Okay, y’all, so I’m going to talk about Lexapro, but I’m also going to talk about sex drive, so this may be too much information for some of you (such as say, my dad, or my aunties and uncles, or my students) — so I will kindly start with the non-sex parts, and will put a little space before the sex parts, so you can stop reading if you’d prefer. 
Ready? Onwards.
So, I started Lexapro a little over a month ago, 10 mg daily, to hopefully help with mild anxiety. I should emphasize that I don’t think I *needed* to take it, per se — I was just stressed and tense, with my neck and shoulder and upper back muscles really tight by the end of the day. Kevin wondered whether the ADD meds were causing that, but I don’t think so, because they wear off around 5 p.m. (8 hr timed release), and I was still really tense when I was going to bed. And I think I was feeling this way before I started the ADD meds a few years ago.
To recap, I started taking Lexapro in the morning with my other meds (I take Tamoxifen to keep the cancer from coming back, Synthroid supplemental thyroid hormone for my thyroid disase, and Vyvanse for ADD). Lexapro made me crashingly exhausted, so within a few days, I moved to taking it at bedtime, which was better.
It takes your body a while to adapt to Lexapro, so I tried to be patient with it. It immediately and effectively got rid of the tension, so that was good — my muscles stopped knotting up, and I stopped asking Kevin to massage my back every night so I could go to sleep. Good, yes?
However. It made me feel muffled — the best way I can think to describe Lexapro’s effects is that it was like having a thick blanket wrapped around me all the time. In some ways, maybe that made me a little easier to live with, because very little bothered me. I could listen to kids or friends being annoying (as sometimes everyone is, not picking anyone out in particular), without actually getting annoyed, which was nice. I became a more patient person.
But I also just didn’t care as much about getting things done — I completely failed to motivate to exercise, for example, for that entire month, and I’d been used to exercising daily. And while I was able to get my regular work done, I had a really hard time doing anything beyond the minimum necessary. Which is maybe good, in some ways, because I generally try to do too much and I pretty clearly should’ve been resting more previously.
Slowing down a bit was good. But it felt like too much. I was also just tired all the time — bludgeoned with it at the beginning at the month, but still there at the end. Lethargic all day long.
By the end of the month, my body had adapted somewhat, and instead of feeling like a heavy blanket wrapped around me, it felt more like a light one. But that really was still more than I wanted. I asked my doc when we spoke on Friday about cutting the dose in half for the next month, and she agreed that was worth trying. So starting on Saturday, I’ve been using the little pill cutter to cut my dose in half, taking 5 mg at night.
(She also emphasized that we could try different meds that had a similar action to Lexapro to see if they suited me better, or even different meds that functioned very differently — I wanted to try the half-dose, so we’ll hold those options for the future.)
I felt the effects pretty much immediately (I don’t know if that’s common, or if some of this is placebo effect; it feels like changes to this med hit me very clearly and directly). I felt more like myself this weekend, more energetic. Still feeling the Lexapro a bit, but more like a cozy light cardigan than a muffling blanket. The tension did come back somewhat in my shoulders, which wasn’t fun, but not being tired all the time is, I think, a worthwhile tradeoff, if that ends up being the necessary tradeoff. I could live with this.
I’m going to stick with this half-dose for a month, then re-evaluate. So we could stop right there, but I do want to talk about the sex part, so here’s the promised space break:
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So, I’d been warned that Lexapro might affect sex drive. It doesn’t for everyone, to be clear. I know people who take it, and they don’t have any sexual issues as a result.
For me, initially, I didn’t think it was affecting sex drive at all. I had sex in the first week after I started it, and it was fun and fine per usual, so if anyone had asked me then, I would’ve said it wasn’t having any effect.
I realized as the month went on, though, that that wasn’t actually the case. I’d say for the entire month I was on it, I didn’t initiate sex at all, and had no interest in sex. Sex didn’t sound particularly fun — I was more interested in watching a murder mystery, having some ice cream, etc. I think I had sex maybe once or twice in that month at most? For me, 2-3 times / week is more typical these days, as a point of reference. And this wasn’t about partner sex; I also had no interest in solo sex, which is also atypical for me.
When I mentioned this to my doctor, she got a little embarrassed, which was honestly sort of cute, but she powered through to ask me relevant questions. She first asked if I was having trouble with orgasms (no) or with wanting to have sex (yes).
Once we’d clarified where the issue lay, she then had two things to offer:
a) if I typically had ‘relations,’ as she put it, before bed, have ‘relations’ first, and then take the Lexapro afterwards
b) think of it like a train — ‘you might not feel like getting on the train, but once you’re on it, you might still find yourself really enjoying the ride’
I am still amused by her ‘relations’ and train metaphor. But I think she’s basically right about the latter — once I was on the train, I did enjoy the ride.
That’s a tricky thing, though — in the context of the almost-30-year relationship I have with Kevin, we’ve been through lowered sex drive due to pregnancy / small child exhaustion, plus chemo and post-surgery/radiation/cancer body dysphoria, etc., and we’ve figured out how to talk about that and be okay with sometimes long stretches without much sex, without taking it personally as a rejection.
We are long past needing to worry about consent issues between us. If Kev’s feeling like sex and I’m not particularly into it, but I know I’ll enjoy it fine once I’m ‘on the train,’ as it were, we’re both fine with starting that way. I can even keep watching my murder mystery for a while, if I want. (Too much information? Sorry, I warned you….)
Those dynamics are trickier to manage without that kind of solid relationship history, though. And it all makes me feel like our society is really TERRIBLE at talking about sex drive — what it is, why it might go away, how to manage it.
We’re particularly bad at the gendered aspects of it. Our society is terrible at talking about how that might play out in a heterosexual marriage, especially if both people are actually committed to joint pleasure and not inclined to subscribe to the ‘close your eyes and think of England’ plan for the wife…
So, anyway. I’m not sure I have any conclusions here. I can tell you that I noticed a clear uptick in interest on my part with the drop to 5 mg dosage, which is very nice to feel. I don’t like not having much (or any) sex drive; it doesn’t feel like me. (Says the woman who spent her 20s writing erotica. The hormones were raging back then…)
I wonder if people handled this better when we all lived in small communities and had trusted village religious leaders to talk to about how to sustain a marriage for the long haul. A celibate Catholic priest? Maybe not…
Mostly, I think we need to talk about this all more. How to do this, how to do it better in a long relationship, with all the expected ups and downs (that maybe aren’t expected if no one has ever talked to you honestly about them, and if you’ve been raised on a diet of Hollywood heat).
How to not be embarrassed when talking about sex, how to treat healthy sexual function as a priority in healthcare, and now I’m wondering if sex therapists are even covered by health insurance in America…
Anywhere, there we are. Hopefully this is helpful to some of you. If you have questions, ask. I’m no expert, but I’ll do my best to answer.
