“Being adapted to a profoundly sick society is not a good measure of health,” said Jiddu Krishnamurti (1895-1986), thinker, teacher, philosopher, and lecturer. The gregarious nature of the human being seeks to live in community and be recognized by his peers.

The conflict appears when the individual notices that in order to be accepted by society and to obtain the benefits of said adaptation (material goods, family, partner, fame and prestige) he must do things that may go against his health, his own vision of the world and its principles. Fortunately, or unfortunately, not everyone has the flexibility of Groucho Marx: “These are my principles, and if you don’t like them I have others.”

The Headway Mental Health 2022 report on mental health positions Spain as the country with the second most cases of mental health disorders in Europe, behind Portugal. In addition, both countries are the only ones that exceed 20% of cases, that is, one in five Spaniards suffers from some mental health disorder. The pandemic has added fuel to the fire, but everything cannot be blamed on the virus because, according to WHO estimates, in 2017 Spain was already the tenth world power in the consumption of antidepressants.

“In recent years we are witnessing a high increase in what I call adjustment disorders, such as depression and anxiety,” says Jose Antonio Lopez, a psychiatrist with a practice in Madrid and former vice president of the Spanish Association of Private Psychiatry. “They are also known as minor psychiatric disorders, but I prefer to call them adaptive because they are derived from the society and lifestyle in which we are immersed. In addition, they affect the female gender more, since out of every three cases, two are women. I collaborate with an NGO called Andalusia for a New World and that has projects in Malawi. Well, there you can find people with schizophrenia or neurosis, but depression and anxiety are unknown to them”.

The sexual life of a person who suffers from these mental disorders and who has to take medication is not only limited by the disease itself, but also by the remedy. “All selective serotonin reuptake inhibitors (SSRIs) decrease desire, and those that do not touch serotonin (there are two or three) are not as effective,” says this psychiatrist. “So you enter a vicious circle, because sexuality is already affected by these disorders and, wanting to cure them, desire is suppressed. Thus, these patients are deprived of their sexual dimension, which could help them improve their state of mind and, in addition, problems may appear in the life of a couple”.

Despite the fact that science advances and discoveries follow one another, in terms of psychiatry there has not been much to celebrate in recent decades. “There is no research into new drugs or remedies to treat these conditions with fewer side effects. Pharmaceutical companies seem more interested, right now, in the field of cardiology and endocrinology, but not in mental illnesses”, says Jose Antonio Lopez.

Weekends without medication

According to this psychiatrist, “the most frequent request when you prescribe SSRIs is, if the patient is a man: ‘Please, don’t let my libido decrease’ and if he’s a woman: ‘Don’t let me get fat.’ Psychiatrists have a serious problem with this, because there are not many options and the treatment of these disorders can take years. Sometimes men are prescribed Cialis, a drug that promotes erections; but for them there is nothing, although it is also true that female sexuality and desire are very complex factors. On one occasion, years ago, I met a psychiatry guru at an event and asked him what solution he saw for this problem and he replied: ‘Weekend drugs free. It is the only one, possible’. Today, many people leave the medication during the 48 hours of the weekend, as the maximum time, to suffer less from its adverse effects and to be able to recover something of your sexual life. It doesn’t always work, and I’m not a big fan, but a lot of people already do it and on Monday they resume their routine”, says Lopez.

Bipolar disorder, the subject of a recommendable episode of the Modern Love series (starring Anne Hathaway), is on the rise as well. Although, as Lopez points out, “we must not confuse bipolarity, which has a very large genetic component and which is very easy to diagnose (with its alternating depressive and euphoric phases), with an unstable personality. They are different things. To treat bipolarity, mood stabilizers are given, which affect libido less.

Anne Hathaway, in an episode of the first season of ‘Modern Love’ (Prime Video).

Mental disorders improve a lot if some type of therapy is done that helps to understand the situation. What’s more, in mild cases, they can be solved without medication, but not everyone can afford to pay for a psychologist or psychiatrist (we don’t even talk about the Spanish public health system in this area anymore). As a consequence, the vast majority will have to anesthetize their vital anguish with antidepressants or anxiolytics and suffer their side effects.

Binge eating disorder

Food has gone from being our fuel to fulfilling other functions: it can be a gratifying element, the only source of pleasure available just by opening the fridge, supplying love or affection and acting as an instant anxiolytic.

“Eating disorders (ED) have increased and women represent 80% of the people who suffer from them,” says Susana Rodriguez, a psychologist specializing in eating disorders who works at the Susana RodVar Integral Psychology Center in Seville. “Men also suffer from this disorder, although to a lesser extent, and they take longer to seek professional help. The age ranges are expanding; They have already decreased at 12 years of age (there are already 10-year-old children hospitalized) and we are beginning to see them in people of mature age”.

“The so-called binge eating disorder is an uncontrolled impulse to eat everything, which only ends when the food is finished. Unlike bulimic binges, here there are no compensatory behaviors, no feelings of guilt, and people can indulge in several a day,” says Susana Rodriguez, a psychologist specializing in eating disorders. 

Anorexia, vigorexia and bulimia, the most common eating disorders, are now joined by a new one: “The so-called binge eating disorder is an uncontrolled urge to eat everything, which only ends when the food has finished. Unlike bulimic binges, here there are no compensatory behaviors, no feelings of guilt, and people can have several a day,” explains Rodriguez.

The treatment of EDs must be multidisciplinary, because there are many spheres to heal, including sexuality. Hence, in this clinic they have sexologists. “In all these disorders there is a common base, which is body dissatisfaction. In Spain, seven out of 10 adolescents disagree with their body”, points out this psychologist. “Anorexic people hide their bodies and avoid sexual contact. In fact, we have patients in their 50s who are still virgins. There is a lack of desire and excessive control, and in men a difficulty in maintaining an erection. On the contrary, the bulimic presents a compulsive sexuality, although without a pleasant base, since later he feels bad; but the fact of maintaining relationships makes him perceive himself as valuable. In those with vigorexia,

The treatment of eating disorders begins with a renutrition to then move on to work on the psychological and sexual sphere. “Self-concept, self-esteem, self-image. We try so that the patient does not see the body as his enemy, quite the contrary. A vehicle that, if we take care of it, gives us autonomy, well-being and pleasure”, says Rodriguez.

What to do if medication is an obstacle in relationships

Thinking about an erotic life when you have depression is not very common. Neither on the part of the sufferer nor on the part of the health professionals, who relegate it to the end of the list. “Thinking about it is frowned upon and people avoid talking about it,” says Antonio Daniel Garcia Rojas, psychologist, sexologist, director of the Department of Pedagogy at the University of Huelva and member of the Spanish Federation of Sexology Societies (FESS). “Therefore, the first thing to do, from the point of view of sexology, is to treat communication in the couple. That the person who suffers from depression or anxiety express their situation, their fears, the effects of the treatment, since it is important to verbalize it and feel understood”.

As sexual performance is not the same, partly due to medication, it may be tempting to bury sexuality until fully cured, but it is the worst thing to do. “What we propose is to carry out other types of practices outside the coitus format. A sexuality where the affected person plays a more passive role and focuses more on sensuality, on feeling, rather than on doing. Explore new stimuli, spaces, games, massages and try to discover where the desire activation button is. Indulge yourself and allow yourself things (in any sphere of life) so that the sadness dissipates”, proposes Garcia Rojas. Desire can sometimes leave us. Rather than waiting for him to come back, we can try to find him again; because, if we look for it, in the end we will find it.

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