 Good morning. Happy Tuesday. Remember, it's 11 o'clock now, QuokTalk signing in today, first new time. Welcome to Think Tech and welcome to our show today. I have a question for you. So what do you think is worse? Being depressed about having a horrible sex life or having a sex life that's depressing, or because you're depressed. That didn't come out the way I wanted it to. But it's a depressing thing anyway, because whatever way you look at it, it sucks. If your sex life is not good because you're depressed or you're depressed because your sex life is not working, whatever the reasons are, whether it's medical, whether it's psychological, physio, social, you know, we're going to talk about this today. So I've got a returning guest, wonderful, wonderful, Dr. Claire Rantry, who's here again. Welcome again from the Hawaii Psychology Collective. Thanks for having me, Crystal. It's a pleasure to be here. It was so fun last time. It was. Thank you so much, Claire, last time. We had a ball talking about plastic surgery and your personal experience and all these other aspects of it. So today we're going to focus on depression and how it affects sexual health or sexual life. Indeed. And so I think first maybe we should just talk a bit about the prevalence of major depression. This is not to be confused with situational depression, such as, you know, my pet passed away and I'm sad, or I lost my job. There are very, very normal things that occur in life and we have normal responses to them. When we're talking about major depressive disorder, things get much more serious. And statistics from 2012 show that about 16 million cases of major depressive disorder were treated in the U.S. So, you know, we're looking at about 6.9 to upwards of 9% of the general population here in the United States. Very high numbers. Yeah, crazy. And that encompasses so many different areas. I mean, where, you know, where does depression stem from or how much was it embedded in your own genetic makeup or what environmental issue has caused it? So can you maybe lay out some common depressive reasons so that we can move forward with how it affects our sex life? Sure. Well, what I think would be a good idea is to again distinguish between situational, which those are environmental factors that create a depressive response in us. It's an appropriate response to something that's occurred in our environment. When we're really talking about true major depressive disorder, we have to look at the neurochemistry. We have to look at DNA because often people will come in and say things like, I don't know why I feel like this. Life's pretty good. Nothing's really happened. But I don't want to live. I'm having suicidal thoughts. I'm incredibly irritable. I don't have any interest in any of the things that I had interest in. These are really textbook symptoms of major depressive disorder. So once we have evaluated a person and know that they're suffering from major depressive disorder, it really is not uncommon also for them to talk about how it's affecting their most intimate relationships. And this is really important and not always something that gets looked at, unfortunately, in treatment. I kind of like to talk about three aspects of major depression and how it affects sexual intimacy right now. The first one really is being self-doubt. So when a person's suffering from major depression, they don't feel good about themselves. Their whole thought field is actually distorted. So information's coming in, but everything's going through a very negative filter. I don't look good. He doesn't love me. Things are never going to be better. I have nothing to live for. So can you imagine trying to have a fulfilling hanging from the chandelier sex life when you're feeling this way about yourself? So that's a very, very important factor impacting. Is that usually come gradually or are there signs some people can actually turn in some trigger situation? Well, again, when we're talking about major depressive disorder, there's simply an onset of symptoms. So there are people that really enjoy their life, can't really target something that changed in their environment, but will start thinking in these ways. So then we're going to talk about this a little later in the show, but then we have to look at the neurochemistry. But the effects of these symptoms really, truly change the way that we think and feel about ourselves as well as our environment, including our primary relationships. So we're also going to talk about solutions. That self-doubt is a really, really big one. The next one I would say is criticism. So often people who are suffering from major depression, they're kind of hypercritical and they can be really irritable. They can be pretty angry about things. So the poor guy that forgot to put the cap on the toothpaste, who may get like, God, honey, can't you do it again? But they may get something very different from a spouse who's suffering from major depressive disorder, right? Really an over-exaggerated response. So what that creates, and a couple often is, the partner who's not suffering from major depression kind of feels like they're walking on eggshells all the time. I better not get too close. I need to stay away. So you can imagine again, what is that going to do for themselves? And it might trigger their own self-doubt and therefore kind of spiral into something themselves, right? Absolutely. Absolutely. And then I think that the third component that we need to look at, which is very prevalent in people suffering from major depression, are these unrealistic expectations. So again, keep in mind that all of the cognitions, all of the thought material are really being affected in a person who's suffering from major depression. So their expectations about their partner and about the relationship are also skewed. So for example, if I got in a big fight, which I do from time to time with my partner, it's normal, right? I'm probably not going to have the thought process of all is lost. We are definitely breaking up. He's never going to forgive me. It's hopeless. I probably will think, oh, things don't feel very good right now. I was right. I was right. He was right. Or let's fast forward this day. But you know what? We'll come back together. Right. Right. It's not the end of the line. It's not that type of severity. That's right. But in a situation where somebody, one partner's experiencing again major depression, the expectations that they can have again are really skewed and unrealistic. So it creates distance in the couple. You have to be careful with that, right? Because if you create distance every day. Oh, sure. Pretty soon you can find yourselves really far apart. And the problem is most people tolerate or try to work it out or ignore it until it's too far. Absolutely. Because if so, non-tangent, this type of depressive behavior or, you know, you can't see it and you don't know. How do people recognize when there's a serious problem and when to do something about it other than the partner saying, you need help? You know, that's almost insulting when people hear that. Yeah. Yeah. That's a really great point. People who generally come into my office are coming in because they're having issues at work, because they may have received some feedback from their partner, because they're having suicidal thoughts and they know that's not them. Because their joy and their zest for life is just gone. So that's very common for me to see in my practice people coming in with those types of presentations. All hope is not lost, though, however. Good. Right? Because depression is an incredibly treatable thing. Thank goodness. You just have to get the right good treatment. So with regard to the three components we've talked about so far, the unrealistic expectations and the criticism and the self-doubt, we can really help people restructure these unhealthy skewed thought processes. Through medication or through combination? Sometimes medication, sometimes only therapy. And really, for the most part, the therapy of choice for major depression is something called cognitive behavioral therapy. We really focus on helping a person identify where the distortions are in their thought process. And that's not enough, because we also have to teach them how to challenge these distortions instead of just accepting them as the truth. Right. Remember, just because we have a feeling it doesn't make it true. Right. It just exists. Right. The power of the mind, though. That's right. We can't stop a thought from arising, but we certainly can work with it once it's arisen. It's amazing, though. I don't know how this happens. I mean, that's the beauty of your world, is to be able to do that. But how do you, in a situation where it's affecting your partner, do you often bring the partner in? In separate occasions, you do it together. How does that work? I very often, as often as I can, I bring the primary partner in, the romantic partner, because what I've found is a little bit of education goes a long way for the partner. Right. So I will, of course, with my client's permission, invite the partner in so that I can educate him or her on what the heck is going on here. They often feel like, where is he gone? Where is she gone? Am I ever going to get them back? Right. You know, they don't know. So with a little bit of education and really helping them feel a part of the solution, it's incredible to see how empowered the partner can become and actually become a part of the treatment. Right. It's really exciting because if the partner knows how the client and I are working together, here's what we're doing, here are some of the distortions, here's what you can do. You're sharing, you're knowing how to support that at home. Incredible. But when it comes to sexual intimacy, I mean, it's almost like you're a sex therapist, or is there a fine line between the two, really? I actually work with a lot of intimacy issues in my practice. Right. So I talk about sex very frequently in all sorts of forms. Can people become depressed because they do have sexual issues? Like I said in our opening statement, people can definitely develop mood disorders or at the very least inconsistencies because they're not happy in their sex life. When we love somebody or attached to somebody and we don't feel connected to them, whether it's sexual or otherwise, of course it's likely to affect us. Some people are very proactive about solving those problems and some people just are so scared they don't know what to do. But I think that it's just so important for your audience to really hear, again, that this is so treatable. Okay. It's really treatable. You mentioned something else, Crystal, which was what about the medication piece. Yes, right. And we do need to look at that because for a few reasons, people who do choose to go on antidepressants can receive great benefit in terms of... Is it quite immediate? Usually about four to six weeks. All right. Yeah, for really all the benefits to kick in if they're going to work. Right. But sexual side effects are incredibly common, especially with a class of antidepressants known as SSRIs. Okay. They kind of keep serotonin in our brains where it's supposed to be. Yeah. A lot of people who have depression don't have enough serotonin. It's leaking. Okay. You kind of think of it that way. All right. So these SSRIs say, hey, wait a minute. You need to stay right here. Okay. And so the people might feel calmer. They might feel less anxiety. But often it just turns the dial down on their sex drive. So it's too relaxed in different levels. Kind of like, yeah. Everything's kind of flaccid. Yeah. They're kind of like a plain peaceful lake. It can really turn down the dial. You know, these antidepressants too and some people can also cause things like weight gain. Yeah. Okay. That's a really, really dangerous thing. And then it goes back to more depression. Yeah. That's right. You don't feel good about what you're seeing in the mirror. And you can see yourself gaining weight. You may not feel as attractive. It's going to be a perpetual thing. Nausea, sluggishness. You know, all of those things can be side effects, although most of the time they go away. Okay. That's important to note too. Okay. Okay. But in men, these antidepressants can actually cause blocked or delayed orgasms. Delayed. Like they have to perform for a long time. That's right. That's right. Just to reach climax. So that sometimes it may sound good. Right. But it's not a great thing. Yeah. You know, it's not necessarily a great thing when you're romantic with your partner and you see them really struggling to get to climax. That's kind of a joke. Yeah. Or why can't you? Right. Are you not attracted to me anymore? Yeah. I hear you. Come on. Okay. Now we're touching on this whole link to the problems in the relationship in their sex lives. So why don't we hold that thought? We'll take a quick break. We're starting to get into the juice. Now, what does depression do to your sex life? Don't go away. We're going to come back and continue talking about this. I'm Stan Energy Man and I want you to be here every Friday. Noon. ThinkTechHawaii.com. Watch the show. Be there. I'm hitting the full weight. Aloha and welcome to The Savvy Chick Show on ThinkTechHawaii. I'm the weekly host at 11 a.m. Honolulu time. I'm very excited for the next six weeks. We have the Aspire series, which is all about the coolest careers I could find and interviewing and getting insights from these amazing people who want to share it with you and help you live your dreams. Look forward to seeing you on the show. Aloha. Aloha. It's summertime in Honolulu, Hawaii. My name is Steven Phillip Katz. I'm your host for Shrink Wrap Hawaii. We're on every Tuesday at three o'clock and we talk about mental health and general health. Please join us. Thank you. Sexual intimacy and depression. How to keep the fire burning. This is what we want to know. We want to keep everything healthy. You know, in a relationship, it's so important to keep that going. So back to Dr. Claire Rountree talking about this. Now, we've kind of set up like all these different aspects of depression. You mentioned the neurochemical, so therefore depressive medication. And there are some therapeutic ways to do it. Now, we're linking it to your, the consequences on the sex life because you did say that antidepressants do affect your sex life, which is really horrible because that's like the one thing you want to heal. And that's like just, it's horrible. I would agree. It's really kind of a catch-22. It is. If people could just wait it out, though, for many people, the sexual side effects will decrease. But many people say, I can't wait six months or whatever the case may be. So that's what is so important for an individual to have a great working relationship with his or her psychiatrist. You can change medications. We all have individual biochemistry. Yes. So what works for me may be horrible for you. Right. You can definitely go down on the dosage and play with the dosage a bit to see if that affects. Can you combine it with other things that can help with your sex life? You certainly could. I mean, for gentlemen, I think that we all know about the Viagras and the Cialis. And again, that's something that you'd really want to discuss with your primary physician. But that doesn't counter-effect the anti-depressants. No, many people are on both anti-depressants and Viagra or Cialis. But when you say anti-depressants, mainly do reduce your sex drive. Is it so men can't perform as well? You said previously, it takes longer, or they can't even... Sometimes it's very difficult for them to get an erection or sustain an erection. And so often what I've seen in my practice I'm about 20 years in now, men will choose their sex life over the anti-depressant. And this is really complex issue because you really have to look at overall quality of life. Right, right. So a lot goes into really helping somebody live what they believe is their best life when we're trying to treat them for major depressive disorder. And it's so imperative, not just for the person who's in a relationship I want to add, but also for singles. Imagine being single and having had a pretty okay sex life and to have no desire or not feel attractive. Exactly. That's probably the worst thing to start with. That's really scary for somebody who doesn't have an erection. Does it mean they have no drive? Not only do they feel unattractive or low self-esteem, but they have no drive. Or do they want it, but they can't feel it like it doesn't connect? So often how it's been described to me over the years is it just doesn't matter. It's not even something that I'm thinking about. Could, could not, really don't care. Maybe I'd rather be reading a book. Or would men try and opt for more things like masturbation or porn to release in a different way? That's a whole nother show that we could really get into to your believing. You talked about porn last week. Yeah, absolutely. But yes, men definitely who are having trouble getting an erection, sustaining an erection, reaching climax, you'd better believe that the majority of them are going to try to come up with solutions. Right? I know I would. Right. I know I would. So whether or not they work is kind of really a different thing, especially when they're experiencing this as a result of or comorbid with their major depressive disorder. It's just really important as providers that we help people get back on track with this. Right. Because a healthy sex life, you know, really is correlated to, I do feel pretty good about myself. And I do want to participate. Right. Yeah. So, you know, when people say, oh, I'm not in the mood, you know, women, you can just write it off as being kind of that time or just the way a woman works. But if it is triggered by medication for the woman's side, how do you help that situation? Or do you have like a case where there have been women who have been depressed and it's dramatically affected their relationships and what to do? Too many to talk about. But, you know, one that comes to mind, of course, I'm not going to use any identifying features. But I was seeing a couple and I think I ended up seeing them for probably close to a year, pretty regularly. It was the woman who was very, very much suffering for major depressive disorder. She felt horrible. Felt horrible about herself. And in this case, she really developed the sense that I don't know why he's still with me because I can't do anything. I can't really support her. Sexual relationship. I'm no good, et cetera, et cetera. So here we go with all of these distorted cognitions. The husband who loved her very much, loved his wife very much, felt incredibly helpless. It's a very powerless feeling to kind of come home day after day, right, and be around really the negativity and the sadness. It can be crippling. So I found in the year that I spent with this couple really what helped so much among a few other things, but was ensuring that the husband was right there with us in the treatment room, hearing the techniques that I was using with her, actually being able to ask questions or say, here's how I'm feeling. I'm mad. Or I'm confused. So this went on little by little, but again for about a year. In this case, she did get on some medication, not an SSRI, another class of medication, which was a bit better in terms of sexual side effects. It can really vary again person to person. The combination of the therapy, the support of her partner, changing her distorted thoughts, really produced a beautiful outcome, I'm happy to say. Good. But that again takes two, and you really have to have that supportive partner to really be there for that person and really just to hands on down to that support. But what about in terms of the actual practice, let's say they've sustained, let's say they hadn't had a sexual relationship for months on, and it's really not healthy and you're encouraging them to go and give it a try. Are there specific activities or do you make it into like a project or like homework? I do, absolutely do. So for a couple who has not been sexually intimate in terms of intercourse for some time, typically what I will do is we're not going to start with intercourse. That's become the big elephant in the room. So we're going to take that off the table often. In every case it's different. So I really encourage couples through therapeutic homework assignments. They could do or not do them, obviously, up to them. But let's get back to the basics. Let me spend a couple of minutes looking into your eyes or telling you that I love you or telling you thank you for sticking by me. I know this is hard on you. Holding your hand. Yes. Spending just a few steps. That's right. Being tactile is very important. So is the verbiage. Yes. We've been made that, don't they? I think men do too. Men do too, you're right. I mean, you've been married or been with someone for a long time. It's very hard to do that. It's painful for a lot of people. It's also incredibly powerful when we do it. Yes. I cannot tell you the effects that just taking 60 seconds out of your day to just look at your partner and say, I really appreciate you. I still find you attractive. That really, really can create a much, much lower barrier to entry. Yes. No pun intended for sexual intimacy to come back into the relationship. So I do assign a lot of homework assignments related to touch. Okay. And they get increasingly kind of more intimate. Right. As we go along, as long as both parties are feeling confident. And I have found that in doing so, couples really love coming back in and reporting to me. Guess what we did? That's the grace, isn't it? Are we able to do this? And you see their eyes light up. The energy in the room lifted. It must be. It must. It's really wonderful. And for that person suffering from major depression, it's really a victory. Yes. Because they're demonstrating to themselves that they can actually get behaviorally active and change an outcome. They've been feeling really rotten. Yeah. But here, they're invested. They're empowered. They're doing something and it feels good. Right. And I like that you said that you don't have to go straight to sexual intercourse. There are so many intimacies that you can explore with a partner. It doesn't have to be. You can't say, oh, I haven't had sex with my partner for years, but you could be intimate. That's right. So many ways. Again, we're all different. So we do have to find some of the things that appeal to us. Yeah. That are maybe not totally outside of our comfort zone. Okay. You know, for some people, that would be to watch an erotic movie together. Right. I was going to say, are there other tools at the innate parts or imaginative sensitivity? Sure. Some people really love playing with toys. Yeah. They like to go on a trip to the sex shop together. Right. Some people, again, will focus more on the affection components. Right. Really? Depending on them. Then the more erotic sexual components. And that's really just so important to understand in the therapeutic relationship with my patients. Right. Who are they? It's very individual. It's going to work for them. That's your craft. That is your talent. And, you know, again, that's your amazing talent. But when it comes to the physiological aspect, so we say we have all these tools to help create an intimacy and to build it up. But in fact, if you are, let's say the woman's just so dry and just can't enjoy or the man can't get it up or, you know, all those type of physical situations. Those individuals, it's imperative, and I really, really try to bring this home with them. We have to revisit your medication. Okay. We have to revisit your medication because it isn't a winning situation. If you're a little less anxious, perhaps, less calm, but you could give two rips about sex because that's not you, right? So then we look at quality of life and I work with that individual psychiatrist to say, let's try something else. Let's lower the dosage. Okay. Very, very important to have that cohesive treatment team in place, especially for cases like this. Right. So it's really a balance. What about those single people you're talking about? How are they going to go and... Single people are really fun to work with. I really enjoy working with them around sexual intimacy issues in my practice. Again, we still have to treat the depression. Yes. That's just a root, right? That's what we're talking about today. Do you encourage them to tell their potential partners that they are depressed? I mean, how much of that do you keep to yourself? Well, that's a great question. I typically wouldn't necessarily say you need to tell them on this first date. Right. So a relationship is built in general through levels of self-disclosure. Yes. Over time. So it isn't necessarily healthy to vomit everything out about yourself on the first date. Right. So I try to empower those types of individuals to make their own decisions. Okay. And we really look at their motivations for making the decisions that they're making. And I definitely encourage them, where are you getting social satisfaction? Where are your connections? Do you know how to make connections? Yeah. You know, tell me. Tell me about your sexual history. Let's look at that. So again, many, many variables that go into that, but just because somebody isn't in a relationship doesn't mean that having a healthy sex life is unimportant. Absolutely. Yeah. It's very important. But going back to the pre-diagnosed depression is how do people find, when do they need to seek help? Or when do you know it's like a serious problem? I highly recommend that if somebody is experiencing an incredible amount of sadness that's affecting their ability to do the things they enjoy, that's affecting the health of their relationships, that may or may not be also affecting their participation in their career, don't let that last beyond 30 days. Get in to see a provider. Again, it's incredibly treatable. There's no reason to suffer. In fact, about 82% of people that come in for treatment report significant symptom reduction. As long as they get good treatment. So you need to be aware of your behavior, though. Again, going back. Yeah. So if in this short time, Claire, would you have any recommendations or just positive thoughts for our audience to take away? And if they do have problems, how to even reach out to you? Sure. Well, there's hope. There's hope. You don't have to live this way forever. And if anybody is interested in scheduling an appointment, you can contact the Hawaii Psychology Collective at 840-0787. We have wonderful providers that would be more than happy to help you with this or any other situation. Right. Thank you, Claire. Again, it was wonderful. Lots of things to think about. And you know, take it with you. Keep that intimacy going and just keep that fire burning for everyone, right? It's a good thing. Have a great day and thank you again, Claire. Thank you.