Lovemaking, shopping, and videogaming. What do these three activities have in common? Answer: They all carry the potential to send human dopamine levels on a wild roller coaster ride, creating negative side effects that can linger for weeks. Irritability. Poor focus. Restlessness. You name it.
Yes, you understood that correctly: Sex, specifically orgasms, can make some people with ADHD cranky.
Lynn, married to man with ADHD, explains her experience this way:
I have definitely observed this problem. I have pointed it out to my husband, who denies that it happens. But it’s like clockwork, the next day he’s a jerk.
And he wonders why I’m not so motivated anymore. Maybe because I feel like there’s punishment involved?
What Does This Mean for the “Dopamine Vulnerable”?
Here’s the simple explanation: What goes up must come down—and then drop lower than it was before.
That is, when we perform these highly pleasurable activities, the brain floods with dopamine. Then, when those activities stop, so does the dopamine flow.
Moreover, those dopamine spikes (during highly rewarding activities) can result in a tamping down of the dopamine system altogether. Think of it as the brain’s effort to stay balanced.
The bottom line: It takes even more intensely rewarding activities to enable the person to feel pleasure again.
Consider people with ADHD, who are already “dopamine vulnerable.” It is easy to see how flooding the brain with dopamine, and then restricting dopamine flow, can pave the way to a predictable next step: irritability and even intensified ADHD symptoms. This effect can last for days, if not weeks.
The science behind this is complex, and it is still unfolding. My goal in this brief post to simply to emphasize the importance of at least recognizing this neurobiological phenomenon. That way, you are less likely to be thrown off by it in yourself or an ADHD partner—or attribute it to other causes. Especially when it comes to sex. More about that shortly.
“Start Out Laughing, End Up Crying”
The father of a childhood friend regularly issued a warning as to our neighborhood gang of kids. Quite simply, it explains the dopamine spike-drop phenomenon on a basic level:
“Start out laughing? End up crying!”
Only now do I fully appreciate the neurobiological implications.
As a child, I accepted, empirically, that he was right: When we neighborhood kids got more and more “hepped up” in our contagious hilarity, it wasn’t long before one or two of us were crying.
To be clear: Out of 6 or 8 of us, only one or two children predictably started crying or getting angry first. Why didn’t we all? Different brains; different reactions? Perhaps. Yet, there might have been a particular implication for the children with ADHD, virtually unheard of in my youth, especially in less-than-severe forms.
Videogaming: Start Out Engaged, End Up Addicted?
Consider another example: the “grown-up play” of videogaming.
Even after my husband was diagnosed with ADHD and began medical treatment for it, I used to observe this happy-then-cranky phenomenon where he played Starcraft When he’d end a gaming session, he’d behave like a complete jackass for hours—mean, demanding, short-tempered, and imperious.
In truth, he was grouchy a lot then, but post-videogaming brought grouchy to new heights, complete with a cold-eyed imperious stare aimed in my direction. He would then treat me as if I’d just wronged him somehow.
Fortunately, he finally believed me when I emphatically pointed out this withdrawal phenomenon. I think the change scared him, too. Out went Starcraft. Taking that step didn’t resolve all ADHD-related challenges, but at least it stopped making them worse.
Post-Coital Tristesse, or After-Sex Sadness
So, guess what? For some people, a similar phenomenon presents around sex—at least the kind that involves orgasm. There’s even a term for it: Post-coital tristesse (PCT), or after-sex sadness.
Keep in mind: “sadness” or “depression” manifests in some people as irritability, perhaps especially men.
This very phenomenon came up in conversation among some female friends of mine—all partners of adults with ADHD. As one said:
You’d think my husband would be nicer to me after sex.
Instead, he acts like a jerk, almost as if he’s punishing me for having sex with him!
Neither she nor her husband recognized that the behavior was not intentional but neurochemical.
I detail many of the ADHD-related challenges to a satisfying sex life in Is It You, Me, or Adult A.D.D.?. For an expanded examination of the topic, ADHD and Sex: What You Need To Know (That Sex Therapists Cannot Tell You) Kindle Edition (free to Kindle Unlimited members).
Along with all the other ADHD-related domestic challenges, this kind of post-sex Dr. Hyde-into-Mr. Jekyll turnabout can put the death knell to a couple’s sexual relationship. It also can add a whole other layer to existing resentments in other areas of life.
Early Writings on The Phenomenon
PCT is not a new phenomenon. It actually has been documented for centuries, with one reference from the famed Greek physician Galen, around the first century AD:
Every animal is sad after coitus except the human female and the rooster.
We know now that the phenomenon also happens with women. And we also know that PCT is not universal. Just as only a minority of my neighborhood pals “ended up crying,” some people experience PCT more than others, and some hardly at all.
The 17th Century philosopher Spinoza, wrote an apt description:
For as far as sensual pleasure is concerned, the mind is so caught up in it, as if at peace in a [true] good, that it is quite prevented from thinking of anything else.
But after the enjoyment of sensual pleasure is past, the greatest sadness follows.
If this does not completely engross, still it thoroughly confuses and dulls the mind.
Most likely, the causes of post-sex sadness/irritability are variable among individuals. Causes include:
1. The Psychological
For example, individuals experiencing PCT might feel remorse at having allowed lust to lead them into an unwise pairing. Or, by contrast, they might feel an overwhelming sense of loss when the enveloping sense of connection ends.
2. The Physical
It is with the physical that science is beginning to shed some light, with specific implications for people with ADHD. Read on.
Orgasm as “Heroin Rush”
During orgasm, one research team reported it this way (Holstege et al. 2003): The dopamine flooding the brain’s reward pathways resembles a “heroin rush” to the brain: overwhelming feelings of well-being and pleasure. Just as with heroin and other substances, “withdrawal” can be a problem. It follows that sex addictions and other types of addictions go hand-in-hand, indicating poor regulation in this part of the brain.
After the dopamine-flood accompanying orgasm, dopamine levels drop below baseline—that is, lower than they were before orgasm. (The term for this is “rebound.”) Essentially, the same thing happens during withdrawal from substances. So, it’s highly possible that orgasmic sex can intensify ADHD symptoms for some people, especially if they are not taking medication.
Could it be that orgasms, simultaneous to ejaculation, are good for the species but bad for the brain?
Evolutionary biologists argue that we might be “hard-wired” to act in ways that propagate the species but that simultaneously jeopardize harmonious intimate relationships.
In other words, orgasmic sex is a “win” for reproduction but a “lose” for the kind of steady brain function that enhances and stabilizes a relationship.
So, What To Do About It?
To be clear: Orgasms do not cause ADHD. 🙂
Yet, some people with ADHD might be more vulnerable to this phenomenon. And there are good neurophysiological reasons why this is so.
That makes it important to understand: Post-sex problematic behaviors might have a biological basis.
Step One: Understand the Neurobiology
Again, PCT and other post-sex reactions are nothing new. They have been observed in humans for centuries.
A physician practicing in the 19th Century promoted a remedy, perhaps based on ancient texts, called Karezza. Adapted from the Italian for “caress.” Alice Bunker Stockham, a gynecologist and obstetrician, had larger societal goals with the introduction of Karezza, which resembles Tantric sex without the cultural references.
Simply put, Dr. Stockham’s method is a form of sexual intercourse without orgasm, focusing instead on the “plateau phrase” of intercourse. The practice includes bonding activities that reportedly enhance oxytocin. It’s often called the “bonding” hormone, thought to promote connection and feelings of love (though in recent years we’re learning there can be a dark side to oxytocin, too).
Bottom line; By avoiding orgasm, it is thought, dopamine levels remain more balanced.
Will this be a realistic practice to experiment with, especially if ADHD symptoms are causing chaos in the rest of life? Probably not. But it provides interesting food for thought and perhaps worth some experimentation, especially if ADHD symptoms are well-managed to the point of having the patience and focus required.
Step Two: Counter the Dopamine Flood—and Rebound
Two medications might help but in different ways: SSRI antidepressants and stimulants.
1. SSRI Antidepressants:
Some psychiatrists have treated PCT in their patients with an SSRI (a type of antidepressant, such as Prozac, Zoloft, etc.). The medication might blunt their sexual arousal and delay orgasm (or minimize the intensity), but it also pre-empts the post-orgasmic depression.
2. Stimulant medications:
Many individuals with ADHD have reported to me more satisfaction around sex once they began taking stimulant medications. For some, they were able to prolong sexual intimacy instead of racing to the finish line. Others were better able to linger and cuddle afterward—instead of bolting off to the next activity—in doing so perhaps boosting oxytocin levels thought to aid bonding and relaxation.
Perhaps the stimulants also helped to keep dopamine on a more even keel. That is, instead of going from 0 to 60, they perhaps went from 30-60, a slower buildup and less precipitous drop-off.
From the Archives: The Karezza Method
Books from 100 years ago are hardly informed by neuroscience. Still, they sometimes make for compelling reading.
To learn more about the ideas behind Karezza, click here to download The Karezza Method. published in 1931 by J. William Lloyd, an “individual anarchist” born in 1857. Here is the last paragraph of his book:
To sum up: The orgasmal school is honest but mistaken. Its fault is that it is a doctrine of the strong, only for the strong.
Just as a wealthy man may spend money recklessly for a while and still not be poor, so a man rich in thyroxin and adrenalin may spend recklessly in orgasms for a while and not seem any the worse.
And the method, taught by the orgasmal school is such that it creates a demand, by congestion, for the orgasm, which must then occur or bad results follow. But for a weak man to follow their advice is very dangerous and courts a nervous breakdown, while my method builds him up.
That orgasms are weakening is easily proven. Just as the way to get real facts about alcohol is to consult life-insurance companies, so to get facts about the orgasm go to the stockbreeder. Business has no sentiment or prejudice. Every stockbreeder will tell you that to permit a bull or stallion to serve too many or too often is to devitalize him.
I’d love to hear your thoughts on this topic. Please share them in a comment—no annoying codes to enter.