The answer is not a simple one. Most people have heard of the “love drug” called Oxytocin. Oxytocin, a hormone, is released into the female bloodstream during labor and delivery of the fetus, and also during stimulation of the nipples in breastfeeding. Research with animals and man has shown the Oxytocin to create a bonding effect, and the drug has been used in some experiments to facilitate empathy and affection. However, the drug has never been licensed for any non-maternal use, and Oxytocin has the current status of an experimental agent for any other human application. It may be that someday refinements of the drug will establish its usefulness in people who cannot bond, such as autistic children, but for the time being it is not available for psychological conditions.
This leaves the clinician with mainstream psychotropic drugs to help treat the difficulties in finding or tolerating affection. Perhaps the most common drug I use in certain patients with impaired capacities for love are the antidepressants. I can sometimes diagnose an illness called Dysthymia (pronounced dis-thyme-i-a). Dysthymia is a low-grade chronic form of depression. It is common. Patients with Dysthymia can suffer a loss of energy, a vague feeling of hopelessness and a lack of joy. Love seems a remote passion. Or, if sexual engagement is used to temporarily dispel Dysthymic symptoms, sadness descends as soon as the sex is over. Dysthymic patients can recall months and years of lack of fulfillment and their relationships can be a disappointment. Each new intimacy ends in disillusionment. The origins of Dysthymia are unclear. Sometimes, patients relate a lack of nurturance in their early lives and they have struggled on, trying to capture a sense of contentment. There are newly published scientific articles linking early trauma, such as the loss of a parent, to actual physical changes in those deep parts of the brain (the limbic system) that regulate emotion.
When the antidepressant Prozac first became available, some clinicians likened it to a normalizing drug which rather rapidly corrected a pervasive sense of despair to the point that patients reported feeling ”complete” or “whole” for the first time in their lives. Indeed, psychiatrist Peter Kramer, in his book Listening to Prozac, described these changes with an enthusiasm that has been challenged by many clinicians. Since then, antidepressants are viewed as sometimes curative and often helpful. As far as lovelessness is concerned, I try to figure out whether a low dose of an antidepressant such as Zoloft or Paxil might be useful. You may ask: why not put everyone with love problems on a trial of the drugs? First of all, these drugs have side effects and not everyone wants to take a pharmacologic agent. And second — and more importantly — the drugs are not the fast fix for patients who cannot or dare not become romantically intimate with someone else. To repair these deficiencies takes some old-fashioned talk therapy which is not as much in vogue and rarely compensated in full by the insurance industry which reimburses “medication management” to the exclusion of traditional psychotherapy.
I’ll talk further about medications in cases of lovesickness.
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