It was an unseasonably warm day in June, with the temperature hovering in the high 80s. Sandy thought it might be cooler by the waterfront. So when she finished breastfeeding her 7-month-old daughter, Haley, she put the baby into the stroller and headed down to the water.
As Haley slept, Sandy sat on a bench, letting the gentle breeze sweep over her body and watching the sailboats and jet skis go by. It seemed like a metaphor for how she had been feeling lately.
Ever since she’d had the baby, Sandy was nothing more than a spectator in her own life. She hadn’t gone out with friends, or her sister, in weeks. She couldn’t remember the last time she enjoyed a good laugh or was really excited about anything.
Despite her mood, Sandy convinced herself that she wasn’t suffering from depression. After all, she wasn’t weepy, and she hadn’t lost her appetite. Sometimes she enjoyed sex when her husband, Kevin, initiated it.
After more than an hour lost in thought, Sandy decided to head home. As she and Haley passed in front of the local ice cream parlor, she heard a voice call out, “Sandy, you stranger! Where have you been?” It was Julie, her neighbor. “Come in and join me for some ice cream. I just ordered a sundae, and I can’t eat it all.”
“No thanks, Jules,” Sandy found herself saying. “Kevin will be home soon.”
Sandy continued up the hill to their apartment, contemplating the excuse she had just given. Sandy wasn’t surprised that she hadn’t wanted to hang out with Julie, whom she found too self-centered. What did surprise her was that she had turned down ice cream. She never turned down ice cream! Sandy didn’t know why, but that day, she just wasn’t interested.
Judging by Sandy’s story, she is not suffering from severe depression. The classic symptoms—feelings of hopelessness and anxiety, changes in sleep patterns, a desire to self-inflict harm—result from a deficiency in the neurotransmitter serotonin. (You’ll find an in-depth discussion of various forms of depression a bit later in the book, in chapter 12. For now, if you are experiencing the symptoms described above, please seek help from a physician or mental health professional as soon as possible.)
Instead, Sandy has mild depression, brought on by a deficiency in dopamine. This neurotransmitter is responsible for anticipatory drive—that is, the pursuit of pleasure. Clearly, Sandy isn’t interested in pleasure. She doesn’t think about what would be fun or feel good. She can’t see that if she’d go out with her friends or sister, she might have a good time. She even passes up ice cream, something she relished in the past.
Surely, Sandy doesn’t have much of a sex drive, either—even though she enjoys sex when her husband initiates it. What we call sex drive or libido is, after all, a specific kind of anticipatory drive. If Sandy doesn’t look forward to sex, of course she won’t want it.
What causes dopamine deficiency? Doctors can’t always pinpoint the cause. But in Sandy’s case, she has two major risk factors: breast-feeding and chronic sleep deprivation that started with the birth of her daughter.
As mentioned in chapter 6, breastfeeding increases production of the hormone prolactin. Levels of prolactin and dopamine are inversely proportional. That is, when prolactin is high, dopamine is low, and vice versa. Dopamine may not return to normal for several months after a new mom stops breastfeeding.
As for sleep deprivation, it has a profound effect on the biochemistry of the brain. Altered sleep patterns, such as those that follow childbirth, not only reduce dopamine but change the levels of almost all neurotransmitters. In fact, in women with a prior history of depression, one of the most significant risk factors for a recurrence is sleep deprivation.
Can your doctor measure your dopamine level to see if you’re running low? Not easily. Researchers have studied dopamine using positron-emission tomography (PET) scanners and radioactive labeling, but generally, these diagnostic techniques are not available outside of a laboratory setting. You and your doctor must rely on symptoms of diminished anticipatory drive to identify a dopamine deficiency.
For the fifth time in 7 years, Janet made a New Year’s resolution to join a gym and lose some weight. This time, however, she seemed to get over the hump. She continued her workouts well past mid-February, when she had given up before.
By mid-May, Janet was 10 pounds lighter and much firmer. She felt comfortable parading around the gym in her Lycra shorts and sports bra. She drew plenty of leering glances from the hard-bodied regulars, but she didn’t mind. In fact, she enjoyed it.
Janet felt better outside the gym as well. She showed more confidence at work. Her concentration improved, and she wasn’t as restless as before. Her relationship with Brian, her semiserious boyfriend, also heated up. Their sex life burned with a new fire.
Janet always had been a willing participant in bed. She enjoyed sex, and more often than not, she experienced an orgasm. But recently, she noticed that she was thinking about sex more. She had frequent sexual fantasies, and she didn’t hesitate to initiate sex with Brian. “I can’t remember when I felt so…so horny,” she confided to her best friend, Lauren.
If you suspect that you may be running low on dopamine, how might you go about increasing the hormone? In Janet’s case, she stumbled onto one of the most effective treatments: exercise. Regular physical activity stimulates production of dopamine as well as other hormones called endorphins. They are responsible for the “high” that comes after physical exertion.
Of course, exercise has other benefits that improve the quality of your life both inside and outside the bedroom. It can enhance your fitness level, muscle tone, and stamina, all of which can pay dividends for your sex life. If you are overweight, it can help melt away the extra pounds and possibly improve your body image. (We discussed this in much greater detail in chapter 4.)
If exercise by itself doesn’t do the trick, your doctor may prescribe one of several medications to increase dopamine. The most common of these is Wellbutrin (bupropion), a dopamine reuptake inhibitor approved for the treatment of depression.
Several studies have shown that Wellbutrin improves libido and orgasmic potential both in depressed and in nondepressed women. In addition, the drug appears to reverse the negative sexual side effects of selective serotonin uptake inhibitor (SSRI) antidepressants such as Paxil (paroxetine), Prozac (fluoxetine), Zoloft (sertraline), and Celexa (citalopram). Up to 75 percent of women who take SSRIs report a decline in libido, and 35 percent either have great difficulty achieving orgasm or don’t climax at all. If a woman who is suffering from SSRI-induced sexual dysfunction adds Wellbutrin to her treatment regimen, she likely will regain her libido, as well as her ability to experience orgasm. She also may notice improvement in her energy level and motivational drive, both of which can be blunted by an SSRI.
Two new dopamine-like medications—Dostinex (cabergoline) and Uprima (apomorphine)—have shown great promise in treating low libido. In a study published in the International Journal of Impotence Research, researchers gave Dostinex to 60 healthy men. Before taking the medication, the men needed 19 minutes, on average, to regain an erection after ejaculation. With Dostinex, they were able to climax several times within a few minutes.
Usually, the amount of the hormone prolactin in the brain rises after orgasm. This acts as a negative feedback mechanism, inhibiting intercourse for a while. Dostinex prevents the increase in prolactin, thereby allowing the men in the study to quickly regain their libidos and experience multiple orgasms in rapid succession. Even better, the drug produced no noticeable side effects. This research supports the theory about dopamine steering sex drive and orgasm.
Researchers are in the process of testing Dostinex in women to see if it has the same benefits for libido and orgasm. In the meantime, it has been approved by the FDA for the treatment of Parkinson’s disease, a neurological disorder caused by a deficiency of dopamine-producing neurons in the part of the brain that controls movement.
Uprima also increases dopamine. It has been approved in several European countries for the treatment of male erectile dysfunction. Uprima is different from most medications because it comes in sub-lingual tablet form. In other words, the tablet is placed under the tongue, where it quickly dissolves and gets absorbed into the bloodstream. This delivery system speeds the effects of Uprima, allowing men to achieve erections in less than 20 minutes. (By comparison, Viagra may take up to 90 minutes to produce results.)
Uprima had been under FDA review, but the manufacturer, TAP Pharmaceuticals, retracted its application for approval because clinical trials showed two significant side effects: Up to 20 percent of men taking Uprima experienced nausea, and 0.6 percent reported fainting—neither of which can be good for sex drive! The manufacturer is working to modify the drug’s formulation to help limit these side effects. Research focusing on women also is under way.
For the sake of completeness, we should mention Mirapex (pramipexole) and Requip (ropinirole), which are two dopamine-like medications approved for Parkinson’s disease and restless leg syndrome. Anecdotal reports have described increased libido (and even hypersexuality) in Parkinsonian patients taking these medications. Unfortunately, the side effects of nausea and dizziness will probably limit their usefulness for the majority of women experiencing low libido. However, science may be coming to the rescue. Scientists employed by Pfizer Inc. presented data at the 2008 Congress of the International Society of Sexual Medicine for a new dopamine-like drug. This drug, which showed great promise in animal studies, works on only one type of dopamine receptor, thereby increasing libido but limiting nausea and dizziness.
Before we wrap up our discussion of medications that can elevate dopamine, we must acknowledge that none of these pharmaceuticals has received FDA approval specifically for the treatment of low libido in women. For this reason, we recommend trying them only under the close supervision of a health care provider who’s familiar with them as well as their potential side effects.