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The Monster Under the Bed

The Monster Under the Bed: Sex, Depression, and the Conversations We Aren't Having by JoEllen Notte
Finally! A book about the intersection of sex and depression!
JoEllen Notte has written a book that millions of people need and will benefit from! "The Monster Under the Bed" is a very valuable new book from Thorntree Press. Notte eloquently describes all the ways in which depression can take a terrible toll on your sex life, and how the cascading effects of a dwindling or disappearing sexual relationship can destroy your self-esteem and your relationship.

She courageously uses herself and her own severe depression to illustrate how her own lack of understanding and knowledge about depression, as well as her husband's lack of resources in coping with her depression, ruined their sexual relationship and led to divorce. She also interviewed 1300 people through an on-line survey about their experience with depression and the enormous impact of depression on their sex lives. So she has a ton of information that she skillfully weaves into both a clear explanation of the problems and a manual for finding solutions. Armed with all this raw data, she successfully debunks a lot of outdated myths about depression as well as a lot of inaccurate information about sex and relationships.

The book is very balanced, and does not blame or shame either the depressed partner and the partner who is not depressed. Instead she articulates very clearly both the experience and point of view of the partner who is suffering with depression and the partner who is not depressed but is helplessly watching their partner's struggle depression. The depressed partner feels "unheard, unseen, broken, and alone," often feels pressured for sex and feels like a failure for disappointing their partner if they are not feeling very enthusiastic about sex. And often are plagued by such low self-esteem that they feel unworthy of love, they don't feel sexually desirable, and feel they should be grateful that anyone wants them. The non-depressed partner usually has no experience with what depression feels like and no education on how to be supportive, and on top of that, they are probably not getting laid much (if at all), so they feel unsatisfied, unloved, rejected, unattractive, and resentful. So it's certainly not surprising that both people are suffering in silence and don't have a clue how to talk to each other or come up with solutions.

And to make matters worse, more than half of people taking anti-depressant medications experience what the drug companies euphemistically call "sexual side effects," such as your extreme fatigue and lethargy, low or no libido, lack of sexual sensations or pleasure, difficulty reaching orgasm, and difficulty getting and/or keeping an erection. And most doctors aren't much help, as many people she surveyed reported that their doctors were extremely uncomfortable talking about sex, and made them feel ashamed for bringing up the subject of how their depression was affecting their sex life. This is not surprising, as Notte says that most medical students only receive about two hours of education about sex and sexuality, in their four years of medical school!

Since most people are uncomfortable talking about depression or any kind of mental health conditions, the combination of depression and sexual problems creates a "double taboo" subject that causes many people hide their diagnosis of depression and not ask anyone, even their doctors, for help. In my own private practice, I can confirm this. Many clients have reported sexual problems related to their depression, but their doctors and psychiatrists have not ever broached the topic or offered support for sexual problems, and the doctors get tense and uncomfortable if the client brings it up. And many of my clients report sexual side effects from medication, and most say their doctors have not even warned them about these side effects, so they were not even aware that the medication was at least part of the cause of their sexual problems. When I confronted a client's psychiatrist about this, he said, "She was severely depressed and I was giving her the medication to keep her from killing herself, so I was not that concerned about whether she could have orgasms."

Notte gives great advice for both partners on how to communicate about your sexual feelings and needs, and the importance of rejecting old beliefs about yourself, your partner, about sex, about depression, in order to create a more satisfying sex life.
More than anything, Notte urges couples to talk openly and honestly with each other about what they are going through and what they are feeling, rather than making assumptions and trying to protect each other's feelings.

This book is also a very valuable resource for therapists, doctors, and other clinicians that treat clients struggling with depression. There are very few books or other sources of information available for the "helping professionals" who want to educate themselves in order to better support their clients. This book adds a great "tool to your toolkit" for anyone working with individuals or couples where depression has affected their sexual relationship.

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