SSRI use is not associated with the intensity of romantic
love, obsessive thinking about a loved one, commitment,
or sexual frequency in a sample of young adults
experiencing romantic love

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SSRI use is not associated with the intensity of romantic love, obsessive thinking about a loved one, commitment, or sexual frequency in a sample of young adults experiencing romantic love. Journal of Affective Disorders, 2025, 375, pp.472 - 477. 10.1016/j.jad.2025.01.103 . hal-05461806

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Research paper

# SSRI use is not associated with the intensity of romantic love, obsessive thinking about a loved one, commitment, or sexual frequency in a sample of young adults experiencing romantic love

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Adam Bode<sup>a, *, b</sup>, Marta Kowal<sup>b</sup>, Fabio Cannas Aghedu<sup>c</sup>, Phillip S. Kavanagh<sup>d, f</sup>

## ARTICLE INFO

### Keywords:

- Antidepressants

- Romantic love

- Romantic love survey 2022

- SSRI

## ABSTRACT

For >15 years, researchers have speculated that selective serotonin reuptake inhibitor (SSRI) use is associated with negative romantic love outcomes. No one has empirically investigated this, however. Drawing on 810 participants from the Romantic Love Survey 2022, we used binary logistic regression to identify differences between young adults experiencing romantic love who were and were not taking SSRIs. Predictor variables were biological sex, mental health problems, intensity of romantic love, obsessive thinking about a loved one, commitment, and frequency of sex. Only biological sex and mental health problems were associated with SSRI use. None of our romantic love variables were associated with SSRI use. This is the first evidence to demonstrate that SSRI use is not associated with some features of romantic love in a sample of young adults experiencing romantic love. The findings have implications for clinical practice and can be used to allay some concerns among individuals considering commencing SSRIs for common mental health problems.

Claims that selective serotonin reuptake inhibitors (SSRIs) may negatively impact romantic love have been posited for over 15 years (Fisher and Thomson, 2007). These claims may dissuade people from taking these medications for treatment of common mental health disorders such as major depressive disorder (Gabriel et al., 2020), and various anxiety disorders (e.g., generalized anxiety disorder, social anxiety disorder, panic disorder; for which they have good efficacy both standalone and as an adjunct to psychotherapies; Breedvelt et al., 2021; Cuijpers et al., 2023; Szuhany and Simon, 2022).

SSRIs function by reducing the reabsorption of serotonin into neurons and increasing intracellular serotonin levels (Etievant et al., 2020). They have downstream impacts on the dopamine system (Di Giovanni et al., 2010) and are associated with a number of side effects, including sexual dysfunction (Rothmore, 2020) and a “blunting” of positive affect (Jawad et al., 2023). SSRIs can take up to 6 weeks to become fully effective (Taylor et al., 2006) because they function by changing serotonin receptor expression (see Artigas, 2013), something which does not happen immediately.

Romantic love is a motivational state that serves reproductive functions (i.e., mate choice, courtship, sex, and pair bonding). It has been associated with cognitive, emotional, and behavioral characteristics and has been attributed to a range of social, genetic, neural, and endocrine mechanisms (Bode and Kushnick, 2021). Romantic love is often associated with the early stages of a romantic relationship but can occur in the absence of a romantic relationship (Bringle et al., 2013) or, less commonly, many years or decades after establishing a romantic relationship (Acevedo and Aron, 2009; Acevedo et al., 2012; O'Leary et al., 2011). It is associated with intense cognitions, emotions, and behaviors and contrasts with companionate love, which is felt less intensely, and, usually, at later stages of romantic relationships, when romantic love subsides (Hatfield and Walster, 1985). Romantic love is the basis upon which long-term romantic relationships and families are formed throughout much of the world. It is sometimes referred to as “early-stage romantic love,” being “in love,” or “passionate love” (see Bode and Kushnick, 2021).

Although Fisher and Thomson (2007) speculated that SSRIs might

<footnote><sup>a</sup> School of Archaeology and Anthropology, The Australian National University, Canberra, ACT, Australia</footnote>

<footnote><sup>b</sup> IDN Being Human Lab - Institute of Psychology, University of Wrocław, Wrocław, Poland</footnote>

<footnote><sup>c</sup> Emotions, Neurocognition and Therapeutic Behavioral Approaches (ENACT) Team, University of Nîmes, France</footnote>

<footnote><sup>d</sup> Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, ACT, Australia</footnote>

<footnote><sup>e</sup> Justice and Society, University of South Australia, Magill, SA, Australia</footnote>

<footnote>* Corresponding author at: School of Archaeology and Anthropology, The Australian National University, Canberra, ACT, Australia. E-mail address: adam.bode@anu.edu.au (A. Bode).</footnote>
regularly blunt romantic love, their theory was based on an outdated biological model, now challenged by recent research (Bode, 2023). The original biological theory of independent emotion systems in mammalian reproduction (Fisher, 1998) was generated before a single biological study of romantic love had been undertaken. That theory explained the phenomenon of romantic love as serving a narrow function (i.e., focusing energies on a preferred mating partner), and being constituted by a single neural system. Evidence on the functions and mechanisms of romantic love, as reviewed by Bode and Kushnick (2021), demonstrates that romantic love actually serves a broad array of functions and is constituted by involvement of many interacting neural and endocrinological systems (see Bode, 2023).

Fisher and Thomson (2007) claimed that the effects of SSRIs can affect what Fisher (1998) called three “emotion systems for mating and reproduction” (p. 24): lust, attraction, and attachment. According to Fisher and Thomson (2007), the mechanism is through indirect effects of SSRIs on androgens and catecholamines. They also suggested that obsessive thinking may be impacted through the direct effects of SSRIs on the serotonin system. At the time their chapter was published, it was believed by some (Fisher, 1998, 2000; Marazziti et al., 1999) that romantic love was associated with a down-regulated serotonin system, whereas SSRIs serve to increase intracellular serotonin levels (Etiantav et al., 2020). An additional suggestion they made was that sexual dysfunction, a common side effect of SSRIs (Rothmore, 2020), may impede the progression of an individual's romantic relationship to romantic love. Since first proposed, the idea that SSRIs might negatively impact romantic love has been raised by others (e.g., Andrews et al., 2012; Earp and Savulescu, 2018; Sanches and John, 2019).

Fisher and Thomson's (2007) theory seems plausible, as two studies have identified variation in circulating serotonin markers in people experiencing romantic love and numerous studies have implicated dopamine. Marazziti et al. (1999) found lower levels of serotonin transporter in platelets in a sample of mainly females experiencing romantic love compared with normal controls. Langeslag et al. (2012) found significantly higher levels of plasma serotonin in females experiencing romantic love and significantly lower levels of serum and plasma serotonin in males experiencing romantic love compared to sex-matched controls not experiencing romantic love. Marazziti et al. (2017) found decreased lymphocyte dopamine transporter density and functionality in people experiencing romantic love compared to controls. Furthermore, numerous neuroimaging studies repeatedly implicate dopamine receptor dense structures in romantic love (for reviews, see Bode and Kushnick, 2021; Xu et al., 2015).

As noted above, SSRIs have good efficacy at treating a range of psychological disorders, especially chronic and pervasive major depressive disorder (Cuijpers et al., 2023). While psychological therapies such as cognitive behavior therapy have demonstrated excellent efficacy in treating mood disorders (Ciharova et al., 2021; Cuijpers et al., 2023) and various anxiety disorders (Mayo-Wilson et al., 2014; Wuthrich et al., 2021), for some clients, psychological therapy is not sufficient, and they need medications as an adjunct (Szuhany and Simon, 2022). If clients falsely believe that SSRIs may negatively affect their romantic relationship, and decide not to take them for that reason, this may have negative consequences on effective intervention and relapse prevention for their mental health disorder.

To our knowledge, no studies have quantitatively investigated the relationship between SSRI use and romantic love. One study (Marazziti et al., 2014) has empirically investigated the relationship between anantidepressant use and love (not romantic love). The authors found a small, but significant negative association of SSRI use on feelings of love among males. Another study (Nunes and de Medeiros, 2022) using a small sample (n = 84) compared individuals in a romantic relationship who were and were not taking antidepressants (most of which were SSRIs) and found no differences between groups on measures of love. This study extends those studies by investigating the association between SSRI use and various features of romantic love in young adults

experiencing romantic love. Specifically, we investigated SSRI use and the intensity of romantic love, obsessive thinking about a loved one, commitment, and sexual frequency.

The intensity of romantic love is a global measure of romantic love. It assesses the cumulative expression of cognitions, emotions, and behaviors associated with romantic love. It is most commonly assessed using the Passionate Love Scale (Hatfield and Sprecher, 1986; see Bode and Kowal, 2023; Feybesse and Hatfield, 2019), but other means can be used (e.g., the Triangular Love Scale-15; Kowal et al., 2024; or the Infatuation and Attachment Scale; Langeslag et al., 2013).

Obsessive thinking about a loved one signifies intense thoughts about a loved one. These are commonly associated with romantic love (e.g., Bode and Kavanagh, 2022; Langeslag et al., 2012). Individuals experiencing romantic love tend to have somewhat intrusive thoughts about a loved one that affect their focus and attention about half the time they are awake (Bode and Kavanagh, 2022). It was previously thought that obsessive thinking about a loved one was the result of the same mechanisms involved in intrusive thinking in obsessive-compulsive disorder (see Fisher and Thomson, 2007; Marazziti et al., 1999; Fisher, 1998). This stemmed from the beliefs that serotonin transporter density was positively associated with intracellular serotonin levels. The findings by Marazziti et al. (1999) that individuals experiencing romantic love possessed lower circulating serotonin transporter density in platelets compared to normal controls, and at similar levels to OCD patients, were used to claim that individuals experiencing romantic love possessed a down-regulated serotonin system. However, more recent studies (e.g., Jorgensen et al., 2014; Mercado and Kilic, 2010) have demonstrated that serotonin transporter density is actually negatively associated with intracellular serotonin levels. Since Langeslag et al., 2012 observed that females in love display higher circulating serotonin levels in plasma than controls (but in males this was reversed), some scholars believe that romantic love is not generally associated with a down-regulated serotonin system (Bode, 2023; Bode and Kushnick, 2021).

Commitment is one of three components of love according to the Triangular Theory of Love (Sternberg, 1986), along with passion and intimacy. It is a cognitive aspect of love associated with the desire to maintain the relationship in the future. Commitment is believed to increase in the early stages of a romantic relationship (Freeman et al., 2023; Garcia, 1997; Sternberg, 1986).

Sex is one of the functions of romantic love (Bode and Kushnick, 2021) and sexual desire is one of the components of romantic love (Bode, 2023). Individuals experiencing romantic love have sex more often than do individuals in a romantic relationship not experiencing romantic love (see Bode et al., 2024).

This article reports the first study to empirically investigate the relationship between SSRI use and romantic love. To test the hypothesis proposed by Fisher and Thomson (2007), we undertook a binary logistic regression analysis using data from the Romantic Love Survey 2022 (Bode and Kavanagh, 2022), the world's largest dataset of individuals exclusively experiencing romantic love. Based on Fisher and Thomson's (2007) theory, we hypothesized that participants taking SSRIs would report less intense romantic love, lower frequency of obsessive thinking, reduced commitment, and less frequent sexual activity.

# 1. Methods

## 1.1. Participants

Participants were 810 (female = 48%) young adults (from an original 1556) from 33 countries who self-identified as being in love from the Romantic Love Survey 2022 (Bode and Kavanagh, 2022). Only participants who had been in love for 23 months or less and who scored above 130 on the Passionate Love Scale-30 (PLS-30; Hatfield and Sprecher, 1986) were included. Two years is a timeframe in which romantic lovers are likely to be experiencing early-stage romantic love,
rather than long-term romantic love, which differs in function, form, and mechanism (Acevedo and Aron, 2009; Acevedo et al., 2012; O'Leary et al., 2011). Scores above 130 on the PLS-30 are associated with an increased likelihood of individuals experiencing romantic love (Hatfield and Sprecher, 2011). This approach to ensuring the sample represented people experiencing romantic love has been used previously (Bode and Kavanagh, 2022). Data for two cases were removed because they indicated that they had been in a romantic relationship for more than four years, which was deemed improbable. Data for one intersex participant were removed to facilitate the use of sex as a binary variable. Two cases had one missing data point and all data for these two cases were removed. Supplementary Table 1 presents the characteristics of the sample. We follow most of Bode and Kowal's (2023) recommendations for sample characteristics reporting. Table 1 presents the country of residence of participants.

We performed a sensitivity analysis to test the magnitude of the effects we were able to detect in our study. Given $n = 810$, $\alpha = 0.05$, and six predictors, we were able to detect small effects ($d = 0.26$ or larger) with power 0.80.

## 1.2. Measures

The outcome variable was SSRI use. This was assessed by asking participants, “Are you currently taking SSRIs (selective serotonin re-uptake inhibitors)?” Responses were coded $0 = no$, $1 = yes$.

The predictor variables in the model were biological sex, mental health problems, intensity of romantic love, obsessive thinking, commitment, and frequency of sex. Biological sex and mental health problems were included in our analysis because they could feasibly influence both the outcome measure (SSRI) and the predictor variables of interest (see below).

Biological sex was assessed by asking participants, “What is your biological sex?” Responses were coded $1 = female$ and $2 = male$.

Mental health problems were assessed using item 11 from the Assessment of Quality of Life-4D (AQOL-4D; Hawthorne et al., 1999). Participants were asked how they generally felt in the past week. Options were $1 = I do not feel anxious, worried or depressed$, $2 = I am slightly anxious, worried or depressed$, $3 = I feel moderately anxious, worried or depressed$, and $4 = I am extremely anxious, worried or depressed$. A variable was created whereby $0 = do not feel$ or “feel slightly” anxious,

<table><caption>**Table 1**
Participant country of residence.</caption><thead><tr><th>Country</th><th>n</th><th>%</th></tr></thead><tbody><tr><td>South Africa</td><td>101</td><td>12</td></tr><tr><td>Poland</td><td>71</td><td>9</td></tr><tr><td>United Kingdom of Great Britain and Northern Ireland</td><td>59</td><td>7</td></tr><tr><td>Portugal</td><td>57</td><td>7</td></tr><tr><td>Mexico</td><td>56</td><td>7</td></tr><tr><td>Greece</td><td>51</td><td>6</td></tr><tr><td>Germany</td><td>49</td><td>6</td></tr><tr><td>Spain</td><td>49</td><td>6</td></tr><tr><td>Italy</td><td>47</td><td>5</td></tr><tr><td>Hungary</td><td>39</td><td>4</td></tr><tr><td>United States of America</td><td>39</td><td>4</td></tr><tr><td>Netherlands</td><td>31</td><td>4</td></tr><tr><td>Canada</td><td>22</td><td>3</td></tr><tr><td>Chile</td><td>22</td><td>3</td></tr><tr><td>France</td><td>16</td><td>2</td></tr><tr><td>Slovenia</td><td>14</td><td>2</td></tr><tr><td>Estonia</td><td>11</td><td>1</td></tr><tr><td>Australia</td><td>10</td><td>1</td></tr><tr><td>Czech Republic</td><td>10</td><td>1</td></tr><tr><td>Latvia</td><td>9</td><td>1</td></tr><tr><td>Austria</td><td>8</td><td>1</td></tr><tr><td>Rest of sample</td><td>39</td><td>5</td></tr></tbody></table>

Rest of sample: Finland, Ireland, Israel, New Zealand, Belgium, Sweden, Switzerland, Japan, South Korea, Denmark, Luxembourg, Norway.

worried, or depressed and $1 = “feel moderately” or “feel extremely” anxious, worried, or depressed. Scores of 1 were taken to mean the presence of mental health problems.

Intensity of romantic love was measured using the PLS-30 (Hatfield and Sprecher, 1986). The PLS-30 and its short-form are the most commonly used validated measures of romantic love in psychological (Feybesse and Hatfield, 2019) and biological (Bode and Kowal, 2023) studies of romantic love. The scale was reliable (Cronbach's $\alpha = 0.934$).

Obsessive thinking was assessed by asking participants “What percentage of your waking hours do you spend thinking about the person you love (slide to the correct position)?” Participants could select a score ranging from 0 % to 100 % on a slider. Obsessive thinking about a loved one is characteristic of romantic love (Bode and Kavanagh, 2022; Langeslag et al., 2012, 2013).

Commitment was assessed using the five-item commitment subscale of the Triangular Love Scale-15 (TLS-15; Kowal et al., 2024). The Romantic Love Survey 2022 used the traditional nine-point response format (Sternberg, 1997) rather than the five-point response format validated by the authors. Commitment is believed to be both a contributor to (Sternberg, 1986), and consequence of (Frank, 1988), romantic love. The subscale was reliable (Cronbach's $\alpha = 0.899$).

Frequency of sex was assessed by asking participants, “How many times per week do you have sex with the person you love? “Sex” is however you choose to interpret it.” Possible responses ranged from 0 to 50 or more. Sex is one function of romantic love (Bode and Kushnick, 2021) and sexual desire has been considered one component of romantic love (Bode, 2023).

## 1.3. Procedure

First, $\phi$ and point-biserial correlations across variables of interest were determined. These are presented along with descriptive statistics for variables of interest. A binary logistic regression was then performed using biological sex, mental health problems, intensity of romantic love, obsessive thinking, commitment, and frequency of sex to predict SSRI use. Mahalanobis distances (Mahalanobis, 1960) with a cut off of $p < .001$ (Penny, 1996) were used to identify potential outliers. All assumptions of binary logistic regression (Stoltzfus, 2011) were met. We paid particular attention to collinearity diagnostics because of the high univariate correlations among variables included in the regression. Variance Inflation Factors for all variables were below 2 (the highest was 1.86) and tolerance was well above the threshold of 0.25 (the lowest was 0.613). All the analyses were performed with IBM SPSS 26 software.

## 2. Results

Among the sample of 810, 76 (9 %) were taking SSRIs at the time they completed the survey. Table 2 presents the $\phi$ and point biserial correlations for variables included in the binary logistic regression as well as their descriptive statistics. Seven outliers were identified but their removal did not meaningfully change the results of the logistic regression. As a result, outliers were not removed prior to the regression analysis. Supplementary Table 2 presents the results of the binary logistic regression analysis with outliers removed.

Binary logistic regression was used to analyze the relationships between biological sex, mental health problems, intensity of romantic love, obsessive thinking about a loved one, commitment, and frequency of sex and SSRI use (Table 3). Holding all other predictor variables constant, the odds of SSRI use decreased by 44 % (95 % CI [0.336, 0.926]) among males compared to females. Holding all other predictor variables constant, the odds of SSRI use increased by 137 % (95%CI [1.443, 3.896]) among those experiencing mental health problems compared with those not experiencing mental health problems. All other predictor variables were not significantly associated with the outcome variable.
<table><caption>**Table 2**
Correlation among variables used in the regression analyses and their descriptive statistics.</caption><thead><tr><th></th><th>Variable</th><th>1</th><th>2</th><th>3</th><th>4</th><th>5</th><th>6</th><th>7</th></tr></thead><tbody><tr><td>1</td><td>SSRI</td><td>1</td><td>-0.098**</td><td>0.144***</td><td>0.045</td><td>0.011</td><td>0.004</td><td>-0.014</td></tr><tr><td>2</td><td>Biological sex (male)</td><td></td><td>1</td><td>-0.151***</td><td>-0.111**</td><td>-0.208***</td><td>-0.073*</td><td>0.020</td></tr><tr><td>3</td><td>Mental health problems</td><td></td><td></td><td>1</td><td>0.102**</td><td>0.069</td><td>-0.041</td><td>-0.050</td></tr><tr><td>4</td><td>Intensity of romantic love</td><td></td><td></td><td></td><td>1</td><td>0.469***</td><td>0.610***</td><td>0.087*</td></tr><tr><td>5</td><td>Obsessive thinking</td><td></td><td></td><td></td><td></td><td>1</td><td>0.336***</td><td>0.108**</td></tr><tr><td>6</td><td>Commitment</td><td></td><td></td><td></td><td></td><td></td><td>1</td><td>0.094**</td></tr><tr><td>7</td><td>Frequency of sex</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td></td><td>n</td><td>76</td><td>422</td><td>213</td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>%</td><td>9.38</td><td>52.10</td><td>26.30</td><td></td><td></td><td></td><td></td></tr><tr><td></td><td>M</td><td></td><td></td><td></td><td>209.68</td><td>49.07</td><td>36.57</td><td>3.20</td></tr><tr><td></td><td>SD</td><td></td><td></td><td></td><td>31.20</td><td>22.55</td><td>6.82</td><td>2.87</td></tr></tbody></table>

<table><caption>**Table 3**
Binary logistic regression results.</caption><thead><tr><th rowspan="2"></th><th rowspan="2">b</th><th rowspan="2">SE</th><th rowspan="2">Wald</th><th rowspan="2">p</th><th rowspan="2">OR</th><th colspan="2">95 % CI</th></tr><tr><th>Lower</th><th>Upper</th></tr></thead><tbody><tr><td>Biological sex (male)</td><td>-0.584</td><td>0.259</td><td>5.095</td><td>0.024</td><td>0.558</td><td>0.336</td><td>0.926</td></tr><tr><td>Mental health problems</td><td>0.863</td><td>0.253</td><td>11.615</td><td>&lt;0.001</td><td>2.371</td><td>1.443</td><td>3.896</td></tr><tr><td>Intensity of romantic love</td><td>0.006</td><td>0.005</td><td>1.071</td><td>0.301</td><td>1.006</td><td>-0.995</td><td>1.016</td></tr><tr><td>Obsessive thinking</td><td>-0.005</td><td>0.006</td><td>0.632</td><td>0.427</td><td>0.995</td><td>-0.983</td><td>1.007</td></tr><tr><td>Commitment</td><td>-0.007</td><td>0.022</td><td>0.107</td><td>0.744</td><td>0.993</td><td>-0.950</td><td>1.037</td></tr><tr><td>Frequency of sex</td><td>-0.006</td><td>0.044</td><td>0.020</td><td>0.887</td><td>0.994</td><td>-0.913</td><td>1.082</td></tr></tbody></table>

Outcome variable = SSRI; n = 810.

### 3. Discussion

This is the first empirical study to examine the relationship between SSRI use and romantic love. We used binary logistic regression to test the hypotheses that SSRI use would be associated with less intense romantic love, less frequent obsessive thinking about a loved one, less commitment, and less frequent sexual activity. None of our hypotheses were supported. The overall findings of this study are not surprising. The theory that romantic love is negatively affected by SSRI use was based on a deficient model of the mechanisms of mammalian reproduction (Fisher, 1998) and a seemingly inaccurate supposition that romantic love is associated with lower levels of serotonin (Fisher and Thomson, 2007). The theory was overextended to suggest that all people taking SSRIs would be likely to have their romantic love affected rather than a small proportion of such people. The results from this study demonstrate SSRIs use is not significantly associated with features of romantic love in our sample of young adults experiencing romantic love.

While the serotonin system is probably associated with romantic love (Langeslag et al., 2012, 2013; Marazziti et al., 1999), the sum of evidence actually indicates an up-regulation of the serotonin system in romantic love (see Bode and Kushnick, 2021), at least in females (note that Langeslag et al., 2012 found lower levels of serum and plasma serotonin levels in males in love than male controls). We believe that up-regulation of the serotonin system in some regions probably partially accounts for the increased intimacy, passion, and possibly, sexual desire associated with romantic love (see similar characteristics of 3,4-Methelyndioxymethamphetamine [MDMA] intoxication; Baylen and Rosenberg, 2006; see also Wagner et al., 2021 in relation to intimacy).

In our sample, the frequency of obsessive thinking about a loved one was not associated with SSRI use. Fisher (1998, 2000) and Fisher et al. (2002) contended that obsessive thinking in romantic love is a result of a down-regulated serotonin system. Aron et al. (2005) subscribed to this belief and noted that the anterior cingulate is associated with obsessive thinking (see McGovern and Sheth, 2017 for consideration in relation to obsessive-compulsive disorder; OCD). The anterior cingulate, which is implicated in romantic love (see Bode and Kushnick, 2021), contains

serotonin receptors (i.e., 5-HT₁A) in particularly high density in one specific region (i.e., BA25) although they are also present in the pregenual (Palomero-Gallagher et al., 2009). Contradicting this, Langeslag et al. (2012), found a positive correlation between serum serotonin levels and obsessive thinking in females who were in love. As SSRIs reduce intrusive thinking in OCD, but not obsessive thinking in romantic love (like Fisher and Thomson, 2007 assert), this suggests that the theory that the same or similar mechanisms are involved in both phenomena is probably incorrect.

In our sample, commitment was not significantly associated with SSRI use. We are not aware of any research that has investigated serotonin and commitment to a romantic partner. There is now evidence that SSRI use does not affect commitment in many individuals experiencing romantic love, suggesting that serotonin may not play an important role in commitment.

The finding that SSRI use is not significantly associated with sexual frequency in our sample is the only surprising finding, given SSRI's well-documented sexual dysfunction side-effects (Rothmore, 2020). This could be because individuals who experience sexual dysfunction are less likely to progress romantic relationships to the point of being in love or romantic love may compensate for these side effects.

Future studies should further investigate the possible influence of SSRI use on romantic love by investigating other specific components of romantic love (e.g., intimacy and passion; see Sternberg, 1986), or attraction, attachment, and sexual desire; see Bode, 2023). SSRIs may even interact with sleep variations associated with romantic love (Bode and Kuula, 2021). The notion that attraction may be influenced by SSRIs highlights the need to consider the process of falling in love. Fisher and Thomson (2007) noted that SSRIs affect behaviors in a manner that may inhibit the formation of romantic relationships (e.g., through sexual dysfunction). There is also some evidence that SSRI use may affect how attractive someone finds another individual (Tocco and Brumbaugh, 2019). Novel efforts to investigate romantic attraction, dating, and the transition into romantic love are needed. There is also a need to investigate the topic from another perspective and investigate relationships formation and romantic love characteristics among individuals who do

<footnote>* p < .05.</footnote>

<footnote>** p < .01.</footnote>

<footnote>*** p < .001.</footnote>
experience strong emotional blunting or sexual dysfunction. It may be that Fisher and Thomson (2007) were correct about the negative impacts of SSRIs in some people. It would also be interesting to extend this research by investigating potential influences of other commonly used medications (e.g., hormonal contraceptives, stimulants) on romantic love. Finally, within-subjects repeated measures design would be extremely informative about the influence of SSRIs on romantic love and permit claims of causality.

Accurate psychoeducation for clients is the cornerstone of most psychological interventions. Therefore, the implications for clinical practice in the context of psychotherapy include the ability for clinicians to be able to provide clients with psychoeducation about the influence of medications on their relationships should they have concerns. This can help with medication adherence if required, and ultimately facilitate better outcomes for clients.

Our study is not without limitations. All participants were from relatively wealthy countries and the majority were current students, somewhat limiting generalizability. The sample was also exclusively young adults, indicating that further research is needed in other age groups. Additionally, participants were only asked if they were currently taking SSRIs, not the dosage, and not the specific reasons. This did not allow consideration of the length of time they had been taking SSRIs or level of functional impairment - relevant factors in determining the effects of SSRIs. Despite these limitations, the present study offers an elegant means of testing a theory that has existed for >15 years and was previously untested. The findings have implications for psychiatrists, psychologists, primary care physicians, and, most importantly, people considering taking SSRIs for a medical condition. Clinical practice can be informed by these findings.

## 4. Conclusion

This paper presented the first study to empirically investigate the association between SSRI use and romantic love. Testing a hypothesis proposed by Fisher and Thomson (2007), we used binary logistic regression to identify associations between biological sex, mental health problems, intensity of romantic love, obsessive thinking about a loved one, and frequency of sex with SSRI use in young adults experiencing romantic love. Biological sex and mental health problems were significantly associated with SSRI use, but none of the romantic love-related variables were significantly associated with SSRI use. This has implications for clinical practice and may allay some concerns of some patients, especially at the early stages of a romantic relationship.

### CRediT authorship contribution statement

**Adam Bode:** Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Conceptualization. **Marta Kowal:** Writing – review & editing, Methodology. **Fabio Cannas Aghedu:** Writing – review & editing, Methodology. **Phillip S. Kavanagh:** Writing – review & editing, Methodology.

### Author statement

AB conceived of the study, decided on the analyses, undertook the analyses, wrote the majority of the manuscript, and edited and reviewed the manuscript. MK decided on the analyses and edited and reviewed the manuscript. FCA decided on the analyses and edited and reviewed the manuscript. PK decided on the analyses, wrote a portion of the manuscript, and edited and reviewed the manuscript.

### Funding

MK was supported by a Foundation for Polish Science (FNP) START Scholarship.

### Declaration of competing interest

The authors declare no competing interests.

### Acknowledgements

The authors have no acknowledgements.

## Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jad.2025.01.103.

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