You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults With Attention Deficit Disorder (35 page)

To our knowledge, there is no research that specifically looks at ADD and sexuality, but here are a few tidbits from studies of the neurology of sexuality:

• Having sex increases dopamine activity in the brain. Of course, the studies that reveal this fact talk about copulating rats, guinea pigs and the like. However, almost everything we know about the human brain is the result of neuroscientists scrutinizing the behaviors of various rodents.
  
• On the flip side, dopamine is a major player in the creation of sexual desire. So we have a variation on the chicken or the egg issue. More sex equals more dopamine, and more dopamine equals the desire for more sex.
  
• Norepinephrine facilitates orgasm, while serotonin inhibits ejaculation and orgasm. In plain English, norepinephrine opens the door to the big “O,” while serotonin closes it.
  
• It is not a matter of taking a lab test to determine the correct level of each brain chemical—it isn’t even possible. Healthy sexual functioning is a matter of the
  balance
  between the different neurotransmitters.
  

What does this information mean to us ADDults who are far more interested in our own sex lives than we are in the bedroom behaviors of laboratory rodents? Well, we know that dopamine, norepinephrine and serotonin are big factors in producing the symptoms of ADD. The jury is out on exactly how these brain chemicals interact to
produce the symptoms, but
the balance between them is critical to optimal human functioning.

Since we know that these neurotransmitters are out of balance in ADD, and we know that they are important to sexual functioning, it stands to reason that ADDults would experience “differences” in the sexual realm. That is exactly what we have discovered in the course of our work with ADD adults. The following
information is anecdotal:

• Many ADDults have revealed that taking stimulant medication for ADD boosted their libidos dramatically. This makes perfect sense, since stims are known to increase dopamine activity, and dopamine increases sexual desire.
  
• For some, the increase in desire led to more frequent and varied sex, while for others it fostered a more intense and pleasurable fantasy life.
  
• Quite a number of ADDults reported differences in sexual desire on different doses of medication. In other words, the changes are dose related.
  
• Of course, as we have stated previously, most people (up to 80 percent) experience a decrease in sexual functioning when taking SSRIs. In some cases there is a lack of desire, while in others the problem is with reaching orgasm.
  

Clearly, the optimal scenario
for treatment of ADD that preserves sexual functioning is using stimulant drugs without the sexually troublesome SSRIs. What do you do, however, when the stims are not enough? There are a host of Web sites devoted to the topic of SSRIs and sexual side effects. Many of the people posting to those sites said that while they were not happy with sexual changes, it was better than living with the symptoms
of depression.

Is the only option a disheartening choice between two evils, or are there ways of working around the problems?

Fortunately, the answer is yes. The following is a list of ways to vanquish the “suppressed sexuality reduces intercourse” demon:

1. Ask your doctor about trying Wellbutrin (buproprion) instead of an SSRI. Wellbutrin is an atypical antidepressant that increases dopamine as well as serotonin. Don’t be overly concerned about the risk of having a full-blown climax while shopping for oysters. The woman described in
   Psychopharmacology Update
   was a very unusual case. On the other hand, some of you might consider it more of a benefit than a risk.
   
2. If your depression (or anxiety or impulsivity … whatever the specific symptom for which you are seeking help) is not relieved sufficiently by Wellbutrin, adding Wellbutrin to an SSRI may do the trick without creating troublesome sexual side effects.
   
3. Some people find that they adjust to the SSRI in four to six months and the sexual side effects improve or go away. Of course, this may be a long time to wait while your love life is on hold.
   
4. A few people have told us that they are able to reclaim their sexual functioning on SSRIs by increasing the frequency of masturbation for a time.
   
5. The “little blue pill” is another possibility. Viagra is not just for men. There is evidence that it helps some women with SSRI-induced delay in or inability to have an orgasm. The downside of this choice is that it is expensive.
   
6. Talk to your doctor about gradually reducing the dosage of your SSRI antidepressant, since the sexual side effects are dose related.
   
7. Case reports and a few studies have shown that the herbal supplement ginkgo biloba is somewhat effective in reducing SSRI-induced side effects.
   
8. A vigorous exercise program can help symptoms of anxiety and depression. This may enable you to decrease your SSRI dose.
   

Of course, it is important to keep your partner(s) in the loop about antidepressant-related sexual
changes. Without this information they may assume that your lack of interest has something to do with them, or the relationship.

ADD and Sexual Differences

It may seem to be backwards—to talk about the sexual effects of medication treatment first, and then the general effects of having ADD on sexuality. Well, we don’t pretend to be linear thinkers, so please bear with us. In this section we will
just highlight and touch upon some issues ADDults experience in the bedroom (or the car, or the chandelier … ).

Fluctuations in Desire:
Of course, human beings are not raring to go at all times and in all situations. We all have normal variations in our level of interest in sexual activity. When you have ADD, however, those fluctuations may be more extreme and hard to explain. As we mentioned
before, you may find that your libido is enhanced on stimulant medication. This, of course, is fabulous news. However, some ADDults find that having an increased sex drive creates new challenges. Their partners are used to the old level of frequency and are not interested in changing it. You may want to consider using masturbation as a means of discharging excess sexual energy in this case. If low
desire is the issue, first take a look at your medication to see if that might be a problem.

Touchy Touchability:
In the chapter about differences, we discussed tactile sensitivity, which is experienced as an aversion to being touched, or being touched in certain ways. As with most brain-based differences in ADD, the symptoms are variable; sometimes they are there and sometimes not. It can drive
your partner crazy, not to mention yourself, when the moves that
had you burning with desire on one occasion are like fingernails on the blackboard the very next day.

The first step in dealing with this pesky problem is to clue your partner(s) in. Frame it as a challenge rather than something horribly wrong with either of you. Experiment with various kinds of touch to find the sweet spot or spots
for a particular lovemaking session. Of course, since the touchiness varies, the solutions will also change. Try out different levels of touch, from light feathery strokes to deep pressure. Engage with your partner verbally so that he or she has feedback on what is working or not working for you. There will be times when the best approach is to put the lovemaking aside for another day or time,
without making anybody wrong for it. You can also decide to concentrate on stimulating your partner, if you are the one who is “touchy” on a particular occasion.

ADD and Kinks:
A number of ADDults we have worked with have made a connection between “kinky” sexual practices and their ADD symptoms. Most of these folks were into what we call “S&M lite.” Playful flogging with soft leather implements,
for example, or tying each other to the bed. That sort of thing. We are not talking about pain here. A number of these folks said they found that the extra stimulation from these practices not only enhanced their love life, but also seemed to enhance their brain functioning. They were more focused after certain kinds of love play. This sort of activity may or may not work for you, but the need
to try something different is worth considering.

The Need for Novelty:
S&M may not be of interest to you, but do consider the need for variation in your bedroom activities. It is well known that the ADD brain craves novelty. The reason for this is that our brains are motivation dependent. This means that we need more incentive to get interested or stay interested in anything. Something new, of
course, is always more fascinating than the familiar. Use your ADD imagination to keep your sex life snazzy. The chandelier might be a bit daunting if you’re not in prime athletic shape, but what about
the kitchen table, or the car? Changing the location is one possibility, as is a change in position. Browse through one of the gazillion sex manuals available if you are stumped for ideas. Spend
some time with your partner sharing your fondest sexual fantasies and create some exciting sexual games. Do you fancy being the parlor maid who is seduced by the lord of the manor? How about playing the duchess and the chauffeur? Let your imagination take flight.

Managing the Stimulus Level for Both of You:
Of course, the need for variety is one aspect of the larger issue of finding an optimal
level of stimulation. That sweet spot, just enough and not too much input, will vary from person to person and from time to time. We already talked about the impact of ADD on our sense of touch, but what about the other senses? Visual stimuli, for example, are an important factor in sexual arousal, particularly for men. Making love with the lights on is one way to enhance excitement, as is watching
videos. You may have a partner, however, who is not turned on by the films, or who prefers to make love in the dark. Your partner, ADD or not, may also be trying to find the right personal stimulus volume. ADD is not some bizarre set of behaviors dropped from an alien planet, but an exaggeration of certain human tendencies. Your “lights out” partner might be dealing with a sense of shame about
sexuality, or he just might need to shut off the visual channel in order to focus on tactile sensations. It is not necessary to get into a struggle over this difference. One way to handle it is to use a blindfold. We recommend that you practice using the blindfold while maintaining a dialogue with your partner. The person who is blindfolded needs to feel secure, as this is a vulnerable position.
Let him or her know what you intend to do, and ask permission first. What about the partner who is not interested in viewing sexual DVDs? Can you make a deal that you will view them by yourself before bedtime? You may want to share reading this section with your partner. He or she may be thinking that your need for more visual stimulation has something to do with their attractiveness or worth as a
person. Viewing this issue through the lens of stimulus management can take the personal punch out of it.

Sex and the Laundry List:
One of our dearest friends does a screamingly funny rendition of her inner dialogue during sex. Of course, like most of our friends, she has ADD. This woman (we’ll call her Jenna) fights valiantly with her independently willful mind, trying to keep it from veering
off into irrelevant topics, such as laundry or shopping lists. She knows that she is supposed to be directing her attention in the vicinity of her partner, but she just can’t seem to make it happen. Jenna is convinced that her partner would be horrified if he realized that she was running down a list that included words like “Tide” or “Cheer” rather than, say, focusing on the incredible size of
his equipment.

We can’t always manage our distractibility. Sometimes we just have to let ’er rip. If you suffer from the sexual laundry list problem, suffer no more! If we took a poll, we bet the vast majority of people (ADD or not) don’t have their attention strictly glued to their partner at all times during sex. Many people find their minds wandering to different images and even different
sexual partners during the act. If you feel comfortable sharing this with your lover, a conversation or two about it may enhance your connection. If not, there is nothing wrong with keeping it to yourself. Stop beating yourself up for something that is out of your control and harmful to no one. If you absolutely must beat yourself up, consider asking your partner to use one of those soft floggers
instead. Who knows? It might be more fun.

Losing Focus—for Men:
Men have the additional challenge of greater performance pressure. It may not be an optimal situation, but at least women can engage in intercourse without full arousal. It is just not as obvious when women lose their focus during sex. Well, we know something about the balancing act involved here from our general struggles with ADD
and attention. As ADDults we have learned to use a kind of mental force to shore up a, shall we say, flaccid attention. People observing us from the outside see all this stress and strain, and they wonder about the “why?” of our single-minded gluing of
attention to the focus du jour. They don’t understand that we feel vulnerable to getting off track, and don’t think we can afford to take a break
or shift attention to something else. When it comes to sexual functioning, this dynamic can play out as a perceived lack of caring for or awareness of your partner. We are going to go out on a limb here and suggest that a partner who insists on performance above all else is going down the wrong road. They are not the one for you. Of course, you need to share your struggle with him or her before
you come to the conclusion that they are judging your prowess in bed. It is possible that you are making it all up in the privacy of your mind. Do you really think that an ever-ready erect penis is the true measure of a man?