW1's bro is in a bad place mentally. In opposite-sex dating, this makes finding a mate nearly impossible. I suspect that the same is true with same-sex dating.
Posted by lorcha on June 27, 2012 at 10:28 AM · Report this
Auragasm 60
#33 speaks the truth. We're so fat-shamed as a nation that we go out of our way to mock "ugly" folks who are just as entitled to intimacy as pretty people. Blame it on mainstream porn and a TV/film industry that shields us from (ahem) warts-and-all sex. People are literally terrified of a little cellulite. We're all going to be old, wrinkly, and irrelevant one day and I hope we're all lucky enough to still have orgasms then.

I was one of those girls who ran to the erotic boutique on my 18th bday to get a vibe; a sort of rite of passage like getting wasted on your 21st. I think more girls should do that for themselves.

I agree with #7's bar/noisy waiting room analogy. SAFF's bro can find love on-line. Just needs to avoid perverts with horrble spelling and he'll have fun.
Posted by Auragasm on June 27, 2012 at 10:29 AM · Report this
mydriasis 61
@59

Except for some people, dating outside their faith isn't a reasonable option. So for those individuals, it is an apt comparison. Which is the one he was making.

Technically there is conversion (and gender reassignment!) but those are both pretty damn hard.
Posted by mydriasis on June 27, 2012 at 10:53 AM · Report this
Auragasm 62
Preach #33! Fat-shaming never works and "ugly" and chubby people are every bit as entitled to intimacy as the rest. I blame it on mainstream porn and TV/film industry that shields us from *ahem* warts-and-all sex. I personally hope to be having orgasms into my wrinkly ol' 70, health permitting.

I was one of those girls who ran to the erotic boutique on my 18th bday to get a nice vibe; a sort of rite of passage like getting wasted on your 21st. I think more girls should do that for themselves.

I'm with #7's bar/noisy waiting room analogy (I like to dance, but I've never met a winner at the bar). SAFF's bro can absolutely find love online. Just needs to avoid perverts and horrible spellers.
Posted by Auragasm on June 27, 2012 at 10:55 AM · Report this
mydriasis 63
@60

Okay this is something else that's been bothering me for a while.

Do you have to be 18 to buy a vibrator in the states??
Posted by mydriasis on June 27, 2012 at 10:55 AM · Report this
Fortunate 64
@59 suggested what I was thinking. Younger brother is right. The numbers do make it harder for gay people. The solution is that if there aren't enough gay people to make finding someone where you are feasible, move.

If he is living in some Podunk town in the Midwest where the few gay people aren't likely to be out then he probably isn't' exaggerating. And bars in places like that really aren't good options.

If you don't have a good pool to choose from then move to where there is one.

If that isn't the case then I agree with Dan that he should still try the bars, but there are other options. As others mentioned, get involved with some group that is either gay oriented, or that would appeal to gay people.

The other is to make friends with open minded, gay friendly people (or gay people you aren't necessarily interested in dating) and meet their friends. I found that the best way to meet potential dates was to meet them through mutual friends.

I had a fling with this guy in my 20's. It didn't last long, but I actually found I liked his gay brother, but just as a friend. His brother introduced me to one of his friends who was involved in a gay organization that was putting on a benefit. When this friend found out I was a musician he asked if I would play at the benefit. I agreed, and that was where I first saw the guy who eventually became my spouse.

You never know what path is going to lead you to meeting someone. Don't turn your nose up at any opportunity, and if necessary create opportunities. But you have to put yourself out there, take chances, meet people, and go on a lot of dates with a lot of guys before you might meet someone you click with. It's a numbers game so stack the numbers in your favor as much as possible.
More...
Posted by Fortunate on June 27, 2012 at 10:55 AM · Report this
65
SAFF, first, how about just letting your brother piss and moan a little?

Second, if he just came out to you at age 20, you weren't that close.

Finally, unlike Jews, a lot of gay people aren't out or are only partially out in their early twenties, so his dating pool will get bigger as he gets older.

Posted by cgd on June 27, 2012 at 11:39 AM · Report this
66
From what I can tell, the entire Jewish subculture is set up in a major way to facilitate Jews finding other Jews to date and marry. Your whole extended family, their friends, their friends' friends, will help set you up. The same cannot be said for gay bachelors.
Posted by cockyballsup on June 27, 2012 at 11:53 AM · Report this
mydriasis 67
@66 Cocky

Yeah, I guess if you're into that.

Not everyone loves the whole parents playing matchmaker "Well I was just talking to your Aunt Julie and her friend's son is a nice boy around your age! He's Jewish you know, you should date him." thing.

I definitely play matchmaker for my gay and lesbain friends also. Especially because my friends tend to be more introverted types who don't hang out in the LGBT 'hood and don't go to pride and don't wear their sexuality one their sleeves at all time. So I know it's not as easy for them to meet suitable people. I don't know about you, but I've had much better success with my friends setting me up and I'd definitely prefer it.
Posted by mydriasis on June 27, 2012 at 12:38 PM · Report this
68
@5: My wife disagrees.

But then, when I go down on her, she can come, like, 100 times. So other women's mileage may vary.

She's not so keen on dick substitutes however. Fingers are fine, but cold, not-so-human-feeling dildoes aren't as good as a proper rug-munching. Not that she's against using toys or anything, but still. Your assertion is wrong. :)
Posted by gromm on June 27, 2012 at 12:57 PM · Report this
mydriasis 69
@68

You misread what he said. He said "a would not win"

In other words, your wife DOES agree. :)
Posted by mydriasis on June 27, 2012 at 12:59 PM · Report this
70
mydriasis: laws on sex toys are state-by-state. In Texas and Georgia (the only ones where I've tried), you can't buy sex toys through the mail no matter HOW old you are! My partner and I once taught a sex-ed class for teens (over the course of a school year), and wanted to give the girls vibrators as graduation presents -- till we discovered we could be jailed for doing so.
On the other hand, no one can stop you from purchasing a "massager"(the box has a picture of a lady using it on her face) from your local Walgreen's. That did the job for my teenaged self. And Walgreen's has partnered with PFLAG in it's "Care with Pride" campaign, so it's a win-win!
Posted by danfan on June 27, 2012 at 1:35 PM · Report this
71
@mydriasis, will you be my friend? :) I always wonder how this kind of networking functions. My friends, straight and gay, have always been useless at introducing me to prospective dates. In fact, it has not even happened once in the past twenty years.
Posted by cockyballsup on June 27, 2012 at 2:28 PM · Report this
72
I don't really understand how people can be in a relationship and having sex and not *talk* about their sex lives. Or why it is that if one partner doesn't want to or can't have intercourse, most people think that there can be no sex for that couple. For most women, a hard dick is not all that necessary for sexual fulfillment.

My boyfriend has a bunch of medical issues, so intercourse is pretty painful for him (hip and back issues). I can happily say that even though we have not had PIV sex in about 2 years, I am very sexually fulfilled - the man is very gifted and enthusiastic with his fingers and tongue. And that is more than enough for me... :)
Posted by curiousgirl_04 on June 27, 2012 at 2:57 PM · Report this
73
I don't really understand how people can be in a relationship and having sex and not *talk* about their sex lives. Or why it is that if one partner doesn't want to or can't have intercourse, most people think that there can be no sex for that couple. For most women, a hard dick is not all that necessary for sexual fulfillment.

My boyfriend has a bunch of medical issues, so intercourse is pretty painful for him (hip and back issues). I can happily say that even though we have not had PIV sex in about 2 years, I am very sexually fulfilled - the man is very gifted and enthusiastic with his fingers and tongue. And that is more than enough for me... :)
Posted by curiousgirl_04 on June 27, 2012 at 3:00 PM · Report this
74
For LW #2, who is moving in with the girlfriend and they will be on different shifts, I do have a piece of advice.

Whenever you are able to spend time together, you should really try to do that.

I was in grad school and was teaching at the same time that my husband was working the night shift at a factory. We were hardly home at the same time and even when we were, we didn't spend time together. He spent his on the computer and I was either reading or doing other things. We didn't make an effort to really be together when we were home together and that seriously affected our relationship. By the end, I felt we were just roommates. We had other issues to be sure, but not spending time together didn't help at all.

Even if it means you have to find ways to have fun together while doing regular chores such as dishes, laundry, etc., whenever you are able to spend time together, make it count. Otherwise, your different schedules might take a toll on your relationship.
Posted by SherBee on June 27, 2012 at 3:23 PM · Report this
75
I bet it will take less than three months for #2 to realize that not being with his partner 24/7 is a pro, not a con.
Posted by mubhappy on June 27, 2012 at 4:18 PM · Report this
76
A data point for non-bar venues: I've been going to my local Queer Tango. I'd recommend this practice to anyone who's open to learning the skill and wants to get next to a lot of gay folk.

I think I'm the only straight cisgendered person there, and I hope I'm not annoying them too much, but it's the best tango in town. Not to mention the only one where you can learn to both lead and follow without a lot of horseshit, and where a girl can get dances even if she's not in a miniskirt and 4" spike heels.
Posted by Moggadeet on June 27, 2012 at 4:38 PM · Report this
77
Ms Driasis - I seem to be getting a sense that you disapprove of "wearing one's sexuality on one's sleeve" and, just out of curiosity, wonder why (or, possibly more informatively, what constitutes your idea of that term). That your LGBT friends tend to be assimilated introverts was very interesting to learn, but quite makes sense when one thinks about it.

I had reasonable success making matches myself for a time, but gave it up as I began to incline to the idea that there are more than enough matches as it is without personally adding to the numbers - a vague variation on the theme of why Rumpole didn't prosecute.
Posted by vennominon on June 27, 2012 at 6:40 PM · Report this
JunieGirl 78
You are so gay, Dan. Ripping farts off while in bed with your partner is a total guy move! (Not saying I don't get gassy, I just take it in another room.)

I'm with Caroline Rhea on this one: if I accidentally farted while I was in bed with a guy I would pretend I had died until he finally gave up and left.

There are probably folks who will disagree with me, but most of the girls I know find that kind of mortifying.
Posted by JunieGirl on June 27, 2012 at 6:55 PM · Report this
79
As to the younger brother in the first letter, I'd suggest repurposing an old "Ann Landers" suggestion(possibly typed on the Ann Landers typewriter Dan bought at that auction)and suggesting that that kid start going to church...specifically, a LGBT-friendly church(the MCC if they have a congregation in his area, the Congregationalists or some other progressive mainstream denomination if not)where he could meet men who aren't part of the bar scene...probably guys who'd be far better for a younger, less-experienced gay man to get involved with, or at least to hang out with).

Posted by AlaskanbutnotSeanParnell on June 27, 2012 at 7:08 PM · Report this
80
@ SAFF (straight brother of the gay sulker), take your brother out to the gay(friendly)bars already, as soon as he is there to have a drink and a laugh with his cool supportive straight brother instead to cruising the sidewalk sale on his own he becomes a milion times more intresting to exactly the kind of guys he is looking for. learning to be a social relaxed person with a big social circle having a good time instead of a desperate hovering solo cruiser does wonder for getting to know potential relationship material
Posted by dutchie on June 27, 2012 at 7:09 PM · Report this
mydriasis 81
@77

I seem to be getting a sense that you disapprove of "wearing one's sexuality on one's sleeve"

No, I don't.

I just find that it tends to correlate with extroversion and my close friends tend to be introverts (gay and straight).

In my wider social circle there's a mix of both introverts and extroverts (gay and straight). In terms of what I meant by "wearing on sleeve" that was a somewhat misleading choice of words. I meant more that they don't present as the TV stereotype of gay. It was more an indictment of straight people who think that all gay men like to wear body glitter and break out into show tunes (yes, I have friends like that too!) than an indictment of gay men who do act that way.

Does that make it clearer?
Posted by mydriasis on June 27, 2012 at 7:10 PM · Report this
82
n.b. its what i did for my lezzy sis and several of my gay friends and even while they often ended up finding their LTR all on their own i take pride in me contributing some in cracking their shells..
Posted by dutchie on June 27, 2012 at 7:12 PM · Report this
83
@46, I sort of copied you...I picked a ten dollar word for sign of sexual arousal, as well as an early symptom of poisoning. Mydriasis is better, IMO, because it is more obscure and could also denote wide eyed wonder/innocence, but it was taken:) Judging from some comments in previous threads, I don't think very many people know what mydriasis is.
Re:sex toys, I live in Georgia and Florida,(going to college, complicated situation) and in my experience the small towns have better sex shops than some of the big cities. Although you do have to be 21...as a previous poster said, laws vary by state, and some sex laws can vary by county within the same state.
Posted by tachycardia on June 27, 2012 at 7:20 PM · Report this
84
@13: The letter writer did not mention his size. He could be skinny as a rail for all we know. Not all thin people are healthy, and not all fat people are sickly.
Posted by Ashley Amber on June 27, 2012 at 7:24 PM · Report this
85
Also, it might be more effective if the straight older brother were to stop trying to make suggestions himself and find, perhaps, a gay man who'd be willing to, in a sense, mentor his kid brother in the ways of finding connection within that community.

Most of us straights aren't born knowing how to get someone to fall in love with us. We often get advice from someone else who is straight about where we might find others who are interested in some sort of involvement. The same would naturally apply to LGBT people-and they would, I'm guessing, be far more open to suggestions from others who are actually "in the life", rather than a well-meaning breeder sibling.
Posted by AlaskanbutnotSeanParnell on June 27, 2012 at 7:24 PM · Report this
86
The best years of my marriage were the ones in which I worked days and he worked 3rd shift. There is such a thing as too much togetherness.

I love sex toys. I have a separate small dresser exclusively for sex toy storage. I have a power strip next to the bed for charging the rechargeables and recharging batteries, and powering the big boys that run on 120V. Dildos needn't be cold, I have a nifty big guy that warms to match and hold body temperature. I nearly cheered out loud for DITD, the only negative in his letter is that he's waited until he needs a little extra help to bring sex toys into the mix. The lovely Tristan wrote a Big Book of Sex Toys, very informative. Now I need to research Texas' restrictions on sex toys by mail. We're considering another move, but I have monthly deliveries from the kitten. This could be a problem.
Posted by catballou on June 27, 2012 at 7:34 PM · Report this
87
I love Clitster and Dickster ! Can we turn this into a thing ?
Posted by SC1978 on June 27, 2012 at 10:45 PM · Report this
88
#87 it could involve puppets.

(Then again, "I'm Clitster, He's Dickster" sounds like the name of a short-lived 60's sitcom starrying Marty Ingels.)
Posted by AlaskanbutnotSeanParnell on June 27, 2012 at 10:58 PM · Report this
89
DIDT says: "I've been with my girlfriend for almost two years. I love her, but in the last year, sex has been an issue. I feel attracted to her, but I find myself easily distracted these days, kind of worried during sex..."

So, extrapolating from that, the first year of sex was good? And, what exactly is on this dude's mind that is distracting and causing him worry? From the way this letter is framed, something other than performance anxiety is causing this dude to perform less than satisfactorily in the sack, which then of course leads to the performance anxiety.

Honestly, (and I absolutely want to be clear that I realize I do not know DIDT and do not hold any kind of psych degree), it sounds like an anxiety issue altogether, and not a performance-specific one. Is the sex getting too routine? Is that why your mind wanders? Is there something about the girl/relationship that's bugging you once you are under the sheets? What's the source of the distraction?

If the sex is routine at this point and you are both pretty much going through the motions, then perhaps you should try to introduce toys. But you have to talk about the toys being share toys, not some agent for you to get your gf off in order to reduce your own anxiety. Odds are that you'll have more fun experimenting this way, and your sexual anxiety will decrease.

Hm. Seems I started talking directly to DIDT in the middle there somewhere. Apologies for the sloppy writing.
Posted by radcake on June 28, 2012 at 12:04 AM · Report this
90
50-turtlemilk-- Thanks for that post. I'd never heard of lasting longer being a side effect of an antidepressant. (The things I learn here on Savage Love.) It will be exciting in the coming years as researchers discover more about the brain and sexuality and how that relates desire and performance.
Posted by Crinoline on June 28, 2012 at 2:38 AM · Report this
mydriasis 91
@90

The sexual side effects of SSRIs are typically considered negative. For the average person, it means "difficulty reaching orgasm" and "low sex drive". To my knowledge, it's only for premature ejaculators (and people who need to squelch their desire for whatever reason) that these are considered desirable.

If you're curious to know - sexual functioning requires the concerted action of the sympathetic and parasympathetic nervous systems. The mneumonic they teach you is Point and Shoot. So the parasympathetic facilitates an erection while the sympathetic allows ejaculation. Because the sympaethic tends to "oppose" the parasympathetic, high stress/anxiety (which will overactivate the sympathetic nervous system) can give two kinds of results - either the inability to acheive erection or premature ejaculation. SSRIs interfere with this balance by (if I'm remembering right) lowering the release of norepinepherine. Norepinepherine is used by the sympaethetic nervous system.

Or to roughly translate - taking SSRIs (or SSNRIs which are used more commonly now) will blunt the sympathetic response, leading to more difficulty with the 'shoot' part. I think the sympathetic system also plays a role in initial arousal before the parasympathetic gets in there, but I forget exactly how, off the top of my head.
Posted by mydriasis on June 28, 2012 at 6:18 AM · Report this
92
As a woman attracted to women, and a submissive besides, I totally understand SAFF's brother's point of view. I mean, I'm already limited to looking for women, but to further limit things by trying to find a Domme on top of that, it's almost maddening. But, I'm still looking! And that's the point. If SAFF's brother gives up, he will *definitely* not find what he's looking for. So, even though it's discouraging, he just has to keep going.
Posted by DarthKelly on June 28, 2012 at 6:32 AM · Report this
mydriasis 93
@ cocky

Totally! How do you feel about Canada? :p

I think being able to set people up requires knowing lots of people, the ability to understand what people like and (most importantly, it seems) the guts to say "hey so I know someone you might like".

A lot of people are really adverse to doing that for some reason. Yet I find most people react pretty positively and are at least curious. Now that most people are on facebook it's easy to give both people a little look so it's not like the 'blind dates' of yore.

If you're not too shy I'd suggest asking your friends if they know anyone you might like - it's possible they just never thought of it before. Not everyone's on the lookout, or they might think you wouldn't appreciate being set up. My longest relationship started with me saying to a friend 'hey do you know any guys I might like?'.
Posted by mydriasis on June 28, 2012 at 8:01 AM · Report this
94
@Juniegirl, farting in bed is not a guy thing. I am a gay guy, and I have actually dumped someone in the past for gratuitously farting in bed. I just couldn't look at him in a sexual way any more after that.
Posted by cockyballsup on June 28, 2012 at 8:20 AM · Report this
95
91- Thanks. I find the subject interesting. How would something like this fit in?

I've had bondage and humiliation fantasies since I can remember. I've never had a desire to act them out. I'm actively disgusted and turned off when I hear about real rape, but I like the fantasies. They help me come. A doctor prescribed prozac for me once. It was to help with pain since depressed patients report that it helps lessen pain. She made it clear that she did not think I was crazy. I was not feeling depressed. I just wanted something for 3 day pain episodes. The rest of the time I felt fine. I can't take other pain killers for a variety of reasons.

I'd never heard of "sexual side effects" when I started on the prozac. As soon as the medicine kicked in, I noticed a lessening of desire. That didn't bother me at first since my desire has always waxed and waned with my cycle. But then I noticed that I'd stopped fantasizing. So, after a number of weeks without feeling a desire for sex, I tried masturbating without the fantasies. I couldn't come and really didn't want to. It just seemed like a bother.

And this is why I want to hear whatever you have to say on the subject. I have some rudimentary understanding of how blood and hormones affect sexuality and orgasms. I don't know how brain chemistry fits in. Why would extra serotonin depress sexual thoughts?

(Prozac didn't help with the pain. Orgasms always had. I got off the medicine. I'd take heroin for pain before I tried that again.)
Posted by Crinoline on June 28, 2012 at 8:24 AM · Report this
nocutename 96
@95 (Crinoline): I've been struggling with mild to moderate depression (which is situational in origin) for the past several years, and I've been really disturbed how many times doctors will suggest or want to prescribe an SSRI in the Prozac family. I always ask, "is there a risk that it will inhibit my libido?" And when they say yes, I decline. Wellbutrin is an anti-depressant that doesn't have the libido-squelching effect but it doesn't treat anxiety, just straight-up depression, so it can be a choice for some people.

I would think that a lowered libido (if the one you had to begin with wasn't tormenting you with thoughts of sex with children, dead people, animals, or sex mixed in with cannibalism, etc.) and the inability to reach orgasm, would make a person far more depressed than he or she was beforehand. Orgasms do a lot to put a bounce in my step. Yet I am surprised how rarely doctors, who surely are aware of this side effect, mention it when prescribing. Maybe I'm not really surprised, given the way the medical profession doesn't treat people holistically or act as if sex is a regular and desirable part of a person's life, but I am dismayed.
Posted by nocutename on June 28, 2012 at 8:51 AM · Report this
nocutename 97
@juniegirl and cockyballsup: farting happens. Bodies do gross things--many much, much worse than farting--sometimes.
Posted by nocutename on June 28, 2012 at 8:53 AM · Report this
nocutename 98
The Amazing Adventures of Clitster and Dickster: a Saturday morning cartoon show.
Posted by nocutename on June 28, 2012 at 8:55 AM · Report this
99
I vote for a hard dick EVERY time. I enjoy oral, but a hard dick is the best.
Posted by Linden on June 28, 2012 at 9:36 AM · Report this
100
Regarding letter #3- beta-blockers that are used to treat panic attacks, hypertension, various cardiac issues are notorious for causing erection problems in men. If I were him I'd look into this. Anti-depressants are another group of meds that cause sexual issues in men and women - very common. Some doctors I've worked with minimize the sexual dysfunction these medications cause, but it's not true. I've heard MANY people complain about them.
Posted by Linden on June 28, 2012 at 9:45 AM · Report this
101
Re Prozac: did you know it's currently the ONLY medication approved in the US for treating depression in teens? Yeah, that'll help a whole lot -- grow up totally out of touch with how your sexuality actually works (e.g., thinking you can't orgasm when in actuality it's the drug). And of course most doctors won't counsel teens on how to deal with sexual side effects, because it's supposed to be a GOOD thing for teenagers (especially girls) to be less sexual. Never mind that there is a WHOLE LOT to sexuality (especially during adolescence) that isn't necessarily about partnered sex.
Posted by Eirene on June 28, 2012 at 11:21 AM · Report this
Auragasm 102
Mydriasis, yup it varies by state. Here in Washington you must be 18 to enter the sexy stores. Back then I lived with my parents, but these days I have toys shipped to me via the internet. What's the law (if any) where you live?

Danfan, that's a bummer about GA & TX. Sometimes you have to get creative. My first vibrator was an aquarium air pump.
Posted by Auragasm on June 28, 2012 at 11:40 AM · Report this
103
Eh I'm glad L3's trying to find ways to please his girl and not asking her "what do you want?" I know this is supposed to be the most wonderful respectful thing in the world between sex partners, but I for one absolutely hate it. My answer typically is "not sex with you." :-/ Fuck, try some things, surprise me, I might like it! If i have to tell you how to fuck me it feels like I'm being serviced, not enjoying an experience with someone. Now that doesn't mean I don't ask for this or that from time to time but asking me reminds me too much of being at a restaurant or a hairdresser.
Posted by wendykh on June 28, 2012 at 12:26 PM · Report this
104
101-Eirene-- Yes, I've wondered about that too. How is a girl supposed to learn what's normal for her when her sexual desire has been suppressed? I liken it to the experiments where they stitch a kitten's eyes closed during the critical months when its brain should be learning to see (brain learning to interpret visual information from the eyes). When the stitches are removed, there's nothing wrong with the functioning of the eye, but the cat is blind. It's another example of thinking that any sexual desire on the part of the female must be either evil or insane and therefore must either be beaten out of her (medieval Europe) or medicated (present day). (And is for her own good which follows from the evil/insane diagnosis.)

The doctors must see it differently. Right now, we don't have the diagnostic tools to know the difference between depression caused by situation/environment (teach coping strategies/get her out of there) and a real chemical insufficiency (analogous to giving diabetics insulin). The doctors can't take the chance of having a suicide on their conscience. (I could have saved her if only I'd prescribed prozac.) It doesn't much matter to them (no one is going to sue them) if the women go on to have horrible sex lives forever after.
Posted by Crinoline on June 28, 2012 at 12:47 PM · Report this
mydriasis 105
@ Crin/Wendy/Nocute

Okay first of all,

Low libido is a really common symptom of depression itself. For some people their libido improves after taking antidepressant drugs due to the alleviation of their depression.

I highly doubt your physician is thinking "oh you'll lose your sex drive on this drug but who cares?". More likely, he or she is thinking "hopefully this drug won't impact your libido but if it does you can come back and we'll work something else out." Before taking any drug you should read the info that comes with it. If it says 'sexual dysfunction' and the risk of having to deal with that temporary side effect is a dealbreaker, then don't take the drug.

As it stands, SSNRIs and SSRIs tend to have the best chance of positive results with the lowest chance of major side effects. Unfortunately nothing is perfect.

And Eirene, do you have any evidence that a doctor would refuse to discuss sexual side effects with a teenage patient? That sounds pretty spurious to me. In fact, when I was around 14 I had a sexual relationship with a guy who was 16 and on antidepressants. He was aware that his longer (for his age) time to reach orgasm was a side effect of his drug. This was not a smart guy - I doubt he researched that himself. More likely his doctor told him.

Which brings me to my next point. Any literate teen can and should read the information that comes with his or her prescription - which will tell him or her that sexual dysfunction is a side effect. This is not some conspiracy to muzzle the sexuality of teenaged girls and/or detach them from their bodies. The use of antidepressants in teenagers is an extreme measure for young people that are in a lot of pain.
Posted by mydriasis on June 28, 2012 at 12:49 PM · Report this
mydriasis 106
A couple other things.

The doctors must see it differently. Right now, we don't have the diagnostic tools to know the difference between depression caused by situation/environment (teach coping strategies/get her out of there) and a real chemical insufficiency (analogous to giving diabetics insulin).

Ugh. No no no. I don't know if the media is treating depression this way - but this is not at all accurate. This distinction doesn't exist. The short answer is that ALL depression is both situational AND chemical.

The doctors can't take the chance of having a suicide on their conscience. (I could have saved her if only I'd prescribed prozac.) It doesn't much matter to them (no one is going to sue them) if the women go on to have horrible sex lives forever after.

Actually, prozac is extremely well known for raising the risk of suicide in people under the age of around 25. The reason it is prescribed is because it is cheap, (relatively) fast acting and usually covered by people's insurance. Therapy on the other hand is less desirable to most patients (especially teenagers), often has long waitlists and can sometimes not be covered by insurance.

Also, you seem to be suggesting that depressed teenagers would have an otherwise healthy sexuality without prozac. Again, low libido is a common symptom of depression, as is low self esteem (I'm sure you're aware that doesn't often help a healthy sexuality form).

To be clear, I'm not pro-prozac. I think that it's use in teenagers should be avoided at all costs. I think that CBT and other effective forms of therapy should be covered by insurance (or the government, up where I live) and wait times should be cut down. Therapy has been shown to be equally effective as medication and it has no increased risk of suicidal ideation or other side effects.

I just think it's bizarre all the weird sinister intentions you guys think your doctors have. I'm reminded of a study that showed that both left-wing and right-wing people love their anti-science conspiracy theories - just different ones. Right wing people think that global warming is a hoax and left wing people hate their doctors. *shrug*
More...
Posted by mydriasis on June 28, 2012 at 1:02 PM · Report this
mydriasis 107
@ Auragasm

I live in Canada. I don't think we have restrictive laws about sex toys here? I've never bought any (I only like sex toys when they're people) but I did hit up a sex shop with a friend of mine a few years back when she wanted to buy a vibrator. We definitely could have passed for grey-area in terms of being 18 and we weren't carded or anything. I also don't remember seeing any signs indicating any age laws.
Posted by mydriasis on June 28, 2012 at 1:05 PM · Report this
108
@mydriasis @106:
To your first point: the question is not so much "Is it situational or chemical?"; but "what was the sequence?"
Sometimes people with low genetic risk for depression get into very bad situations and develop depression. And then there are people with a very high genetic disposition for depression who develop depression without an apparent trigger. First case: focus on the situation; second case: focus on the underlying physiological cause.

To your second point:
My understanding for the increase in suicide after taking Prozac (and other anti-depressants) was that severely depressed patients are too listless for committing suicide. They just do not have the energy to do it. Once their condition is improving (going from very strong depression towards strong depression) there is a point where they regain just enough energy to commit suicide (but not to fight their depression).

And last:
If the depression is caused primarily by some genetically caused chemical imbalance, psychotherapy without medication is not going to help much. Again-, that is my understanding.
Posted by migrationist on June 28, 2012 at 1:29 PM · Report this
mydriasis 109
@108

To your first point: um, no not really. It's more complicated and bidirectional than that. More on that later.

To your second point: that's one theory. Although actually what they found is an increase in "suicidal ideation" which is thoughts of suicide. Which means that on top of the phenom you suggested, there are also people who weren't considering suicide before who begin to think about it after starting SSRIs

Last point

Sorry there isn't a more polite way to put this but... your understanding is wrong. This has a lot to do with how science is written about and reported on for laypeople. In fact, even the idea that it's a "chemical imbalance" is an outdated oversimplication that got one major drug company in a lot of trouble, recently.

I could go into a lengthy discussion of what we do know about depression and why the "chemical" vs. "environmental" distinction is really false, but I'd bore you all. Instead I'll put it this way: recently a psychiatrist came to speak in one my classes about the current cutting edge of depression research. He talked about how depression doesn't just interact with serotonin, it interacts with your inflammatory response and your insulin response. For example they've found that insulin has effects on depression, so does inflammation. I asked then if the reverse was true - does psychotherapy affect inflammation. He said "yes - psychotherapy is a powerful biological intervention"

There's tonnes of scientific lit to support his statement and again, if you want me to go into some more detail as to why that's true I can - but it would be boring. :)
Posted by mydriasis on June 28, 2012 at 1:44 PM · Report this
110
My-- As always, thanks for your comments. I prefer to disagree with people who know what they're talking about.

True, my information is entirely anecdotal and what I read in the media, but I'm hardly a conspiracy theorist. I just got angry with my doctor.

I agree that doctors should prescribe anti-depressants for teens that are severely depressed-- whatever the cause. My problem is with the doctors who prescribe them for teens who are mildly depressed or who are going through a rough patch. The kids get the drugs and avoid life lessons. Or the parents want them on drugs so they can avoid teaching life lessons. I know too many adult women who are going through life without the benefit of learning anything the hard way, or even any way. You're right that I don't know what their lives might have been like without the drugs.

I get it when you say that the teens wouldn't necessarily have wonderful sex lives if not for the prozac, but I think that's more my point than yours: they never have the chance to find out.

And I'm not sure I would put unhappy teens in charge of reading the side effects of all the drugs they're asked to take so they can make informed decisions on their own. Mom takes them to the doctor. After an hour of crying and sniffling, they're going to take the drugs. It's not going to be "gee, I'm not sure about this. I might not have that orgasm I'm so curious about in the event that I find a boyfriend."
Posted by Crinoline on June 28, 2012 at 2:16 PM · Report this
111
Myd,

When you characterized me as being "geriatric" twice in four words, I realized you have no business using medical terminology.
Posted by Hunter78 on June 28, 2012 at 3:02 PM · Report this
112
The problem with the chemical imbalance theory of depression is that (1) the serotonin hypothesis has never been demonstrated despite many attempts to do so; in fact it has arguably been proven false several times over, so (2) SSRIs and SSNRIs do not "fix" any known chemical imbalance in the brain, and (3) SSRIs and SSNRIs help, at best, only 1 in 5 patients who take them better than placebo would have done.

Also, there have been newer studies showing sexual dysfunction to occur in 50% to 70% of patients on SSRIs. That's a LOT, given that only 20% of patients are actually helped by SSRIs at best.

Given these facts, SSRIs are wildly overprescribed. Especially chilling is their being given to adolescents, since we don't really fully understand what they do in the adult brain, never mind the growing brain of a child. The potential for irreversible side effects are particularly large in the latter case.
Posted by cockyballsup on June 28, 2012 at 3:18 PM · Report this
113
A boy is 13 and effeminate. He's not sure if he's gay. He is sure he's unhappy. Gay is a word that he's only heard in terms of the older boys on the bus taunting him with it. They call him gay when they hit him, trip him take his things and refuse to give them back. He has no friends. After several months of this, after getting unexplained stomach aches that make him not want to go to school, after hearing from his parents that he needs to man-up and ignore them because kids can be mean sometimes, he hangs himself.

But wait! There's no difference between chemical and situational depression. Why are we bothering with anti-bullying campaign and awareness in schools and it-gets-better projects when all this boy needed was prozac? It could have cured his depression. Covered by his insurance and cheaper that way. A lot easier all around. Why?
Posted by Crinoline on June 28, 2012 at 3:19 PM · Report this
114
And Eirene, do you have any evidence that a doctor would refuse to discuss sexual side effects with a teenage patient? That sounds pretty spurious to me.

Yes. The doctor said something like "My adult patients complain about lowered libido, but that's not a problem for you." I didn't say they didn't tell kids there WERE such side effects. I said they didn't give any useful advice about what that might mean in terms of the kids' sexual development. (It is possible her actual therapist was more informative, though I doubt it: I wouldn't know for sure, due to patient confidentiality.)

From a comment of mine on another blog: "I was just thinking today about how one of the reasons it was difficult to agree to putting my daughter on antidepressants as a young teen was that they would affect her libido, at this very time when kids need to be figuring out who they are sexually. And one of the doctors actually said to me, re the possibility of lowered libido, "Might be kind of a nice side effect, huh, mom?" Well, y'know, actually I am not that into controlling my daughter through chemistry. I may be a protective mom, but I have limits.

The antidepressants turned out to be necessary for a few years, but it really weirded me out how none of the doctors seemed to think the libido issue was important to a teen (I now know it's more difficulty orgasming than lowered libido as such, but that too is obviously interfering with sexuality).

I wonder how many teens' sexuality is seriously affected by antidepressants (at the moment I think Prozac is the only antidepressant approved for children and teens). And are there really parents who WANT this side effect, or was that truly just a little joke?"
-----------
Fortunately my daughter, being my daughter, had access to tons of information to help her through this. But you take someone who's grown up with terrible sex ed, thinking things like only guys masturbate, well, Prozac's side effects can potentially compound that kind of problem.

Crinoline, drugs are often prescribed short-term specifically to allow people's moods to lift to the point where they can begin to change their way of life so that ultimately they may not need the drugs. For example, people often say how helpful exercise is, but if you can't get out of bed in the morning, it doesn't matter how much brisk walks in the fresh air might help you.
More...
Posted by Eirene on June 28, 2012 at 3:42 PM · Report this
115
I just think it's bizarre all the weird sinister intentions you guys think your doctors have.

I don't think our doctors have weird sinister intentions -- that is, not any weirder and more sinister than our anti-sex culture in general. But they're affected by that culture for sure, and their education is insufficiently holistic.
Posted by Eirene on June 28, 2012 at 3:49 PM · Report this
mydriasis 116
@113

Sighh.

Okay, honestly, really?

No. At no point did I suggest that we shouldn't do what we can to prevent bad situations (whether they cause depression and suicide or not) and at no point did I ever say anything that suggests we put 13 year olds on prozac like it's no big deal.

Did you even read what I wrote? I said that I think we should be VERY hesitant to put young people on SSRIs because of how dangerous it can be and that we should try to put them in therapy instead. Of course it would be great if adults could reach in and end bullying situations. While that can prevent violence and outright blatant bullying, the subtler bullying and isolation will remain - for most kids that's still plenty enough to make them sad.

Yes, we should try to mimize bullying but it's an absolute pipe dream to work on the premise that we can eradicate it completely and we don't need to think about what we should do when it does happen.
Posted by mydriasis on June 28, 2012 at 5:57 PM · Report this
mydriasis 117
@Eirene

Maybe it's an American thing?

First of all, I had sex ed when I was in middle school and in highschool and masturbation was mentioned (to a room of girls) as a positive thing. Personally I didn't need to hear it from my gym teacher because I read but hey.

Both in my hometown and where I live now I've found that my doctors have all been pretty cool about sexual topics. I remember (when I was a teenager) asking my doctor about catching STIs orally and she was very cool about it and did not make me feel weird at all.

To be brutally honest? I think that overprescription of antidepressants has more to do with shitty parenting than anything. It's often parents making their teenagers go on medication - I don't know any teenager who wanted to be on the antidepressants he or she was on. Again, I don't think teenagers should be on antidepressants unless it's an extreme situation. I know you're preoccupied with the sexual development element but I personally think the risk that the kid might try to kill him or herself is a little bit more concerning, wouldn't you agree?

I think doctors tend to be more sex-positive (they're more educated and more comfortable with the human body) than the average person. But I'm somewhat biased.
Posted by mydriasis on June 28, 2012 at 6:09 PM · Report this
mydriasis 118
@ cocky

All good points.

Also, the estimate I've heard is actually closer to one in ten helped.

Again, the popularity of antidepressent medication prevails because of the way our culture is set up. People think that a pill is more likely to work than therapy (even though evidence shows this is untrue). With a pill, they also don't have to make themselves emotionally vulnerable or find a professional they have a rapport with (this can be a lengthy process) add length of wait-times and expense, along with the fact that taking a pill is virtually no effort... well. We can see why antidepressants are so popular beyond what they offer.

The fact is, serious depression is a horrible horrible feeling. If you have a one in ten shot of feeling better - wouldn't you take it? A friend of mine weighed in and said having a slightly worse sex life for a couple years while going to therapy and taking medication is still a better option than leaving depression (and an eating disorder, in her case) untreated and risking her life.
Posted by mydriasis on June 28, 2012 at 6:17 PM · Report this
mydriasis 119
Finally,

Someone call the wahmbulance for Hunter, already.
Posted by mydriasis on June 28, 2012 at 6:18 PM · Report this
120
Ms Driasis - Okay, that makes sense, particularly the rephrase. Sleeve-wearing almost always seems to carry a negative opinion or judgment, which seemed incongruous. It reminds me of Barcelona and the difference between "shacking up" and "living together".
Posted by vennominon on June 28, 2012 at 6:25 PM · Report this
nocutename 121
Given that none of my doctors has EVER brought up the subject of sex or libido in ANY way with me over my entire adult life (including my ob/gyn, outside of questions like "what are you using for birth control?"), I have no doubt that doctors prescribing SSRIs to teens for depression don't mention libido drop, just as they don't tell teenage girls who they put on the birth control pill--for everything from heavy periods with lots of cramping, to irregular periods, to acne, to, oh yes, birth control--that 'the pill' may affect libido.

While I don't think it is a conspiracy, I also don't think that doctors much care about such side effects, Eirene's experience notwithstanding. I don't think that the American--or perhaps Western--medicine regards a vibrant sex life as particularly important; a doctor hears a complaint, runs through the list of medicines to treat it, and prescribes. If a side effect is very well-known and exceptionally onerous or potentially health-threatening, s/he may mention it, but when I've mentioned libido-dampening (which to me includes inability to reach orgasm or difficulty reaching orgasm as well as a loss of interest in sex), the general response has been to downplay it ("oh, yes, that does happen in some cases.")

When I was on hormonal birth control pills, I was routinely prescribed antibiotics, and not one doctor or pharmacist ever told me it might interfere with the pill's effectiveness, yet when I explicitly asked the question (after waiting to see if the issue would be raised), every doctor and pharmacist said, yes, there was a risk, and I should use an alternate form of birth control for the duration of that cycle.

Part of the problem is that for teenage girls, libido is often little reason for having sex (yes, mydriasis, I know you were a precocious teen who pursued lots of sex because of your high libido, but you--and perhaps those friends you were hanging out with--are not the norm). Many teenaged girls are having sex to keep up, to keep their boyfriends, to make their boyfriends happy, to feel close to their boyfriends. They have sex because that's what they think they should be doing, lest they get labeled prudes or old-fashioned. They have sex because they want to feel attractive, or popular. There are a myriad of reasons for teen girls to have sex, and libido is only one of them, and probably a disproportionately weak one.

Unfortunately, a high libido isn't necessary for a female to have sex. So the doctor who told Eirene that it was so much the better that a side effect of an anti-depressant for her daughter would have the collateral effect of diminishing her libido missed the point (I'm willing to bet the doctor was male). Assuming that her daughter experienced that side effect, all that this medication would ensure, is that she get significantly less pleasure from any sex she may have than she could were she to remain unmedicated. But given the general sex-negativity of our culture, that wouldn't be viewed as a problem.
More...
Posted by nocutename on June 28, 2012 at 6:32 PM · Report this
mydriasis 122
@ Cute

Are you American also?

I'm Canadian and I think our culture is somewhat less sex-negative than yours to be honest? At least based on my own experiences and the ones I've heard from my friends.

The fact of the matter is that there are lots of side effects from antidepressants. Yes, we're on a message board where people are very concerned about sex - but for other people 'weight gain' will be way more saleint. Maybe sleeplessness? Etc. Rather than go through all possible side effects most doctors think it's logical to make an educated guess about what the patient will find the most important. Again, IF the person experiences loss of libido AND they find that more troublesome than the condition they're being treated for, they can go off the medication. Or they can switch.

At the risk of beating a dead horse, I'll say it again. Low libido and overall anhedonia are also symptoms of depression which may me another reason why doctors don't go out of their way to list that side effect - chances are, it's a problem the patient already has.
Posted by mydriasis on June 28, 2012 at 6:58 PM · Report this
123
Myd,

Yeah, your cud is so green.

Posted by Hunter78 on June 28, 2012 at 7:00 PM · Report this
124
I know you're preoccupied with the sexual development element but I personally think the risk that the kid might try to kill him or herself is a little bit more concerning, wouldn't you agree?

Are you talking about treating depression, or about the supposed elevated risk of suicide among teens on Prozac? Because if the former, hello, I DID put my kid on meds (and I am not going into any details about how and why we knew it was serious, you're just going to have to fucking trust me on this one). If the latter, well, I was going on the best information I had at the time, which said that idea had been debunked.

I don't know any teenager who wanted to be on the antidepressants he or she was on.

I've never known anyone who wanted to be on antibiotics, come to that, and we know how they work. I have certainly talked to more than one teenager, including my daughter, who felt that going on antidepressants had been the right call for them, even if they weren't happy about it.

I think doctors tend to be more sex-positive (they're more educated and more comfortable with the human body) than the average person.

Oh, they probably are on average. I think the doctor we talked to probably was. Just not nearly ENOUGH so.
Posted by Eirene on June 28, 2012 at 7:06 PM · Report this
125
@1 The brother should offer to go to gay bars with his gay brother and play wingman. That would take a lot of stress off of the situation. The main problem with meeting people in bars is the sexually explosive nature of it all.
Posted by guestt on June 28, 2012 at 7:06 PM · Report this
126
nocutename@121: You lose. The doctor was female. But you're right, girls who are out of touch with their own sexuality are if anything MORE likely to have undesirable sex (by anyone's terms), more likely to get pregnant, yada yada yada.

I'm appalled you didn't routinely get the message about antibiotics interfering with birth control. My doctors and pharmacists, especially the pharmacists, have always handled that fine, I have to say (they've brought it up -- I know I've never asked, because (a) I know about the antibiotic thing and (b) I've never been on hormonal birth control). I would consider it malpractice not to mention that.
Posted by Eirene on June 28, 2012 at 7:08 PM · Report this
mydriasis 127
@124

No, I was talking about the latter not the former.
I had many friends in my teen years who went on antidepressants and I had the opposite experience to you. *shrug*
Posted by mydriasis on June 28, 2012 at 7:25 PM · Report this
Eva Hopkins 128
mydriasis: fans of this whole discussion! Props to you, & Crinoline, & Eirene. I love Sloggin' 'cause I usually learn something.

I'd agree heartily with the assessment that the more sex-negative culture here in the U.S. (I don't mean everywhere, before I get my throat jumped down) can affect one's quality of care. In my experience as a female patient, there's been a slew of health issues throughout my life that would have not been as big a deal as they became, had I gotten the right information, the right medication & been listened to & taken seriously by my doctors & pharmacists.

For just a few examples (I could bore SLOG all night with 'em), my family practice Dr. told my abusive mum when I asked about the Pill when I was a teen. I slunk off to Planned Parenthood - thank goodness I had one, though far away - but I should have been able to get more info from my doc without being ratted out.

Then in college, I got diagnosed w/ PCOS (polycycstic ovarian syndrome).

I mean, the really uncomfortable with me male Dr. I had at 21 figured it out, but didn't bother to tell me. He just said I needed to lose weight. True then, true now, working on it. But I couldn't afford regular checkups, & my hormones got even crazier. Finally saw someone years later who said I might have PCOS, but that it is never, ever, provable, & put me on metformin. A different doc gave me an ultrasound, hey check it out - proof! Clearly PCOS. I realize not all PCOS patients manifest in visible ways, but yeah, would have liked someone to offer to look sooner. & when she read my file, she said - 'OH LOOK, this guy a decade ago said so. Why didn't he tell you? Why didn't these other docs look it up?' Gee doc, I dunno, wish I did. & the other pill they gave me to treat side effects was a diuretic, which they didn't tell me about. :/

I went to get the BC pill prescription refilled at a Walgreens in Scranton, PA, & the pharmacist refused to do it. She said she was allowed to object on moral grounds. So I pointed out it wasn't for dirty dirty sexing, but medication, for my sickness, which is what a pharmacy is supposed to dispense. And if it was for the sexin', it shouldn't be her affair, since it was prescribed by my doctor. She got her manager, who supported her. I then said that perhaps if they weren't in the business of dispensing medication, they shouldn't be pharmacists. They wouldn't even tell me where else the nearest pharmacy was, so I could get it filled.

Last Dr., when I said 2 solid years of more pills hadn't seemed to do me any favors - I felt worse - he said - welp, that's how we treat this, here's yer prescription. I did some research, stopped taking the pills, ditched wheat & started swimming. My cycle has been close to regular for the first time, ever, sans meds, for the past 2 months. & oh the irony! I'm finally starting to lose a tiny bit of weight.

Soooo - yeah. Been to a small part of Europe; been to a small part of Canada; & it's my belief that the culture I encountered in those places was WAY less sex-negative as here in the USA. That has directly impacted the quality of the care I personally have received from doctors. (As has our ridiculous for-profit health care system.) Now I'm a better advocate for my own health, at least.
More...
Posted by Eva Hopkins http://www.lunamusestudios.com on June 28, 2012 at 8:03 PM · Report this
Eva Hopkins 129
@58, sfgurl, yer right, I shouldn't have chosen such pricey "starter kit" vibes. ;) Doc Johnson's Pocket Rocket did the trick just fine, & was about $20.00, when I first bought toys. Those little lipstick vibes were good, too.

But boy I love Jimmy Jane. & Lelo. & Fun Factory - YAY, they finally have a U.S. online store..!
Posted by Eva Hopkins http://www.lunamusestudios.com on June 28, 2012 at 8:08 PM · Report this
nocutename 130
Eirene (@126): I'm 49 now. I was on hormonal birth control from 19-30, and no doctor ever mentioned ANY of the side effects--no, mydriasis, not even weight gain or insomnia, nor diminishment of libido from the pill, nor the possible ability of antibiotics to interfere with its effectiveness. This includes female doctors as well as male. I was an educator/volunteer with Planned Parenthood for three years, back in the late 1970s, as a teenager, teaching the class on "Anatomy, Physiology, and Birth Control" that PP made women sit through in order to get the pill, and the only things regarding collateral damage we were taught to communicate was that if you had high blood pressure, were a smoker, or were overweight, you were at greater risk for stroke if you took the pill, so if those conditions applied, you were ineligible.

I learned about antibiotic's potential to interfere with hormonal birth control's efficacy when a friend on the pill got pregnant not once but twice during or following a course of antibiotics. Thereafter, every time I was prescribed antibiotics, I made it a point to wait and see if the doc or pharmacist would bring the topic up, and none ever did, though when I then asked directly, most conceded that that was an occasional side effect.

Three times I've had doctors or a therapist suggest SSRI treatment for depression (ultimately, when the conditions that led to the depressed state were reversed, the depression organically cleared up, but once, when I was much younger, I was very seriously depressed and it took anti-depressants--old fashioned ones, not SSRIs--plus talk therapy and a mandated 20 hours of work per week to pull me out), never mentioning a hit to libido or ability to orgasm as a possible side effect. These visits were all within the last 5 years. Each time, I said, "I know that SSRI's can have an effect on libido, and I don't want to do that." Once I said that, the two female doctors all acquiesced (the male therapist dismissed my libido, and I stopped seeing him), but none volunteered that information first.

Yes, I'm American. I live in liberal ol' California. Some of these doctors were women. I don't agree that doctors are more sex positive than the general population; neither do I think that most view the libido-dampening side effect as a benefit.

I think most doctors are profoundly uncomfortable discussing the details or even broad strokes--no pun intended--of their patients' sexuality.
More...
Posted by nocutename on June 28, 2012 at 8:19 PM · Report this
Eva Hopkins 131
Ms. Cute - your name should have been in the list that began my longer post above. :) I'm a fan. Not of what your doctors said & didn't say, though.
Posted by Eva Hopkins http://www.lunamusestudios.com on June 28, 2012 at 8:32 PM · Report this
evamoon 132
Not to trivialize the seriousness of SSRIs and competent medical advice, but here's an utterly lame-ass picture of Clitster and Dickster... http://evamoon.net/blog/wp-content/uploa…

Crude but happy. Kinda like me!
Posted by evamoon http://evamoon.net on June 28, 2012 at 8:59 PM · Report this
nocutename 133
I was recently diagnosed with a rather large fybroid uterine tumor; one of my choices, presented to me by a doctor who has repeatedly heard my concerns that my impending menopause will diminish my libido, was the Mirena IUD, which is a localized hormone delivery system. The doc said nothing about libido, but mentioned that that would be a good choice for treatment (lucky me; because of the size and location of my (only) one fybroid, I have multiple options for treatment to consider), because it would double as birth control. She said nothing about the possible deleterious effect on libido.

When I read the glossy advertising pamphlet carefully, there it was, in tiny print, buried at the bottom of some other "minor" possible side effects.

I think doctors are trained not to keep us healthy, but to make us better when we're not. They are also not trained to view a patient holistically, but in light of the specific problem to be isolated and treated.
Posted by nocutename on June 28, 2012 at 8:59 PM · Report this
mydriasis 134
@ Cute

I know California is considered liberal in America but it's all relative. I have family there and visiting them is always a culture shock. They're liberal (when it comes to sex, at least) but when my sister lived there for a couple of months and interacted with people around her age who weren't family and she was speechless at how accepted racism and homophobia were. A coworker of mine also lived in many places in California over the years and his assesment of California (as a Canadian) was that riiiight up against the coast it can be liberal but everywhere else... it's America.

Not that it's perfect here, but my experience with doctors re: sexuality has been largely positive. I did have an awful experience with an ultrasound tech but that's another story for another day.
Posted by mydriasis on June 28, 2012 at 9:21 PM · Report this
135
@Cute, I have a Mirena (good bc choice for pcos)and have not noticed any deleterious effects on libido. YMMV of course. I am fortunate to see an ob/gyn who has a very holistic view of medicine and who is not afraid to ask for advice from his wife, who has her own alternative medicine practice.
@My, thanks for being a consistent voice of reason when health topics come up. There are a lot of studies showing that our environment and actions affect our physiology, just as our internal state affects our moods and actions.
Posted by tachycardia on June 28, 2012 at 9:41 PM · Report this
Free Busch On Tuesday 136
@84,33

If he has high blood pressure and sleep apnea, dollars to donuts he's overweight. Getting frustrated that you're body doesn't work right when you don't maintain the health of your body is called stupidity. It has nothing to do with the aesthetics of obesity. It has everything to do with how sick I am of people getting frustrated at a lifestyle choice.

Keep in mind, obesity=lifestyle choice, GLBTQI=Biology.

Oh and there's no way you can convince me otherwise. I diet, exercise and stay active to battle my genetic predisposition to be overweight, why can't he?
Posted by Free Busch On Tuesday on June 28, 2012 at 10:59 PM · Report this
137
@mydriasis:
There's nothing impolite in pointing out in a discussion that someone else's understanding is wrong.

However, could you point me in the direction of those studies that show that psychotherapy is better to treat depression than medication (medication is therapy as well)? I'd be especially grateful if there was a meta-analysis, and if the studies looked at severe, not mild, depression.

Posted by migrationist on June 29, 2012 at 1:03 AM · Report this
mydriasis 138
@137

If I'm remembering correctly I believe that they're about equally good in terms of effectiveness. My conclusion that therapy is better is based on the opinion that the downsides of medication (side effects, withdrawl, etc) are worse than the downsides of therapy (effort, time, expense). That's a matter of opinion so you're not going to see a study that says "CBT better than SSRI medication' - better isn't really a discrete dimension, right.

I can have a look around but the other issue is that since I've graduated I don't have unlimited access to journals. And even if I did get a hold of them, would you be able to access them also? Or do I need to find something that's publicly available.
Posted by mydriasis on June 29, 2012 at 5:10 AM · Report this
139
@136, the three people I know with BP and apnea problems are all thin. Heaven forbid you should ever have a health problem if you have been wearing that judgmental attitude on your sleeve.
Posted by cockyballsup on June 29, 2012 at 5:19 AM · Report this
140
@138:
Thank you. I meant just the references. But after I had posted my comment above, I realised that I am able to google myself...

Some of the papers I found were open access, but I primarily skimmed the abstracts anyway.
Posted by migrationist on June 29, 2012 at 5:29 AM · Report this
mydriasis 141
@tachycardia

Thanks!

@136

Wow, you're ignorant!
Plus willfully ignorant!
Too bad you can't read a book and battle your genetic predisposition for being a stupid twat. Oh well, can't win 'em all.

@ Migrationist

I did a quick google check and noticed that people especially reccomended therapy for younger patients? I actually wasn't able to check through abstracts earlier because it just wants me to give my acess info - it doesn't give me a preview.

My understanding is that the 'ideal' situation is for people to be on both medication and therapy.

Did you find anything useful?
If not I can try to check later with my roommate's access.
Posted by mydriasis on June 29, 2012 at 5:57 AM · Report this
mydriasis 142
@120 (throwback)

Yeah it wasn't a great word choice on my part. I'm glad I cleared it up. :)
Posted by mydriasis on June 29, 2012 at 6:02 AM · Report this
143
@mydriasis:

The abstracts mostly showed similar results for psychotherapy and medication, and better outcomes for a combination (like 47 %, 48 %, 74 % positive outcomes).
One study I found interesting was where they switched non-responders from medication to psychotherapy and vice versa, and had positive outcomes in each directions, which suggests different approaches work for different people. Unfortunately I can't find that paper any more.

I guess what makes it so difficult to find a definite answer is that there are not only different people, and psychotherapy vs. pharmacotherapy, but also different approaches of psychotherapy and different kinds of medication.
Posted by migrationist on June 29, 2012 at 6:14 AM · Report this
144
LW #2... I was in pretty much the same situation. But you know what? We had been working those conflicting shifts before we moved in together, and it worked. It worked after we moved in together, too. My worrying was just creating a problem where one didn't need to be. We still saw each other when we could, slept in each other's arms when we could, ate together when we could, and the overfamiliarity that happens when you live with someone was much slower in coming. I think Dan is right, just take it as it comes and enjoy.
Posted by tgotf on June 29, 2012 at 7:51 AM · Report this
nocutename 145
@tachycardia and mydriasis, I'm glad you've had such positive--and sex positive--experiences with health care. I am not ranting against doctors and the system, just giving my perspective of it and that of the teen women I know (I know a lot). I would be tempted to write off our different experiences to generational or nationality, but this issue is a kind of big deal to me, and I've been checking with teen women for the past 3-4 years. Those I've asked, report to me that no one advised them that any medication they've ever been put on (including hormonal birth control and antidepressants) may cause a drop in libido or hinder their ability to orgasm. Since Mydri has decided that only that part of California that hugs the shoreline is liberal enough to bear a favorable comparison to Canada, let me specify that I live and all these incidents took place in the San Francisco Bay Area, a region somewhat well-known for its liberalism and sex positivity.

Girls are put on the pill easily and matter-of-factly, and rarely are they told that this same drug which they are taking because they are having sex (yes, yes, in addition to the other legitimate reasons for which it is prescribed) is likely to interfere with their ability to fully enjoy sex. They think their low response cycle is "normal." Or they think that they're missing out on something that everyone else seems to get to have, and they feel broken.

They don't report this to their doctor, because it's embarrassing and they don't even see it as a medical condition, much less a side effect of a pill that is supposed to help them
(a) have sex
or
(b) make them less depressed.

A side effect that is clearly physical, such as headache, nausea, elevated blood pressure, is easy enough to understand as being caused by a new medication. Sometimes doctors even ask about those conditions or check for them at a follow-up visit. But sexuality isn't cut-and-dried like a headache is. Young patients aren't as likely to make the association with the onset of the medicine and the decrease of satisfying or fantasy life.

And back to one of Eirene's earlier points, if a young person gets put on a drug with libido-dampening side affects *before* he or she even has a clearly defined sense of what sexual normalcy means for him or her, then you have a host of potential problems. If the drug is used for many years (as both SSRIs and birth control often are), real, long-term damage can be done to a person's sense of her sexual self. It's not an irreversible problem, but it's an unnecessary one, if more doctors felt more comfortable treating their patients' sexual satisfaction as an integral part of overall good health, and checking in to make sure it isn't compromised.

This is not to say that those in need of the most appropriate medicine to treat or help treat the most pressing problem should avoid it. SSRIs help a lot of people (and I'm not going to get into the whole "are they over-prescribed" and "should depressed teens be given them when research shows that in some cases, the drugs increase suicidal ideation?"). It's just to say that if a patient came to a doctor with depression, and the doctor thought of a drug that was often useful but frequently had the side effect of quadrupling cholesterol, the doctor would mention this to the patient, outline the risks and benefits of using such a drug, and say that the patient should return for blood work-up in three months to see if his cholesterol level was up. But it's unlikely that that same doctor would call the patient back in after three months of treatment for depression and anxiety and ask, "so, how's your libido? Do you think about sex less often? Masturbate less frequently? Have less desire for sex? Have a harder time reaching orgasm? Are you unable to come?" Yet these questions (or the answers to them) are just as integral to the holistic health of the patient as any information related to blood pressure or the like.

Part of it, of course, is that there is no simple blood test that can be ordered, or results that can be measured or quantified. The only way for the doctor to know this information is to have a very honest, and somewhat lengthy, talk with the patient, a problem on multiple levels. Insurance companies, who desire doctors to keep their interactions with patients very brief, would likely not encourage it. I would think that people need extra time to get over shyness talking about their own sexual dysfunction with relative strangers--which brings up another, related point: for many of us, gone are the days of the family doctor who delivered you and has known you and your family all your life, with whom you feel somewhat comfortable (which relationship itself, ironically, may be a hindrance to wanting to take explicitly about your sexual habits), and who might even notice when something seems "off" about you. That's what continuity of care can provide. But these days, many of us see a different doctor (or health care provider) virtually every time we go in the office. For some, it's hard to relax enough to tell a stranger something that could be viewed as so personal and embarrassing.

Another factor is that our culture, hyper-sexualized as it seems, is still pretty prudish. Most of us don't want to hear the details of the sex life of someone we don't find attractive. We communicate that subtly all the time. Most of us don't want to share the details of our sex lives--even if those sex lives are mind-bogglingly awesome, thankyouverymuch--with someone we regard as outside the sexual realm. It's uncomfortable to bring up that much detailed information about one's sex life, especially if the primary reason that the person is in treatment wasn't about sex! So to expect (perhaps depressed), teens to bring up something like "my fantasies no longer are enough to get me to come when I masturbate, and furthermore, I don't even really care that I don't. But I used to like to and I kind of miss it in theory," so that the fine-tuning of medication can happen, is unrealistic. Our whole culture would have to do some very serious chilling the fuck out about sex and its importance in everyone's--even teen girls'--lives. So far, at best, our culture accepts sex as a given in adults' lives, but that's a long way away from seeing a vibrant, active, satisfying sexual life as contributing to overall good physical, mental, and psychological health for everyone past the point of puberty. (I'm not advocating promiscuity for pre-teens, by the way. "Vibrant, active, and satisfying sex life" can consist of fantasy and masturbation, and for a 13-year-old, should probably be limited to that.) If a satisfying sexuality was as important to our general culture, and to our medical profession and its practitioners as regular bowel movements, ideal blood sugar, etc., people of all ages who need medication for legitimate reasons which may interfere with libido, would have that side effect monitored.

AS for mydriasis and tachycardia's praise for the Mirena, I'm sure it's excellent. And there's even the possibility that it wouldn't affect my libido. But my libido was suppressed for many years, from 19 (when--surprise: I went on the pill) to 37 (after I'd weaned my second baby and hormones seemed to have shifted and swung around a bit). So now I'm cautious about protecting what was lost for so long.

More...
Posted by nocutename on June 29, 2012 at 9:13 AM · Report this
nocutename 146
@131 (Eva Hopkins): Thanks!
Posted by nocutename on June 29, 2012 at 9:24 AM · Report this
mydriasis 147
@ Cute

Wow, that is a doozy of a post. I'll do my best to address it.

I'm glad you've had such positive--and sex positive--experiences with health care. I am not ranting against doctors and the system, just giving my perspective of it and that of the teen women I know (I know a lot). I would be tempted to write off our different experiences to generational or nationality, but this issue is a kind of big deal to me, and I've been checking with teen women for the past 3-4 years. Those I've asked, report to me that no one advised them that any medication they've ever been put on (including hormonal birth control and antidepressants) may cause a drop in libido or hinder their ability to orgasm.

I think it's a legitimate concern - I was just pointing out that it might not be as universal as you think it is. People are more vocal about bad experiences than good ones.

This is how I think doctors approach the discussion of side effects. They tell the patient about the most likely and most troubling side effects (I'm talking life threatening and/or permanent side effects - low libido is neither) and work on the premise that the patient will read the info that comes with the prescription (which will list all the side effects that the doctor didn't have time to list, including low libido) and if the patient experiences any troubling effects (including low libido) then he or she can come on back and discuss that.

I think the blind spot is assuming that patients will

1. read the info (which they should!!! And this would render the following points moot)

and/or

2. understand that low libido can be caused by medication

and/or

3. be willing to talk to their doctor about low libido.

I don't think that doctors consider low libido to be irrelevant, I think it's the assumptions I listed above.

Since Mydri has decided that only that part of California that hugs the shoreline is liberal enough to bear a favorable comparison to Canada

To be clear - that was a coworker's opinion, not mine! I honestly don't know what the difference is, I do get the vague impression that there's less sex-negativity here but *shrug*.

Girls are put on the pill easily and matter-of-factly, and rarely are they told that this same drug which they are taking because they are having sex (yes, yes, in addition to the other legitimate reasons for which it is prescribed) is likely to interfere with their ability to fully enjoy sex.

I went on the pill because I wanted to be on the pill. No doctor ever suggested it. Before I went on the pill my mom told me it would kill my libido. I was thrilled! It didn't though.

My response to your commentary on the pill mostly relates to what I said above so I won't belabour the point. The pill comes with an info page. People should not put chemicals into their bodies without reading the information that comes with it. Yes. All of it. Every medication I've ever taken (over the counter or prescription) I've read every last word on the packaging and on the inserts. It still shocks me that people don't do this. Clearly, doctors need to tell patients that they need to do this. I always figured that was a given. I guess doctors do too.

And back to one of Eirene's earlier points, if a young person gets put on a drug with libido-dampening side affects *before* he or she even has a clearly defined sense of what sexual normalcy means for him or her, then you have a host of potential problems. If the drug is used for many years (as both SSRIs and birth control often are), real, long-term damage can be done to a person's sense of her sexual self. It's not an irreversible problem, but it's an unnecessary one...

I wouldn't lump BC and SSRIs together here because they're very different. With BC I think this is an excellent point. However, if someone is in serious enough of a situation to be put on SSRIs - they are extremely unlikely to have normal sexual development if left untreated. Depression also has a massive effect on developing sexuality by affecting body image, self esteem, impulse control, self harm behaviour, trust, ability to feel emotional pleasure, joy, intimacy, and YES, libido. Let's not forget or diminish that.

So to expect (perhaps depressed), teens to bring up something like "my fantasies no longer are enough to get me to come when I masturbate, and furthermore, I don't even really care that I don't. But I used to like to and I kind of miss it in theory," so that the fine-tuning of medication can happen, is unrealistic.

Again, I don't think that kind of detail is necessary (thank goodness, for those of us who are shy!) to get the point across. In fact the patient could go in and say 'I don't like this pill, and I don't want to take it anymore' and go off it. If she's really daring she can bring in the sheet, highlight the "low libido" part and hand it to her doctor.

AS for mydriasis and tachycardia's praise for the Mirena

Actually I wasn't praising mirena? I take seasonale and I love it very much (4 periods a year is just about ideal in my books). I've had a permanently high sex drive for as long as I can remember. It's never budged for anything. Not happiness, not sadness, not illness, fear, anxiety, etc. I also have a fast metabolism which means that if I don't eat for a couple hours I'm starving. While I like that I can eat all I want and the calories jitter right off, it's also extremely high maintenance. My sex drive is the same way. Sometimes I think it would be nice to be like other girls and not have to put in so much effort.
More...
Posted by mydriasis on June 29, 2012 at 10:01 AM · Report this
148
@mydriasis:
Don't worry. When you hit about 30, your metabolism will slow down.
And about the libido: I don't really understand why there'd be a lot of effort involved if there is a high sex drive. In my experience, the higher the sex drive, the less effort.

@nocutename:
I don't think doctors are sex-negative in general. I think some of them are a bit lazy and one-directional. They are trying to solve the problem they are presented with in as little time as possible.
Posted by migrationist on June 29, 2012 at 10:20 AM · Report this
149
The thing about meds versus therapy is that with the meds you know you're getting the same thing as someone else, and with therapy it could be completely different. There are plenty of psychiatrists and counselors and so on who can be worse than useless. It took us three tries to get someone who even sort of clicked with my daughter, and I'm still not sure zie was more than marginally useful. And though I totally understand why confidentiality is crucial, it's maddening as a parent to be spending all that money and time and have NO idea what's actually happening in those sessions.
Posted by Eirene on June 29, 2012 at 10:21 AM · Report this
Free Busch On Tuesday 150
@141, as a university educated individual that is very familiar with biology the human body and statistics. It's called playing the math. 1) Sleep Apnea strikes overweight people disproportionately higher than normal healthy adults, 2) elevated BP suggests the individual is also overweight 3) inability to maintain erection, suggests cardiovascular dysfunction which can be a part of guess what... Obesity

So please, if anyone is ignorant here it is the idiot who can't answer back and falls back on insults because baby is too afraid to call a spade a spade. All evidence I have suggests he needs to lose weight and get fit. Reading through your inane drivel of faux-pertise and attempt to sound superior as an "enlighted Canadian" shows that the chip on your shoulder is quite large. Perchance you are a little self conscious about being overweight yourself. You're not just willfully ignorant you're willfully incompetent and trying to pass off advice.
Posted by Free Busch On Tuesday on June 29, 2012 at 10:27 AM · Report this
151
My doctors and pharmacists have always clearly been following an established protocol when they talk to me about side effects -- you can hear it in the phrases they fall into that they've said all this over and over in the same words to many patients. So it seems to me that if you're NOT hearing that kind of rundown, it's likely that certain protocols aren't getting followed, which worries me for all sorts of reasons.

@mydriasis: a huge percentage of people, possibly a majority, CAN'T read and understand medication inserts. They simply don't have the necessary comprehension skills. Yes, people who can do so should -- but medical professionals need to help get the points across as well. I'm thinking especially of the antibiotics-and-hormonal-BC thing here, where it really is a crucial matter for one's health.

My HMO not only has doctors and pharmacists emphasize that point with patients verbally, it's automatically printed on the discharge note (which is in much simpler language than the medication insert).
Posted by Eirene on June 29, 2012 at 10:43 AM · Report this
152
Obstructive sleep apnea is a major factor in developing hypertension, completely independent of weight gain.

Obesity alone isn't that much of a factor. It's people who have apple shapes and thick necks who are put at special risk. Incidentally, obstructive sleep apnea is likely to contribute to gaining more weight than one otherwise would (chronically tired people eat more and exercise less, big surprise).
Posted by Eirene on June 29, 2012 at 10:53 AM · Report this
153
Anyone think that guy is worried not because of his problem but hers? She tried masturbation once and never did it again? Sounds to me like she's put all the responsibility for her orgasm on his shoulders. Maybe he's coming so fast because he's sick of that responsibility on some level.
Posted by MinnySota on June 29, 2012 at 11:33 AM · Report this
154
Without going into too much detail, suffice it to say that my experience with the American medical system is closer to nocute's and Eirene's than myd's or tach's. I've never had anything as awful as a pharmacist refusing to fill a prescription based on incorrect assumptions + wtf morality judgments, but I have sometimes felt like I was in a chess game with the medical professional in which s/he made a move to screw me and I made a counter move to avoid being screwed (which resulted in their making a move and so on). I've ended up with a list of defensive moves to make sure I get my questions answered.

For a benign example, there was the time I saw my doctor but was hurried out the door before I'd had the chance to bring up 2 issues I meant to ask her about. The next time I went, I brought a typed list of my symptoms, questions, past treatments, history. It was well-written, brief, in outline form, etc. I was proud of it. The doctor took one look, was impressed, and asked if she could have the copy for her records. I said sure, and before I knew it, I was hurried out the door before she'd answered my questions, the questions clearly typed on the list, or talked to me about what I needed to talk to her about. So I started bringing 4 copies-- one for her, one for me to have when clothed, one that I brought with me when naked, and one as a bookmark in the book I had in the waiting room, etc. I needed to be able to refer to that list of questions!

I've learned:

Never bring up a history of depression or any other psychological ailment with a new medical doctor. If you do, anything the doctor doesn't feel like dealing with can be attributed to stress or anxiety. Your protestations that you know what stress and anxiety feel like and this isn't it will be ignored.

Doctors tell you procedures are painless if they don't feel like dealing with your pain. It's no skin off their nose if they're lying. If you're told you don't need someone to accompany you or to drive you home, don't get stuck at the doctor's office feeling like you need an ambulance and with no one to take care of you.

The female chaperone in the room when a female patient sees a male doctor is there to distract you so you can't pay attention to what the doctor is doing, ask him questions or interact with him. If he misbehaves in any way, it's your word against 2 of theirs.

The 5 copies of the typed list of questions and concerns? You need several copies of the specialist's notes too. Doctor requires having them several days ahead of time so she can review your record before you get there? That's so she can have you come back a 2nd time because they didn't have your record. Need to review the record with your doctor? Make sure you see the actual record, not the doctor's description of it.

If you require confidentiality and share an unusual last name with your family in a smallish town, make your appointment under an assumed name. The doctor has signed all sorts of confidentiality agreements. The staff will call your mother (though you haven't lived with your parents for 30 years).

I've read this over and realize I sound angry and bitter. I have had good experiences with doctors, and I've had overall good luck with good health, but this whole discussion is something of a trigger for me.

Oh, and on the sub-thread about sleep apnea, overweight, and whether fat people may be seen as sexual, if someone told me about sleep apnea and hypertension, whether I thought they were overweight or not, and no matter whose fault I thought it was, I'd tell them to make sure they got medical care. DIDT says he is doing just that so my opinions on the rest don't matter. Way back up the column list, I insinuated that I didn't think much of DIDT because he seemed to be pressuring his girlfriend to use sex toys for his own aggrandizement rather than for her. I also suggested that he sounded overweight, but really, as long as he's getting medical care, he's taking care of the difficult stuff.
More...
Posted by Crinoline on June 29, 2012 at 11:44 AM · Report this
Free Busch On Tuesday 155
@152 roughly 70-95% of all sleep apnea patients that have obstructive sleep apnea are obese. More than likely the person is obese. If they lose 20% of their body weight more than likely their sleep apnea will go away. If it does not go away they are more than likely in need for correct surgery. Dear god are you fucking obesity apologists so dense as to hate science now?
Posted by Free Busch On Tuesday on June 29, 2012 at 11:54 AM · Report this
156
migrationist@148 "When you hit about 30, your metabolism will slow down."
Mine didn't, not significantly. Like mydriasis, I have to eat every hour or two. It's a hassle, and leads to me eating more crappy food than I would eat if I only had to eat at regular meal times.

If my sex drive were proportionally as high as my metabolism, it would take a lot of effort to find that much sex, and I'd probably have a lot of crappy sex just to satisfy that hunger. Hey, now that I think about it, I've been on BC pills since I was 20 (except for the whole having children era); maybe I would have mydriasis' sex drive if I weren't happily living my life on artificial hormones.

Crinoline@154,
My experience mirrors yours. Sneaking a peek at my chart once I saw that the doctor had written down actual lies to protect herself. ("Patient admits that the situation predates the procedure I performed on her." Um, no, I said the opposite. Luckily for that doctor, I'm not litigious.)
Posted by EricaP on June 29, 2012 at 12:04 PM · Report this
157
@155 Dear god are you fucking obesity apologists so dense as to hate science now?

*shrug* I'm not the one who's flying off the handle about it. My reading of the science is quite different from yours. If that bothers you so much, well, not my problem.

Is the Mayo Clinic a fucking obesity apologist? http://www.mayoclinic.com/health/sleep-a…
Posted by Eirene on June 29, 2012 at 12:26 PM · Report this
nocutename 158
@148 (migrationist): I'm afraid you misunderstood me. You said, "I don't think doctors are sex-negative in general. I think some of them are a bit lazy and one-directional. They are trying to solve the problem they are presented with in as little time as possible." I agree. I would think that doctors are no more or less sex-negative than the general population, that sexual well-being is not routinely addressed in the health care field (at least in America), and that yes, doctors are one-directional and mandated by the insurance companies to solve the concern in the shortest time possible.

On to various points raised by mydriasis, mostly in post #147:
You seem to be blessed, my dear: high and healthy libido; bunny-quick metabolism that keeps you slender and able to pick and choose your sex partners for their jaw lines; residency in an enlightened country from which you can look down and dismiss problems that affect hundreds of thousands of people with a shrug ("oh, are you American? Yeah, I'm Canadian. We don't do/have _________(fill in the blank) here."); and the ability to read and comprehend all the literature that comes with a prescription, plus the motivation to do so every time.

But what you don't seem to have much of is empathy. You need to be told repeatedly that not everyone has your gifts, not everyone has your opportunities, not everyone has your advantages. Whether it was your out-of-hand dismissal of vaginal dryness occurring in any but geriatric women to your assumption that just because YOU read the instructions and warnings every. single. time., everyone else does, too, you repeatedly conflate your experiences and attitudes with everyone else's. Not so.

As it happens, I agree with this statement you made:
"if someone is in serious enough of a situation to be put on SSRIs - they are extremely unlikely to have normal sexual development if left untreated. Depression also has a massive effect on developing sexuality by affecting body image, self esteem, impulse control, self harm behaviour, trust, ability to feel emotional pleasure, joy, intimacy, and YES, libido. Let's not forget or diminish that."

With this caveat:

People get put on medication for depression and anxiety all the time when they might not have needed that medication. This is due in large part to the AMERICAN healthcare system, in which insurance companies, not doctors, nurses, physical therapists, psychologists, call the shots. Insurance companies aren't interested in a person's well-being; they are interested in their own profits. So if a patient is being treated for a mild case of depression by a psychologist, if the depression isn't resolved in a certain number of visits for talk therapy (generally 10-14), the therapist and the patient will be under great pressure by the insurance company to use medication instead or as a supplement to the talk therapy. A 12 month supply of Zoloft costs the insurance company a lot less than two years of once-weekly hour-long sessions with someone whose negotiated rate is even as rock-bottom low as $40 (that's the what the insurance company would be billed. If the patient didn't have insurance, that bill would be much higher.). This is one reason that some therapists will often not work with insurance companies, making their services unaffordable to all but the wealthy--they don't want to be told how to treat their patients.

Not all depression needs to be treated medically, though if it is bad enough to need medication, loss of libido is probably an example of lamentable collateral damage for the greater good. Trouble is, often the person/entity making that decision about best treatment practices isn't the trained and qualified mental health professional, nor even the afflicted person, but the insurance company employee who is following the corporate agenda.

More...
Posted by nocutename on June 29, 2012 at 12:40 PM · Report this
Free Busch On Tuesday 159
@155

You do realize that literally almost all by 2 of those factors are DIRECT SYMPTOMS OR HAVE STRONG CORRELATION OF/FOR OBESITY and one of them is literally "excessive weight" you fucking ignorant tool. How about this, Google the percent of sleep apnea patients that also suffer obesity. Most will say it is the high 80s to low 90's.

Jesus fucking christ is the whole world too sensitive anymore to deal with issues. Stop slamming cheeseburgers and start hitting the gym.
Posted by Free Busch On Tuesday on June 29, 2012 at 1:14 PM · Report this
160
@147 Some teenagers can't understand Edgar Allen Poe let alone a fucking medication info packet. So this leaves them to rely on their parents, which even in a best case scenario is a hit or miss. And I can tell you the general attitude down here is- "Oh, it's a prescription so it can't be that bad."

As for the information packet, it isn't always as detailed as it should be. Every time I've had a prescription I've read the papers both from the pharmacy and the drug manufactures (when it's available), it seems just as often as not I get hit by some mystery affliction that ends as soon as I stop using it.

Hell, I once took minocycline for twenty four days with no side affects then boom- covered in painful lesions. Within twenty minutes of the first one forming my arms were covered and it was spreading rapidly. I called the office of the person who wrote the prescription and the pharmacy, because it said I shouldn't "suddenly" stop taking it. Neither had much to say besides "sorry, we can't help" and "oh, that's strange". My grandma begged me to keep taking it, but after a week of little to no sleep I finally put my foot down. Couple weeks later I was mostly cleared up and feeling way better.

And FYI- This is the desclaimer on the bottom of most prescription info sheets;

"Important Note: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you."
More...
Posted by mygash on June 29, 2012 at 2:55 PM · Report this
161
@159:
you say it yourself: HAVE STRONG CORRELATION OF/FOR OBESITY
Correlation is not causation.

Does obesity cause sleep apnea; or does sleep apnea cause obesity?

Please cite the references for at least three studies, or one meta-analysis that obesity CAUSES (not: is correlated to) sleep apnea in more than 70 % of sleep apnea sufferers.

Thank you!

Posted by migrationist on June 29, 2012 at 2:59 PM · Report this
162
@EricaP:
I don't have to, but I do eat every 1 to 2 hours. While I was skinny as a teen and in my early 20ies, I have gained some weight in my 30ies. I am still "normal" (=healthy) weight but wouldn't be considered skinny anymore. (anecdotal evidence = no evidence.)

Most people's metabolism slows down after the age of 30. Exceptions are - exceptions.
Posted by migrationist on June 29, 2012 at 3:09 PM · Report this
163
156- Perhaps #1 on my list should be to talk to the doctor, listen to the doctor, take notes on the doctor's diagnosis and instructions, then, 2 days later, call the office and get the doctor's own notes on the office visit. Keep those records along with your own.

Under the best of circumstances, there can be misunderstandings. Maybe you don't understand some medical jargon. Maybe the doctor misunderstood something you said. Waitresses get orders wrong in restaurants too. The medical profession isn't that different. That way you can clear up the worst of the mistakes (lies?) at the time while your memory is clear.

Now on to obesity/sleep apnea-- For the sake of argument, let's say DITD is fat and his being fat is the cause of his sleep apnea, hypertension, anxiety, and difficulty getting hard. If that's the case, he probably wants to lose weight, but the cold hard truth is that losing weight is difficult. If it were easy, people would do it. Under those circumstances, wouldn't the advice be to see a doctor? And wouldn't the doctor's advice be a sensible diet and appropriate exercise? Also, hopefully, helpful usable advice as to calorie counters, cooking lessons, equipment, gyms, trainers, recipes, strategies, and support groups? It ties in with the discussion about doctors and anti-depressants. You would hope the doctor would talk about all possible strategies, medicines and side effects for a complicated and multi-faceted problem.
Posted by Crinoline on June 29, 2012 at 3:27 PM · Report this
164
Let's make this a fill-in-the-blank game:

"If fat-shaming actually worked, ___________"
Posted by vennominon on June 29, 2012 at 4:53 PM · Report this
165
@162, Exceptions are exceptions, agreed, but mydriasis is pretty exceptional and may be well into her thirties and beyond.
Posted by EricaP on June 29, 2012 at 5:14 PM · Report this
166
The gay brother sounds like a douche bag which I define as being offended by a go to the gay bars suggestion when whining like a bitch about not being able to get what is at the gay bars. Huh? The pattern appears to be have a big coming out drama fest, then when that shock value wears off start the drama about not having a boyfriend. Let me just predict that when he gets a boyfriend it will be all drama all the time.

Rolling over and saying "morning beautiful" is MUCH less common than a ripped fart. Living together is like getting preggo- not much of a middle ground, split shift, ripped farts, and all.

Finally, methinks the non-masturbating GF is not going to be very interested in toys. She just doesn't sound very interesting. Dan should have told him to DTMFA.
Posted by Professor on June 29, 2012 at 6:53 PM · Report this
mydriasis 167
@ 150

Fun fact - the brain is part of the body. Your understanding of how obesity happens is painfully simplistic.

You went to university? Big deal, so did I. That's not exactly impressive in developed countries so stop swinging it. No one's buying that bullshit here.
If someone openly admits they're willfully ignorant (to the tune of "I won't be convinced otherwise") means that they are unwilling to learn new information or look at new data.

That's called being a stupid twat, son.

Oh and by the way I'm 105, if you must fucking know.
Posted by mydriasis on June 29, 2012 at 10:20 PM · Report this
mydriasis 168
@ Nocute

Okay, look. A few things.

1. The way I come off online is different than how I come off in real life, so I'd prefer you not make any moral judgements on my character (or at least not bestow them on me) based on your intepretation of what I write. The text-only nature does not translate my sense of humour very well. There's no body language, no facial expressions, no sarcasm, no tone of voice. So the flippant side comes out more, unfortunately (when there's pompous psuedo-intellectual dickwads like that Busch guy around it certainly doesn't help my decorum). I'm actually an excruciatingly empathetic person in real life. It doesn't translate well or come out completely online.

2. I don't like talking about painful experiences with strangers on the internet. Some people do, I don't. I assure you I have had some very fucking bad ones and the whole 'oh life is so easy for you' spiel is really uncalled for.

Now to the individual points.

residency in an enlightened country from which you can look down and dismiss problems that affect hundreds of thousands of people with a shrug ("oh, are you American? Yeah, I'm Canadian. We don't do/have _________(fill in the blank) here.");

I thought I made this clear in... post 147, but maybe not clear enough. I was suggesting different cultures a possible reason why my experiences were different than hers. That was all. I specifically said 'this is a legitimate concern' (that's kind of the opposite of dismissing something, isn't it?). But Americans have a tendency to talk about their country as if it's all there is. So they'll say 'doctors' when they mean 'American doctors', etc. That's why I sometimes bring that point up.

and the ability to read and comprehend all the literature that comes with a prescription, plus the motivation to do so every time.

I wish I could remember the stat.... but I think I remember reading somewhere that prescription inserts are written at a middle-school comprehension level with just this concern in mind. They may look intimidating because they have tiny writing and tables but the actual content tends to be pretty jargon-free. Especially the side effects part.

But what you don't seem to have much of is empathy. You need to be told repeatedly that not everyone has your gifts, not everyone has your opportunities, not everyone has your advantages. Whether it was your out-of-hand dismissal of vaginal dryness occurring in any but geriatric women to your assumption that just because YOU read the instructions and warnings every. single. time., everyone else does, too, you repeatedly conflate your experiences and attitudes with everyone else's. Not so.

This is just straight up wrong, but I'll elaborate. That one comment (which I was corrected on, and I said 'thanks, good to know' to those who informed me AND which I apologized for) was meant to be somewhat humourous. Some people got it. Some people didn't. You didn't. I was making fun of myself by showing I was completely clueless on the issue. Again, my sense of humour does not always come across the way I intend it to especially online. And I apologized for it, but if you want to bring it up every week I really can't stop you.

As for the inserts. I always read them, yes. I never much considered whether other people did. It's kind of like how food has expiry dates on them. You like to read them before you eat that thing. (Or is this not common practice either). Then I found out a friend of mine didn't and I was surprised. I was suggesting that doctors probably also make this erroneous assumption. Which is why I brought it up!

People get put on medication for depression and anxiety all the time when they might not have needed that medication....

Every point you make from this part on are points I've made myself (albiet with slightly less detail, anecdotes and stats). I understand if you missed it. I totally text-spammed this week.
More...
Posted by mydriasis on June 29, 2012 at 10:48 PM · Report this
mydriasis 169
@ 156/Erica

Thank you for your understanding!
Posted by mydriasis on June 29, 2012 at 10:51 PM · Report this
170
@mydriasis:
Food usually doesn't have expiry dates, but best-before dates. The former: don't eat after expiry date! (ground meat, fresh fish, etc...),; the latter: usually safe to eat for days (yoghurt) to months (frozen pizza) to years (canned tomatoes) after best- before as long as stored properly.

Re medication inserts: last week I read that less than 50 % of Germans understand the medication inserts. (That is independent of education level.)

Posted by migrationist on June 30, 2012 at 12:48 AM · Report this
171
I've asked this question before, don't recall the answer, and am asking again: What do doctors learn about sex in medical school? When a patient comes in with premature ejaculation, inability to orgasm, sexual side effects from SSRIs, or any of the other things that we talk about here, what can the standard primary care physician be expected to know? If the primary care doesn't know the answer, what sort of specialist is called in?
Posted by Crinoline on June 30, 2012 at 8:05 AM · Report this
mydriasis 172
@171

I can't answer your first question, but I'd imagine a urologist is called in?
Posted by mydriasis on June 30, 2012 at 8:27 AM · Report this
mydriasis 173
And a quick glance a wikipedia gives this

http://en.wikipedia.org/wiki/Andrology
Posted by mydriasis on June 30, 2012 at 8:28 AM · Report this
mydriasis 174
@170

That didn't really answer my question, though.
Do you read expiry dates? Or do you ignore them.

I can't speak for Germany, (or whatever study determined that) but a quick google tells me that precription inserts are written (or are meant to be written) at around a grade 6-8 comprehension level. I first read about this in the context of why literacy is so important (and in certain places literacy is really lacking).

Which is not to say that it's not a problem that needs to be fixed. I should be fixed, in my opinion. But functional illiteracy, for example is wayyy underplayed (especially in America, from what I've read) while generous metrics of literacy catagorize the vast majority of people as 'literate' while many cannot read at a 6th grade level.
Posted by mydriasis on June 30, 2012 at 9:09 AM · Report this
175
DITD,

Talk to her. Too much internal dialog.

Do you use a cpap machine? Does it make you feel unworthy?
Posted by Hunter78 on June 30, 2012 at 9:42 AM · Report this
176
@174:
No, I usually don't read expiry dates. The foods that would come with expiry dates, I usually use within one or two days of purchase.

Yes, there are standards for writing prescription inserts. In Germany, the doctor who precribes the medication and the pharmacist who dispenses the medication are both required to highlight risks and side effects. They rarely do.
Posted by migrationist on June 30, 2012 at 12:21 PM · Report this
177
Mydriasis, I agree that teens/kids being put on meds by their parents can often result from shitty (lazy) parenting. But let's put the side effects of psych meds into perspective:

If the choice is to medicate or not medicate a suicidally depressed child, I would no more refuse anti-depressants for my depressed kid than I would refuse corticosteroid inhalers for my asthmatic kid. I would choose psychiatric medication *every* *time* -- because you can't take a dead kid off medication.

EVERYTHING you take into your body can affect your biochemistry and therefore your mood, libido, and energy level. *Everything*. That includes herbs, foods, drinks (not just ETOH but also caffeinated and energy drinks, e.g. Red Bull, Monster, etc.), physical activity, OTC medications, and the household/parental environment. Hell, just eating nothing but simple carbs can change one's mood and energy level; it's not called "comfort food" for nothing.

ALL of these have side effects. Comfort food eaters gain weight and increase inflammation; runners destroy their knees; Red Bull drinkers get tachycardic and think they're having panic attacks; caffeine drinkers have to cut back as they age because it starts to affect their sleep.
Please don't make it seem like psych meds are the only mood remedy that has undesirable side effects.

You say that mood disorders have systemic effects (which is true), but your preference for therapy over medication treats mood disorders as if they are somehow different from all other health disorders and chronic illnesses. But they aren't. The Christian/Descartian separation of body and mind is an ILLUSION, as science is increasingly proving. Serotonin, norepinephrine, dopamine, etc. are not present exclusively in the brain; they are all over your body, connecting across synapses from your toes to the nerves in your teeth, and especially are found in the "gut brain" (the nervous system of the GI tract).

This is why depressives often have chronic pain issues as well -- and why a chronic pain condition, such as fibromyalgia or rheumatoid arthritis, can cause a mood disorder like depression over time.

And as for the supposedly "powerful biological intervention" that therapy is supposed to be -- first, the only studies that have demonstrated that have been very small, non-randomized studies with methodological problems; second, I would hope that you are aware that therapy is an overwhelmingly white, educated, middle-to-upper class treatment option, historically as well as financially. As such, it is highly culturally biased.

Thus it is hardly going to be a "powerful biological intervention" for poor and working class/blue collar kids, and/or teens of color, especially if their parents have to pay out of pocket for therapy after 20 visits, when insurance covers medication at much lower co-pays 365 days a year.

In addition, therapy has never been shown in any large scale studies to help with severe psychiatric illnesses, such as schizophrenia, for which only medication works.

Your comments seem idealistically enthusiastic about a form of treatment (therapy) that is guaranteed to help only a very small slice of the population that suffers from depression, anxiety and mood disorders. But your comments also seem ideologically opposed to the one treatment option (medication) that has helped more people from widely varying demographics (regardless of class, income, or level of education) than any other treatment, and is most likely to be covered by private or government health insurance (Medicare, Medicaid). Why?

Large scale studies have demonstrated that the least beneficial stand-alone treatment for mood disorders is therapy. These same large scale studies have demonstrated that the most successful treatment is therapy combined with medication. But the same studies have also found that medication alone works better than therapy alone, although not as well as medication combined with therapy.

Yes, therapy might help some depressed teens/kids -- if the kid/teen comes from the overwhelmingly white, educated, middle/upper class demographic that therapy helps most. If they're not, though, therapy is unlikely to work as a stand-alone treatment. Should we withhold the treatment that works simply because it can have side effects?

Corticosteroid inhalers have a small but statistically significant effect on bone growth in asthmatic children who use them. Should we withhold this gold standard of treatment from them, simply because of that, despite its overwhelmingly demonstrated efficacy (in many large, double-blind, randomized trials)?

I mention inhaled corticosteroids (Flovent, etc.) specifically because my sister, who worries about side effects enormously (untreated anxiety disorder, but that's another story), asked me if she should let her sons use the RXed Flovent. I asked her, well, how often do you go bring them to the ER for severe asthma attacks?

Turns out, a lot. My point to her was, which is more important to you: that they achieve their full-non-corticosteroid-affected bone growth and height, or that they survive to adulthood? Because asthma kills kids. And so does untreated depression.

Put in that perspective, the small but statistically significant effect on childhood bone growth that inhaled corticosteroids cause pales in comparison with the side effect of not using them, which is an increased risk of death from asthma.

Yes, ideally, teens/kids with depression or mood disorders should get both medication and therapy -- with the caveat that therapy will likely be of less help the children of non-white, non-educated, and poor or working class parents, than medication will be.

We don't live in that ideal world, and despite health care reform, it doesn't look like we will be any time soon. So for the foreseeable future, the best teen/childhood depression treatment option -- and the treatment option most liberally covered by private and government health insurance plans -- remains medication.
More...
Posted by ER RN on June 30, 2012 at 12:51 PM · Report this
178
Mydriasis, I agree that teens/kids being put on meds by their parents can often result from shitty (lazy) parenting. But let's put the side effects of psych meds into perspective:

If the choice is to medicate or not medicate a suicidally depressed child, I would no more refuse anti-depressants for my depressed kid than I would refuse corticosteroid inhalers for my asthmatic kid. I would choose psychiatric medication *every* *time* -- because you can't take a dead kid off medication.

EVERYTHING you take into your body can affect your biochemistry and therefore your mood, libido, and energy level. *Everything*. That includes herbs, foods, drinks (not just ETOH but also caffeinated and energy drinks, e.g. Red Bull, Monster, etc.), physical activity, OTC medications, and the household/parental environment. Hell, just eating nothing but simple carbs can change one's mood and energy level; it's not called "comfort food" for nothing.

ALL of these have side effects. Comfort food eaters gain weight and increase inflammation; runners destroy their knees; Red Bull drinkers get tachycardic and think they're having panic attacks; caffeine drinkers have to cut back as they age because it starts to affect their sleep.
Please don't make it seem like psych meds are the only mood remedy that has undesirable side effects.

You say that mood disorders have systemic effects (which is true), but your preference for therapy over medication treats mood disorders as if they are somehow different from all other health disorders and chronic illnesses. But they aren't. The Christian/Descartian separation of body and mind is an ILLUSION, as science is increasingly proving. Serotonin, norepinephrine, dopamine, etc. are not present exclusively in the brain; they are all over your body, connecting across synapses from your toes to the nerves in your teeth, and especially are found in the "gut brain" (the nervous system of the GI tract).

This is why depressives often have chronic pain issues as well -- and why a chronic pain condition, such as fibromyalgia or rheumatoid arthritis, can cause a mood disorder like depression over time.

And as for the supposedly "powerful biological intervention" that therapy is supposed to be -- first, the only studies that have demonstrated that have been very small, non-randomized studies with methodological problems; second, I would hope that you are aware that therapy is an overwhelmingly white, educated, middle-to-upper class treatment option, historically as well as financially. As such, it is highly culturally biased.

Thus it is hardly going to be a "powerful biological intervention" for poor and working class/blue collar kids, and/or teens of color, especially if their parents have to pay out of pocket for therapy after 20 visits, when insurance covers medication at much lower co-pays 365 days a year.

In addition, therapy has never been shown in any large scale studies to help with severe psychiatric illnesses, such as schizophrenia, for which only medication works.

Your comments seem idealistically enthusiastic about a form of treatment (therapy) that is guaranteed to help only a very small slice of the population that suffers from depression, anxiety and mood disorders. But your comments also seem ideologically opposed to the one treatment option (medication) that has helped more people from widely varying demographics (regardless of class, income, or level of education) than any other treatment, and is most likely to be covered by private or government health insurance (Medicare, Medicaid). Why?

Large scale studies have demonstrated that the least beneficial stand-alone treatment for mood disorders is therapy. These same large scale studies have demonstrated that the most successful treatment is therapy combined with medication. But the same studies have also found that medication alone works better than therapy alone, although not as well as medication combined with therapy.

Yes, therapy might help some depressed teens/kids -- if the kid/teen comes from the overwhelmingly white, educated, middle/upper class demographic that therapy helps most. If they're not, though, therapy is unlikely to work as a stand-alone treatment. Should we withhold the treatment that works simply because it can have side effects?

Corticosteroid inhalers have a small but statistically significant effect on bone growth in asthmatic children who use them. Should we withhold this gold standard of treatment from them, simply because of that, despite its overwhelmingly demonstrated efficacy (in many large, double-blind, randomized trials)?

I mention inhaled corticosteroids (Flovent, etc.) specifically because my sister, who worries about side effects enormously (untreated anxiety disorder, but that's another story), asked me if she should let her sons use the RXed Flovent. I asked her, well, how often do you go bring them to the ER for severe asthma attacks?

Turns out, a lot. My point to her was, which is more important to you: that they achieve their full-non-corticosteroid-affected bone growth and height, or that they survive to adulthood? Because asthma kills kids. And so does untreated depression.

Put in that perspective, the small but statistically significant effect on childhood bone growth that inhaled corticosteroids cause pales in comparison with the side effect of not using them, which is an increased risk of death from asthma.

Yes, ideally, teens/kids with depression or mood disorders should get both medication and therapy -- with the caveat that therapy will likely be of less help the children of non-white, non-educated, and poor or working class parents, than medication will be.

We don't live in that ideal world, and despite health care reform, it doesn't look like we will be any time soon. So for the foreseeable future, the best teen/childhood depression treatment option -- and the treatment option most liberally covered by private and government health insurance plans -- remains medication.
More...
Posted by ER RN on June 30, 2012 at 12:52 PM · Report this
179
My daughter took Prozac for a year starting when she was 15 for mild depression--at the recommendation of a therapist. If anyone convinced her, it was her boyfriend, who was uptight about her lows. She did also continue to see the therapist, and that I think was very helpful to her. She felt the medicine did exactly what she wanted: just make her lows less low. I had told her the one time I tried half the lowest dose of zoloft it took away my feelings almost completely, but she knows she is less medication sensitive that me and indeed it didn't work that way for her.

Her pediatrician said adults sometimes complain about reduced sex drive, so he at least clued her in but was dismissive about it as a problem for teenagers. She doesn't talk to me about her sex life but she is still with the same boyfriend. The doctor was fairly strong in his recommendation that she should stay on it no less and no more than a year; that studies show the lowest relapse rate that way. It worked for her.

The Zoloft did raise my LDL cholesterol 30 points or more. I chose to go off it (tapering down very slowly) and when I was retested my LDL was right back where it had been before taking it. My doctor seemed somewhat convinced by my numbers and the small study I had found, but she said she had never heard of that before. So I think the problem with side effects not being taken seriously is much broader than the sexual.
Posted by redpanda on June 30, 2012 at 3:10 PM · Report this
180
Crinoline@171: you might be interested in http://www.hawaii.edu/hivandaids/An%20Es…
Posted by Eirene on June 30, 2012 at 6:41 PM · Report this
mydriasis 181
@ ER RN

Hey there - I don't know if you read all my posts (there were a lot) but just so you know, I actually agree with the vast majority of what you're saying (and said most of it myself). I just addressed things all over the place.

So since it's late and I'm tired, I'll do this quicker than usual

1. I know mind and body aren't seperate (I studied neuro) and the fact that I pointed out the interaction of insulin and depression sort of would suggest I know that!

2. My preference for therapy applies when there's an option - there often isn't, for the many reasons we both pointed out. But I think you can agree that it would be good if therapy was more available, even as an adjunct to meds.

3. Finally, re: side effects. If you look at how the thread started it was others who were saying that it's horrible that we put teenagers on these drugs because of side effects. I was the one pointing out that people go on these drugs because the illness is worse than the side effects.

So in short, I'm sorry if my posts were unclear, but I'm not against the use of medication at all.
Posted by mydriasis on June 30, 2012 at 10:08 PM · Report this
Eva Hopkins 182
A part of the problem w/ the medical system here has to do w/ the U.S.'s for profit care system. IE, sometimes it's not your Dr. dictating the best course of action for their patients, but the insurance company.

An example:

One time, when at a doctor's office, she was going to write me a prescription & checked her computer screen first. I was over her shoulder as it happened to be a small office. There were three different medicine options (a painkiller) for what she'd typed in. Each option had an emoticon next to it, arranged like a stoplight. The one she'd written down had a red colored "smiley" face with a frown; one was yellow w/ a neutral expression; one was green with a smiling emoticon.

The one she'd written down originally had been the medication w/ the red, frowning emoticon. She crossed that out & started writing down the neutral expression/yellow emoticon one. I asked her why, & what the faces meant.

Those come from your insurance, she said, & the faces represent their respective costs, & therefore how often the insurance wants us to prescribe them.

So, the frowny face doesn't relate to the medication's being addictive or dangerous, I said, just what insurance wants you to do. But you started writing down this other one.

Yes, she said, that's the one that would be most effective.

So, I'm not saying cost is never a factor, I replied, but could you please prescribe me the medication you were going to, before I heard that your decision was made by some smiley faces from an insurance company?

She wasn't thrilled, but did as I requested.

A friend of mine in college started taking an antidepressant sooner than she would have liked, as the insurance covered most of the prescription costs, but only 10 therapy appointments.

You have to be your own best advocate for your health - that's always true - but in a country where the quality of care you receive is so directly tied up with whether you have insurance or not, & then what your insurance chooses to cover, it's more true than in other places.

Sorry so chatty this thread, it hit a nerve. My experiences w/ Dr.'s have been seriously mixed.
More...
Posted by Eva Hopkins http://www.lunamusestudios.com on July 1, 2012 at 1:07 AM · Report this
183
Eirene-- Thanks. That's what I expected. Good to know that someone somewhere is doing something about a bad situation. Sad it's so bad in the first place.

I checked the Mayo Clinic page on treatment for premature ejaculation. (It's a story from 30 years ago, nothing current, but something I've been curious about.) It does mention anti-depressants in terms of the beneficial side effect. I hadn't known that.

Re: Medication vs. Therapy-- There's a 3rd possibility that no one talks about. Not considering it is the thing that bothers me the most as concerns teens. It's the get-out-of-the-bad-situation option. If an adult is in a bad marriage and that marriage is causing the individual to be depressed, the recommendation for therapy has 2 outcomes: Learn better coping skills to deal better with whatever the marriage throws at them or realize that divorce is the way to go. Same goes for job that's making the person crazy or any number of other situational factors that affect our well-being. But with teens, the sort of help that the teen often needs is one where the other kids stop bullying her, the teachers stop singling him out, her parents stop being dicks, etc. The right treatment might be a change of schools or a break from the parents.
Posted by Crinoline on July 1, 2012 at 2:43 AM · Report this
184
If this guy has sleep apnea and high blood pressure he is probably quite overweight. If he is taking blood pressure meds that totally explains the sexual dysfunction. To lose weight the best system I know of is called Metaboliq, which is designed by Dr Donald Layman, the top protein and metabolism researcher in the country. It's based on high protein shakes and eating protein and carbs in the right proportions ( not food deprivation ), so it is sustainable for life. In clinical trials it resulted in 2 pounds of weight loss per week in sedentary women over fifty, so men ( with their higher tester one levels ) get even better results. Additionally the same company that makes Metaboliq makes a health system called Qore, which addresses your core health of immunity, inflammation and detoxification. It often results in a return to normal blood pressure meaning - off the meds. These systems are designed by Doctors but are all natural, no side effects except for better health.
Posted by Sue@ConnectionsGroups.com on July 1, 2012 at 6:23 AM · Report this
mydriasis 185
@183

I'm not 1000% sure on this. But if we're talking about true clinical depression, a change of situation might help, but it's likely not to. Many depressed people change their situations and are dismayed to find that their depression doesn't disappear. It's usually much less simple than that, even with teenagers. Think of it this way. When soldiers with PTSD come home, their situation changes drastically for the better. They're safe, they're with loved ones. The mental issues should go away by your logic. But I'm sure you're aware it doesn't work that way.

Plus on a more practical level. Say it's school that's the problem and not home, a change of school might help (if the parents have the option of whisking their child away) but making friends as a new student is challenging, especially if that teenager's confidence has been shaken. If the student had specific traits (like being, or 'seeming' gay) that got him or her bullied in the first place they may just be bullied again. The other common move is to gravitate towards drug users because that group is typically the most inclusive group at any highschool "oh you get high too? you're in!".

And that's all assuming that the teenager
a. tells his or her parents that there's a problem
b. has parents willing and able to whisk him or her away

Or maybe the parents try to intervene and stop the bullying. This may lead to greater physical safety for the teenager ('zero tolerance' policies can really only enfore no violence, as far as I can tell. You can't make people be friends) but the social situation will likely get worse if this happens.

More likely, the parents don't know at all and are even a source of the problem. So then we come to removing the teenager from the home. And taking her where? Probably a group home. Maybe a foster family. Who's decision is this? How do you envision this practically working out? I can personally say that I moved out the minute I finished highschool. It got the ball rolling for me, but it didn't inherently do much to help me.
More...
Posted by mydriasis on July 1, 2012 at 6:46 AM · Report this
186
185 From the start, I've been talking about mild to moderate depression with a situational cause. Hope that helps.
Posted by Crinoline on July 1, 2012 at 8:06 AM · Report this
mydriasis 187
@ Crin

Okay, again... the fact that it's mild or moderate doesn't really change what I said.

And you seem to think there is a unique and seperate subclass of depression that is 'situational'. I thought my post illustrated why this is not true (PTSD example) and explained that even if it was, the approach you suggested (fix the situation) likely wouldn't be feasible/helpful.

Did none of that come across?
Posted by mydriasis on July 1, 2012 at 10:06 AM · Report this
188
@185/187 I understand supporting antidepressants for "true clinical depression" as you put it, but to throw out Crinoline's distinction of "mild to moderate depression with a situational cause" as somehow fictional is rather silly.

I had some episodes of depression and extreme isolation in my teens, most had an event trigger and occurred during very strained and/or desperate times when I really couldn't count on or confide in anyone especially not my family. Usually I had to wait it out the best I could using what few outlets I had at my disposal. Now obviously I don't want people to try to "suck it up" or anything like that. And my troubles were during the early beginning of social media so I didn't have to deal with that like teens do today. But I noticed what hurt me the most was having no one I could talk to, who would listen and help without judging me or trying to "fix" me. So while leaving the situation isn't always feasible, encouraging people who have young adults in their lives to create an environment where sincere exchanges can happen should be stressed. Plus, just as you mentioned talk therapy isn't always available due to financial and practical reasons, the same can be said of anti-depressants especially here in the states.

To be fair, I am biased against just taking meds for depression. My grandma's doctor did that to her, because he found her heart is declining and he knows that she and my step-grandpa would get into horrific arguments at least five times a day. They don't argue as much, but since she started the meds she's become more listless and prone to fatigue. She even admitted she doesn't like going out anymore (this was a woman who could talk three hours in walmart with a total stranger and go grocery shopping four times a week just to get some air). Some days she's more herself, but others it's just scary how different she is.
More...
Posted by mygash on July 1, 2012 at 12:09 PM · Report this
189
@185/187 I understand supporting antidepressants for "true clinical depression" as you put it, but to throw out Crinoline's distinction of "mild to moderate depression with a situational cause" as somehow fictional is rather silly.

I had some episodes of depression and extreme isolation in my teens, most had an event trigger and occurred during very strained and/or desperate times when I really couldn't count on or confide in anyone especially not my family. Usually I had to wait it out the best I could using what few outlets I had at my disposal. Now obviously I don't want people to try to "suck it up" or anything like that. And my troubles were during the early beginning of social media so I didn't have to deal with that like teens do today. But I noticed what hurt me the most was having no one I could talk to, who would listen and help without judging me or trying to "fix" me. So while leaving the situation isn't always feasible, encouraging people who have young adults in their lives to create an environment where sincere exchanges can happen should be stressed. Plus, just as you mentioned talk therapy isn't always available due to financial and practical reasons, the same can be said of anti-depressants especially here in the states.

To be fair, I am biased against just taking meds for depression. My grandma's doctor did that to her, because he found her heart is declining and he knows that she and my step-grandpa would get into horrific arguments at least five times a day. They don't argue as much, but since she started the meds she's become more listless and more prone to fatigue. She even admitted she doesn't like going out anymore (this was a woman who could talk three hours in walmart with a total stranger and go grocery shopping four times a week just to get some air). Somedays she's more herself, but other's it's scary how different she is.
More...
Posted by mygash on July 1, 2012 at 12:13 PM · Report this
190
Sorry, for the double post.
Posted by mygash on July 1, 2012 at 12:14 PM · Report this
mydriasis 191
@188

I'm not 'throwing out' her distinction. I'm telling her that there isn't any evidence to support that it exists. It's a common misconception that people have and the conclusion that she draws (fixing the situation will solve the depression) can be dangerous and delay helpful intervention (which I attempted to explain above).

Not really sure what "encouraging people who have young adults in their lives to create an environment where sincere exchanges can happen should be stressed." means in this context? I vaguely agree but not seeing your point or where you're going with it?

You mentioned yourself that not having someone to confide in played a role - that is one of the assets of therapy. Do either of you have an example of a free, feasible way that a person can fix the situation that triggered/worsened their depression? Because as of yet neither of you have suggested one. Only claimed that it would help more than therapy/medication if it did exist.

There's a lot of stigma and misconception about mental illness and even the well-intentioned ones can be harmful.
Posted by mydriasis on July 1, 2012 at 12:59 PM · Report this
192
@13 - Sleep apnea can be a cause of high blood pressure. Additionally, overweight can be also, but not all overweight people have high blood pressure. Leave your "really helpful high horse" at home...
Posted by RKS on July 1, 2012 at 1:10 PM · Report this
193
I don't know whether there's a reasonable or useful distinction to be made between endogenous and exogenous depression, but there's definitely a useful distinction to be made between PTSD and depression (speaking as someone who's had both). I suspect a lot of what we think of as situational depression might better be thought of as a reaction to trauma (though not necessarily the classic PTSD kind of reaction).
Posted by Eirene on July 1, 2012 at 2:12 PM · Report this
194
One of my teachers used to say "We have always had our psychologists," meaning that there have always been those with a talent for listening to others' troubles and helping them feel better (often elders such as grandparents, teachers, etc.). I think that's what mygash was getting at. In addition, the fact that they're volunteering the time to listen shows that they're connected to the depressed person in a way that someone who's paid to do so isn't. To someone suffering from a perceived lack of connection, that can be huge.

I do think there's a burden of proof on the therapist to show that they're providing something that couldn't be provided just as well by any sensible, sympathetic listener. I am far from certain that's always true.
Posted by Eirene on July 1, 2012 at 2:27 PM · Report this
mydriasis 195
@194

I suspect a lot of what we think of as situational depression might better be thought of as a reaction to trauma.

Which is why I compared it to PTSD. I didn't say it was the same and I thought it was clear I was using PTSD to illustrate a point, not conflating the two.

Again, yes - in a perfect world a kindly old grandfather or aunt or whatever will also magically have the kind of personality that they can nuture and validate the person and provide free of charge therapy. But this is something that is really up to chance/luck from the teenager's perspective. Not something he or she can make happen. And typically speaking, teachers don't have the time and energy to be Ms. Honey to the Matildas of the world. Oftentime the grandparents of troubled teens are just as emotionally inept as the parents that helped make those teens so troubled in the first place.

What I'm saying is that while the scenario is lovely - it's the exception, not the rule.

People typically take jobs in mental health because they're empathetic, caring people who want to help others. Dealing with people who have psychiatric disorders day in and day out is emotionally draining, stressful, often painful work. People typically don't go into it for 'the big bucks'. Do you have any friends or relatives in any of those fields? Social workers? Psychologists? Nurses? Etc?

Having been a cynical teenager not too long ago I can say that it's a cakewalk dismissing the intentions of those who want to help you. It's easy to say 'oh he's just talking to me because it's his job'. It's just as easy to say that about a teacher or guidance counsellor. A relative? "She's just talking to me out of family obligation" or whatever else.

As for the burden of proof, there's significant evidence that therapy helps people.
More...
Posted by mydriasis on July 1, 2012 at 2:54 PM · Report this
196
Ms Driasis - I'm sure you'll forgive for chiming in that my experience has led me to believe that the therapeutic professions contain a great many would-be Social Engineers, and the skilful ones are quite clever at convincing patients they're helping them while pushing them around like pawns on a chessboard. But thankfully I don't universalize my own (involuntary) experience; having defeated the therapeutic professions, I can be magnanimous in victory.

You omit those who find particular or various disorders quite fascinating and don't much care about the people to whom they're attached except as vessels, but I imagine that sort is a little more common in more physical medical lines.
Posted by vennominon on July 1, 2012 at 4:18 PM · Report this
mydriasis 197
@196

Honestly, I've never met anyone like that in my travels. I'm sure you'll agree they're probably the minority?
Posted by mydriasis on July 1, 2012 at 4:28 PM · Report this
198
mydriasis@195: I didn't say it was the same and I thought it was clear I was using PTSD to illustrate a point, not conflating the two.

I never said you did. Just because I'm talking about something you happened to mention previously doesn't mean I'm trying to tear down your point about it. I was simply reminded of something I've thought before about the difference between PTSD and depression and thought it might add to the discussion.

Nor did I say that therapists were in it for the money (though actual psychiatrists make a heck of a lot more than my family does, most of them work pretty hard for it), or impugn their motives in any way. But there is a huge variation out there, and it can be very hard to know quite what you're getting or whether it's likely to work for you, let alone trying to choose for another person. When there are maybe four to six people in your area who take your insurance and work with the right age group and have free time in their schedules for new patients, well, you get a bit nervous after a couple-three of those folks don't work out.
Posted by Eirene on July 1, 2012 at 6:31 PM · Report this
199
woah. Letter #3: A woman that only masturbated once and "didn't like" it is either A)a lying sack of shit or B) has REAL PROBLEMS.

Or - I vote C) Is both. I'm sure she is doing it AND as real problems.

Jesus - I hope this guy have any idea of what he's missing from oh, the rest of the straight female population. RUN - DON'T WALK. GET THE FUCK OUT.
Posted by LZito on July 1, 2012 at 7:00 PM · Report this
mydriasis 200
@ 198

To your first para - my bad, just wanted to be clear.

To your second para - it is arduous, expensive, and occaisonally time consuming to find an effective therapist. In small towns it can be prohibitively so. I'm aware of this and mentioned it wayyyy back up at the beginning of this thread. But I don't think it's realistic to say 'hey teenagers, meds will ruin your sex life (because depression hasn't) and therapists cost too much so what about this third option of having a personal relationship solve all your problems' a lot of teenagers intuitively are aware of that line of thinking and it usually causes more problems than it solves.

Where I live, psychiatrists (as doctors) are free, which I think makes quite a difference although I wish there were programs to make non-medical therapists accessible to lower-income individuals, especialy young people. I don't know the details but apparently there's a new initiative here that's supposed to cut down wait times for people under 25 and make sure they're able to get help if they have any sort of mental health issue.

Many people close to me have struggled with a spectrum of mental health issues ranging from addictions to eating disorders, bipolar disorder, depression, personality disorders etc. Just anecdotally, the ones who discard options ("I'm not taking medication", or "I don't believe in therapy") are the ones who fare worse, and those who are willing to engage in anything that might help them tend to show way more improvement.
Posted by mydriasis on July 1, 2012 at 7:52 PM · Report this
201
mydriasis,

Sure it's silly to think a single relationship will solve all your problems. And yes, you can cynically write it off just like you can pretend you're taking meds when you're actually flushing them. I'm not saying you can help someone with all their problems, I've just noticed that having support for the few really big problems can make all the difference when you're dealing with the smaller issues. The idea is to accept help so you can reach the point where you outgrow the need for it.

And when you say a spectrum of mental health issues, it's exactly that. I'm not saying someone who's bi-polar or has a personality disorder shouldn't take meds or seek therapy, but that's far different than the person who's dealing with bullying, a bad household, a crappy personal relationship & etc.

Appreciate the Dahl reference though.

@194 That's a lovely way to put it. And yes, it's basically what I meant.
Posted by mygash on July 1, 2012 at 11:16 PM · Report this
202
mydriasis,

I do apologize if I seem I'm being hardheaded, but I've seen too many adults I know (30s & 40s & 60s) reach for a prescription as a way of numbing themselves while they let the same nonsense go on and on and on. Just like they would turn to their liquor in the 1950s, people today seem to depend a little too much on their medicine cabinets.

Now I don't dispute these medications can help people, I just feel a little trepidation whenever the distinction of why they should be given seems rather vague and broad.
Posted by mygash on July 1, 2012 at 11:31 PM · Report this
203
Here's another way to frame the discussion: There's a difference between the way policy makers look at the problem of depression and mental illness and the way individuals do. Policy makers are the government, insurance companies, public health workers and schools. Individuals are patients, and family and friends of patients. Policy makers have to look at broad outcomes for the broadest number of people. They have to be fair. Individuals are looking out for #1. They have no reason to care what worked for the guy over there except how the information affects them. Policy makers should be suspicious of anecdotal evidence. Individuals ARE anecdotal evidence.

If a teenager goes to a doctor with mild, situational depression, and if that doctor prescribes an SSRI instead of helping her cope with her situation, and if that screws the teenager's developing sense of sexuality at exactly the point when she needs to learn what her own normal is, then I'm going to point out that the SSRI in this case was a bad idea. If the doctor pointed out that there's evidence that SSRIs are great treatment for severe depression because severely depressed patients don't have great sex lives anyway, that's irrelevant. If the doctor shrugs and says, well it's impractical to move every depressed teenager to a new school, and besides, therapy and good relationships are hard to come by, I don't care. The point, for me, is that this particular teenager got screwed.

And it's not just teens. As mygash has noted, SSRIs are the new alcohol. Instead of complaining that something is wrong and working to change it, there are too many adults of my acquaintance who reach for their daily pill. Go ahead and make distinctions on why the drugs are prescribed because it makes a difference in how the patients should be treated. Don't just say that there's nothing we can do about it if it is situational so we needn't distinguish between what's situational and what isn't. It matters.
More...
Posted by Crinoline on July 2, 2012 at 8:22 AM · Report this
204
@SAFF,

Tell your brother that I'm a happily married gay man who met his husband online. In the 35+ years since I came out, I've also met dating partners, romantic partners and friends in the following places: in classrooms as a student; in the Gay Student's organization on my college campus (and this was in the 70's!); in faculty meetings as a grad assistant and, later, as a professor; in libraries (the reference section, not the tearoom), at charity fundraising events; during intermission at theaters; in community theater companies and community choirs (cliche', I know, but that's a cliche' for a reson); at professional conferences; through neighborhood organizations; through P-Flag and MCC meetings; at bookstores; in coffee shops; and last, but certainly not least, through mutual friends. And, yes, I've met other gay men in bars, but, that is only one of many sources.
Posted by Clayton on July 2, 2012 at 8:46 AM · Report this
mydriasis 205
Don't just say that there's nothing we can do about it if it is situational so we needn't distinguish between what's situational and what isn't. It matters.

No. No. No.
That's not even close to what I said at any point.

Scientifically speaking there is no such thing as 'situational depresion'. There is no evidence for the premise you're suggesting. Period. There's such a thing as being sad about your situation, there's such a thing as situations triggering depression earlier in life, but as I tried to explain several times, taking away the situation virtually never solves clinical depression.

Though it's generally unrealistic to 'solve' any of the situations you described immediately, that's not why situational depression doesn't exist.

But clearly I'm unable to explain this concept so I give up.
Posted by mydriasis on July 2, 2012 at 11:35 AM · Report this
206
Ms Driasis - Do you mean the Social Engineers or the Disorder Lovers? I don't know that I've ever met a Disorder Lover (cross Spencer Reid with Sherlock Holmes?), but I can report that all the members of the therapeutic professions I have encountered have been Social Engineers. But I am willing to allow that there are probably as many good and honourable practitioners as exist in most professions. It may well be possible that one is more quick to pick up on similar experiences among one's acquaintance in this regard, which might make members of a particular profession appear somewhat more uniform.

Now, to close, this seems the best opportunity I am likely to have to quote the final verse of an old parody. This doesn't really reflect any personal belief, but I want to see if anyone else recognizes this, which should be worth three or four points if anybody knows without using outside references. I present the final verse of "Psychotherapy":

Freud's mystic world of meaning
Needn't have us mystified;
It is really very simple
What the psyche tries to hide;
A thing is a phallic symbol
If it's longer than it's wide
As the Id goes marching on.
Posted by vennominon on July 2, 2012 at 12:02 PM · Report this
207
Well, I wouldn't have known. My first two guesses were G.K. Chesterton and Tom Lehrer, both wrong.
Posted by Eirene on July 2, 2012 at 12:34 PM · Report this
208
If a teenager goes to a doctor with mild, situational depression, and if that doctor prescribes an SSRI instead of helping her cope with her situation, and if that screws the teenager's developing sense of sexuality at exactly the point when she needs to learn what her own normal is, then I'm going to point out that the SSRI in this case was a bad idea.

I'd like to point out that I never said the SSRI should or shouldn't be prescribed in such a case. I simply said that it was shocking that sexual development was not considered an important thing to be considered in the decision-making process, as well as in any subsequent therapy. I just want sexual development issues to be openly on the table, that's all. Certainly if SSRIs are a doubtful treatment anyway, the sexual development angle makes them even more so. But that's a different question.
Posted by Eirene on July 2, 2012 at 12:47 PM · Report this
209
206- Melanie Kafka. I have the album in the other room.
Posted by Crinoline on July 2, 2012 at 12:58 PM · Report this
210
Oops. Safka. That time I googled.
Posted by Crinoline on July 2, 2012 at 1:01 PM · Report this
211
Devil in the Details needs to see a doctor ASAP about his medical condition. Sleep Apnea and high blood pressure are some serious medical conditions and can affect his sexual performance both physically and mentally.
Posted by Asstorian on July 2, 2012 at 1:48 PM · Report this
212
mydriasis: I know this is off topic (again), but what's life for you like in Canada? I'm just curious; I know Canada isn't accepting as many Americans thinking about becoming Canadian as they did 40 years ago during the Vietnam War.
Posted by auntie grizelda on July 2, 2012 at 2:06 PM · Report this
mydriasis 213
@212

Canada's rad but it's getting less so for the moment.

Our current PM is kind of like our George Bush and he's got a few more years to go but he has no chance of doing anything big like getting rid of gay marriage or etc.

But you know... healthcare is free, I feel pretty safe even though I live in a big city, going to school is relatively affordable (it's not cheap but still). I hear a lot about the states because you're all in the news so on balance I'm pretty grateful for what we have here.

I have a really big soft spot for NYC though.
I don't know if that's a great answer but if you have anything more specific I can try to answer!
Posted by mydriasis on July 2, 2012 at 3:10 PM · Report this
XiaoGui17 214
"She didn't even reject it pre-emptively. She heard it was supposed to work, she tried, it did nothing for her."

The vital part of that post was she tried it *once* and it didn't work. ONCE? As a woman, I masturbated several times a week for several years before I brought myself to orgasm for the first time. Anyone who gives up that easily most definitely has hung ups. It's certainly not just a "I'm not into masturbation" thing.
Posted by XiaoGui17 on July 2, 2012 at 3:14 PM · Report this
215
@213: WOW---Free healthcare and affordable college education!!!
You lucky neighbors to the north must be thanking heaven that
you're NOT getting shamefully robbed and dumbed down
by greedy oil-soaked, war-mongering Republicans here in
the States!! And your looney is kicking the shit out of our
dollar, too, isn't it? Your bankers up there knew what they were
doing.

Here's another "dumb" question: what is a typical heterosexual
Canadian guy over age 47 up there like?
Posted by auntie grizelda on July 2, 2012 at 5:19 PM · Report this
mydriasis 216
@215

Haha, well. Again, it's all relative. Students in Quebec are (still?) protesting their tuition going up even though they have the lowest costs in North America. It's definitely not a perfect system but it is more accessible than it is in America (from my understanding).

In terms of oil-soaked republicans - where do you think their oil comes from? :p We have oil-soaked conservatives here, they just usually don't have evangelical motives. They're sort of toned down but they still do damage, I'm afraid.

As for the men in that age demographic I wish I could help you but I don't really know. I don't really socialize with any men that age let alone enough to compare. But I imagine the same general Canadian vs. American trends that apply otherwise (less religious, etc) will apply to that demographic too. Since I already gave the Canadian's perspective on America quote (which was clearly appreciated haha) I might as well give the American's quote on Canada. Another girl I worked with and trained was visiting from the states. I asked her what the biggest difference was. She said 'The culture! It's like everyone here is stoned all the time, you're all so mellow'.
Posted by mydriasis on July 2, 2012 at 6:03 PM · Report this
217
Well done, indeed. I think that's worth three points.
Posted by vennominon on July 2, 2012 at 6:49 PM · Report this
218
@216 mydriasis: Thanks for all the feedback on Canada! If my automotive sweetie and I can't live there, we'd love to "mellow out" and visit!! I'm ashamed to say just how long it's ben since we last crossed over the border north of The Peace Arch!!
This might just be the break we crazy forty-somethings need!!
Posted by auntie grizelda on July 2, 2012 at 10:03 PM · Report this
219
@217: Here, here! That's a hat-trick!
Posted by auntie grizelda on July 2, 2012 at 10:04 PM · Report this
mydriasis 220
@218

If you really want the 'friendly Canadian' experience go out to the East end. I've never been but everyone says it's magical. It's super idyllic there and they allegedly have the nicest people in the world.

Honestly I've travelled to more places in the U.S. than in Canada and I may end up living there for a little while. If I settle down one day I'll be coming back here though.
Posted by mydriasis on July 3, 2012 at 2:15 PM · Report this
221
@mydriasis, I am not sure if your remarks regarding situational depression are true on average or not, but from personal experience I do not think they apply to everyone's depression. I have more than once fallen into a long-lasting (more than a year) severe depression brought on by a traumatic life event such as the end of a relationship. But then, I have also more than once in my life experienced an almost instant reversal of that depression and consequent long-lasting remission brought on by a mere change of situation. These curative experiences included something as complicated as moving to a different city and country where I was more stimulated, and something as simple as having someone express a romantic interest in me.
Posted by cockyballsup on July 3, 2012 at 3:19 PM · Report this
222
221-- Cocky-- Google on "situational vs clinical depression". There's tons of reasonable difference in opinion there. My experience more closely resembles yours, so I'm inclined to agree with one of the first hits that said that it's important to determine the cause of the depression because it makes a difference to the recommended therapy.
Posted by Crinoline on July 3, 2012 at 3:35 PM · Report this
mydriasis 223
Just because something is intuitive and convincingly appears so doesn't make it true. I'll leave it at that.
Posted by mydriasis on July 3, 2012 at 5:28 PM · Report this
224
@220: Thanks! I really do want to visit the East Coast--quite possibly because of my "Maine-r" roots on my Dad's side!
I'm gonna start saving up!
Posted by auntie grizelda on July 3, 2012 at 6:02 PM · Report this
225
I think what mydriasis is trying to say (I hope I'm getting it right)is not so much that situational depression doesn't happen. Just that it's not ACTUALLY situational. I was diagnosed with depression years ago. That doesn't mean that I walk around constantly in a funk if I'm not on medication. In reality I'm a pretty happy person. However, my reaction to "bad situations" is more severe than someone who isn't depressed.
I've had funks that lasted years, but even those weren't devoid of happy moments, it was just that the crappy feeling was more prevalent. A situation may have triggered the depression, and yes, getting out of a bad situation will help, but getting out doesn't solve the problem.
Also, people who don't necessarily suffer from depression have an easier time pulling themselves away from bad situations than someone who is depressed, because when you're stuck in the middle of a depressive spell, you convince yourself that it's your fault and you need to fix it.
So while I get the concept of situational depression, I think there's a lot more to it than that.
Posted by KateRose on July 3, 2012 at 6:36 PM · Report this
Canadian Nurse 226
I wish I had started reading this conversation earlier. @225 has a great way of explaining why "situational depression" isn't as situational as laypeople think.

Another factor that mydriasis might have been hinting around is that as we've learned more about neurophysiology, we've learned that the brain is fairly elastic, and that ways of thinking actually shapes and reshapes the brain. (I'm simplifying horribly, but still trying to be fairly accurate).

So, a bad situation that leads to recurrent hopeless thoughts can change the way your brain functions. In the other direction, a severe clinical depression can be treated by working on changing thought patterns.

Posted by Canadian Nurse on July 4, 2012 at 1:13 PM · Report this
Canadian Nurse 227
In terms of meds. Some of the complication in terms of doctors talking to patients is that the packaging lists every side effect that showed up in 0.1% of the population.

So, for example, if we take Paxil, in double-blind randomized controlled trials 3% of people experienced decreased libido, 13% of men experienced ejaculatory disturbance (mostly delay), 10% of men experienced other sexual side effects (anorgasmia/erectile problems/impotence), and 2% of women experienced other sexual side effect (anorgasmia and difficulty orgasming).

So, if a female patient has depression that makes her day-to-day life difficult to cope with, is a 3% chance of decreased libido and/or difficulty orgasming going to be enough for a doctor to not prescribe the med? More women stop Paxil due to nausea, dizziness, tiredness, headache, and insomnia than who stop it due to decreased libido.

So, should doctors mention it? If they're listing the 17 other side effects that effect as many or more people, definitely. In a perfect world, there'd be time to do that with each patient. At present, I've found most doctors list the most common three side effects, the most deadly three side effects, and then encourage you to call their office if you have any other side effects they want information about. When I used to work in family practice, I had these sorts of conversations with patients every day. That said, like mydriasis, I live in Canada, so the structure existed for me to spend time on the phone with patients talking through side effects. I don't know whether that's a normal part of health care in the US.
Posted by Canadian Nurse on July 4, 2012 at 1:20 PM · Report this
mydriasis 228
@ KateRose and Canadian Nurse

Thank you for simplifying better than I ever could!

@ Canadian Nurse

Thanks for explaining why libido isn't typically mentioned in a much less rambly way than how I put it. :)
Posted by mydriasis on July 5, 2012 at 8:37 AM · Report this
229
@KateRose, so if I understand what you are saying, people who tend to get what is thought of a situational depression are often already depressives (though not necessarily depressed) before the trigger, in the sense that their brain is wired in such a way that they will have an exaggerated negative response to the trigger.

I guess I can buy that. I certainly have the tendency to fall into abject despair from triggers that others would shake off. Other positive triggers can flip the switch the other way and almost instantly remit me.
Posted by cockyballsup on July 5, 2012 at 12:57 PM · Report this
230
Just wanted to add a response to the person who made the cheeseburger comment. Yeah, no one's going to get fat eating nothing but celery and exercising 5 hours a day, but there's a lot of ways you can be fat without scarfing cheeseburgers all the time and getting no exercise.

It is entirely possible to eat fairly healthy food in reasonably moderate proportions, get at least some regular exercise, and still be fairly fat... and it's possible to eat tons of cheeseburgers, sit on your butt all day, and still be pretty skinny. There are inherent biological factors at work... some people hit the metabolism lottery, and some didn't.
Posted by Melissa Trible on July 5, 2012 at 10:24 PM · Report this
231
@Cocky, that's basically it, yes. I'm the same way. Things that would, for "normal" people be a bad situation, and upsetting, are for me weeks to months of despair where nothing can really fix it. Sometimes, when it's really horrible, medication can be a "quick fix" to at least bring me to a point of being able to function in day to day life without having panic and anxiety attacks until I can get it under control myself.
I've had a lot of practice with using meditation and sheer willpower to control panic/anxiety attacks to the point where others may not even notice I'm having one unless they know me really well (I'm sure it would scare the hell out of people to know I was having one in the middle of driving on the highway, lol). So, for me, medication is a last resort. And I typically only use it when needed. Luckily, I am one of the Americans with an AWESOME PCP who understands me, and knows that things are serious if I'm ASKING to be prescribed something. He also understands that I want to be taken off whatever it is as soon as possible.
I haven't really noticed a huge change in libido when on meds, but at the same time, I'm in that group where, if I wasn't on anything, it's not like I'd be able to attract anyone anyway, so if it did take my libido away, it wouldn't really be counterproductive to what I was attempting at the time.
And, like you, it is possible for something great to happen to swing the pendulum the other way. Usually, though, it has to be something in the same family as what set me off in the first place: Loss of relationship being the trigger, meeting someone amazing fixes it. Crazy issues at work, finding a new job, or position that both takes away the bad and gives me something to look forward to, etc.
Posted by KateRose on July 6, 2012 at 7:07 AM · Report this
232
You missed the boat Dan, on #1. Well, you gave good advice, but missed what was really going on. It's not so much wallowing in self pity that the guy is having a problem with, it's fear. He is scared to have his first boyfriend and all that entails. That's why he is staying away from bars, using online only, etc. I'm surprised you missed something so obvious and disappointed you would judge the guy as involved in his own self pity instead of being more sensitive.
Posted by twiggn on July 9, 2012 at 8:52 AM · Report this
233
232-Twiggn

You are spot on! As a gay guy, hot guys are absolutely terrifying. I get the jitters if there is mutual attraction and turn totally chickenshit around them and so therefore avoid hot gay guy situations and am still without a boyfriend like the LW minus the complaining about being single to family. He may very well have issues with body image like I do or feel nerdy and outcast and afraid to get out there. There is also the fear that you'll be rejected or meet a total psycho.
Posted by arachnar on July 10, 2012 at 2:32 PM · Report this
234
Some ant hypertensive meds as well as other meds alone or in combinations can contribute to ED or related issues. Possibly this can add to the writers performance anxiety to result in a less than satisfactory outcum, I mean outcome.
Posted by SNJ-RN on July 11, 2012 at 6:40 AM · Report this

Add a comment