But search as I could for a good explanation, I could find none. Though his symptoms and distress were quite real, I told him he did not have a major psychiatric problem that required treatment.The author also notes that he is completely unaware of any evidence-based biological explanation for the depression:
Little is known about what happens in the brain during sex...The research literature is virtually silent on sex-induced depressionSo the author admits he has no psychological or biological explanation for the condition. What does he do? He assumes the explanation is biological and prescribes drugs:
When physicians run through the usual treatments to no avail or find themselves, as I did, in uncharted territory with little evidence as to what to do, they can consider so-called novel treatments. Often, you design such a treatment based on your speculation about the underlying biology of the syndrome at hand. This can involve using approved drugs in situations for which they are hardly ever prescribed.When the drugs work (he used SSRIs), at least he admits he doesn't know why:
(T)here are at least three possible reasons my patients felt better: The drug worked; it had a placebo effect; or there was a random fluctuation in symptoms — they would have improved if I had done nothing.He does (what I'd consider) the ethical thing and suggests his patients stop the drug. They did, and in both cases...
...the symptoms came back and then abated with the drug — suggesting, based on this admittedly small sample, that the drug effect was real.But he's wrong on that. There's no reason to rule out the placebo effect based on his observations. If it was the placebo effect when they were taking the drug the first time, it would make absolute sense that the symptoms would come back when not on the drug and be abated with the drug.
Anyway, I have to admit I like this line:
After just two weeks on an S.S.R.I., both said that while sex was less intensely pleasurable, no emotional crash followed.Reminds me of an old song, Happy Town, by Jill Sobule (from which this title is pilfered).
My boyfriend Bob he said I made him miserable But we stayed together 'cause the sex was really good And then he packed his bags with me to happy town We don't fuck anymore but we can really snuggle down