The link between sex and depression, a doctor’s perspective

from “Sex and Depression: In the Brain, if Not the Mind” in The New York Times, by Dr. Richard A. Friedman:

Recently, a psychoanalyst colleague — a man known for his skill in uncovering psychopathology — called me about yet another case. He was puzzled about a 24-year-old man whom he viewed as psychiatrically healthy except for intense depression that lasted for several hours after sex.

There is nothing strange about a little sadness after sexual pleasure. As the saying goes, after sex all animals are sad. But these patients experienced intense dysphoria that lasted too long and was too disruptive to be dismissed as mere unhappiness.

Still, the temptation to speculate about psychological explanations of sexual behavior is hard to resist. Psychiatrists like to joke that everything is about sex except for sex itself, which is another way of saying that just about every human behavior is permeated with hidden sexual meaning.

Perhaps, but I wondered whether in these cases, it might be nothing more profound than a quirk in the neurobiology of sex that made these patients feel awful.

Little is known about what happens in the brain during sex. In 2005, Dr. Gert Holstege at the University of Groningen in the Netherlands used positron emission tomography to scan the brains of men and women during orgasms. He discovered, among other changes, a sharp decrease in activity in the amygdala, the brain region involved in processing fearful stimuli. Aside from causing pleasure, sex clearly lowers fear and anxiety.

The anthropologist Helen E. Fisher, of Rutgers, used functional magnetic resonance imaging to look more broadly at the neural circuitry of romantic love. She showed a group of young men and women who reported being passionately in love a photo of their beloved or a neutral person. Subjects showed marked activation in the brain’s dopamine reward circuit only in response to the beloved, similar to the brain’s response to other rewards like money and food.

Could it be that some patients have particularly strong rebound activity in the amygdala after orgasm that makes them feel bad?

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