Many clients ask me how to recognise an abuser. My own story is a painful example—I spent decades in an abusive relationship, cut off from friends and family, convinced for years that it was love. Only when the abuse became physical and uncontrollable did my doctors and psychologist urge me to leave for my own safety.
Part of the complexity was this: when my partner stayed on his prescribed medication, his behaviour was tolerable, even manageable. But whenever he stopped, his personality would shift dramatically—physically, emotionally, and mentally. The pattern was clear: the medication helped regulate him, but he resisted it because of one particular side effect—it affected his libido.
For many people in similar situations, this raises difficult questions about intimacy, abuse, and the neuroscience of how medication changes the brain and body.
How Medication Affects Libido: A Neuroscience Perspective
Sexual desire is not just about the body—it’s rooted in the brain. Libido depends on a delicate balance of neurotransmitters such as dopamine, serotonin, and norepinephrine, alongside hormonal systems like testosterone and estrogen.
When psychiatric medications are prescribed—whether antidepressants, antipsychotics, or mood stabilisers—they can alter these systems in different ways:
- Dopamine Regulation
- Dopamine is central to both motivation and sexual drive.
- Many antipsychotics block dopamine receptors to calm delusions, paranoia, or agitation—but in doing so, they can also blunt sexual desire and pleasure.
- Serotonin Elevation
- SSRIs (antidepressants that increase serotonin) are known to reduce libido.
- High serotonin can dampen sexual arousal by inhibiting dopamine circuits in the brain’s reward system.
- Hormonal Interference
- Some medications disrupt hormonal balance by raising prolactin, which lowers testosterone and estrogen.
- This can cause erectile difficulties in men and reduced arousal in women.
- Brain–Body Disconnect
- The stress-regulation effect of medication (by calming an overactive amygdala or balancing the prefrontal cortex) can reduce emotional volatility.
- But if intimacy is associated with past violence or trauma, lowered libido can become an unconscious protective mechanism for the survivor, regardless of medication.
The Impact in Abusive Dynamics
In abusive relationships, the issue of medication and libido can become a dangerous cycle.
- The abuser resents the loss of libido, so they stop taking medication.
- Stopping medication destabilises the brain, reactivating aggression, impulsivity, and paranoia.
- The survivor feels unsafe, retraumatised, and unwilling to be intimate, because the connection between sex and past abuse remains unresolved.
From a neuroscience perspective, trauma leaves deep imprints in the amygdala and hippocampus, meaning the body remembers abuse even when the conscious mind tries to move forward. For many survivors, sexual intimacy after violence becomes nearly impossible without extensive healing work.
Why Understanding Matters
Recognising these dynamics is critical. Medication doesn’t excuse abuse—but it does explain how biology, chemistry, and behaviour can become dangerously entangled. Survivors often blame themselves for “not wanting sex” or for being “too sensitive,” when in reality, their brain is protecting them.
Healing means untangling these layers:
- Rewiring trauma responses in the brain through therapies like EMDR and CBT.
- Building safe environments where intimacy is no longer tied to fear.
- Recognising that medication may stabilise symptoms, but it cannot change abusive patterns rooted in choice, control, and power.
Final Reflection
For me, the turning point came when I realised this cycle would never change. The medication could regulate him temporarily, but the moment he chose to stop, the abuse returned. And I could no longer sacrifice my safety—or my body—for the sake of preserving a distorted idea of love.
Neuroscience teaches us that medication can affect libido by shifting brain chemistry. But lived experience teaches us something just as important: safety, respect, and compassion are non-negotiable in any relationship.
