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Love drugs: Why scientists should study the
effects of pharmaceuticals on human
romantic relationships
Brian D. Earp & Julian Savulescu
University of Oxford
Abstract
There is ongoing disagreement about the moral implications of developing and/or using
neurotechnologies that would affect romantic love and relationships. In this paper, we
argue that scientists should actively pursue a research program into such technology. Our
call for research is based in part on the fact that a number of pharmaceuticals already in
use are very likely to have ramifications for our relationships (romantic and otherwise);
and we suggest that we should attempt to understand the effects of these drugs on our
interpersonal commitments. In a similar vein, we argue for a shift in scientific research
norms, according to which the study of relationships and other social factors would be
given higher priority than they are currently given. Finally, in an Appendix, we discuss
our use of the term “love drug,” and consider whether it is appropriate in light of debates
about neuroreductionism.
Key words: love drugs, neuroenhancement, medicalization, pharmaceuticals,
relationships, science
This is the authors’ copy of an accepted paper, now in press. Please cite as:
Earp, B. D. & Savulescu, J. (2017). Love drugs: Why scientists should study the effects of
pharmaceuticals on human romantic relationships. Technology in Society, in press. Available at
https://www.academia.edu/21966987/Love_drugs_Why_scientists_should_study_the_effects_of_p
harmaceuticals_on_human_romantic_relationships.
Accepted Manuscript
– In Press
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Introduction
Over a series of papers,1 we have offered a limited defense of what we have been calling
"love drugs" and "anti-love drugs.” Roughly, we intend these terms to refer to current and near-
future technologies that would enhance or diminish, respectively, the romantic bond between
individuals in the context of an extant relationship (see the Appendix for further discussion).
While the aim of our defense has been different in different papers—ranging from the right of
couples to use such drugs, should they become available (Savulescu & Sandberg, 2008), to the
obligation that some parents may have, in the future, to take them (Earp et al., 2012)—in this
paper, we are going to focus on an argument which we have not yet advanced directly: namely,
that scientists should actively pursue a research program into the effects of pharmaceuticals and
other brain-level interventions on romantic relationships, and that significant funding should be
allocated for this purpose.
Background
In some of our earlier work, we trained our attention on a narrow question: that of
permissibility. We asked: Are there any cases in which it would be morally permissible to take a
drug—or employ a technology, etc.—that would either strengthen or help to break down a
romantic bond, depending on the desired outcome? By thinking through various hypothetical
scenarios (such as the case in which a victim of domestic abuse, who is uncontrollably in love
with her abuser, might voluntarily take an “anti-love” drug to sever her emotional ties)2 we came
to answer in the affirmative. That is, we identified a number of cases that, in our view, could
morally justify the use of love-altering biotechnology given certain constraints and conditions.
Responses were mixed. Some commentators largely agreed with our reasoning
concerning the cases we explored, while others took issue with our assumptions or conclusions.
For example, in response to the domestic abuse scenario, Diana Aurenque and Christopher
McDougall (2013) wrote, “The first and most obviously justified intervention in [this] case is …
not to drug the woman into unfeeling, but to alert the authorities to the violence and refer her to
supportive social and legal services” (p. 35). This objection calls attention to the vital issues of
social context and alternatives to drug-based interventions, which we have discussed at length in
1 Chiefly: Earp (2012); Earp, Sandberg, and Savulescu (2012); Wudarczyk, Earp, Guastella, and Savulescu (2013);
Earp, Wudarczyk, Sandberg, and Savulescu (2013); Earp, Sandberg, Savulescu, and Andersen (2013); Robson and
Earp (2014); Earp, Sandberg, and Savulescu (2014); Savulescu and Earp (2014); Earp and Savulescu (2016); Earp,
Sandberg, and Savulescu (2015, 2016); Vierra and Earp (2015); Earp, Wudarczyk, Foddy, and Savulescu (in press);
Earp, Foddy, Wudarczyk, and Savulescu (in press); Earp and Hauskeller (2016).
2 See Earp, Wudarczyk, Sandberg, and Savulescu (2013).
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a separate publication (Earp, Sandberg, & Savulescu, 2015; see also Earp, Douglas, & Savulescu,
in press). The point here is that the debate concerning individual cases is ongoing, and that
different scholars have taken, and will presumably continue to take, different stances with
respect to each one.
For the purposes of the present essay, then, let us just assume that the “narrow” question
has a positive answer: let us assume, that is, that there are indeed at least some cases in which the
use of love drugs or anti-love drugs by an individual or couple would be morally permissible.
Implications
What follows from this? Does it follow that such drugs should be made widely available?
That society would be better off, on balance, if they were? That their use, even in “permissible”
cases, is necessarily desirable? By no means. As we have argued previously, societies are under
no obligation to develop, much less make easily obtainable, the kind of technologies we have in
mind, just so that they could be used for what we have argued are “permissible” purposes. Thus,
“even though we think that mature individuals—that is, individuals who have not been
brainwashed, who are competent to reason about their own goals and values, and who are
meaningfully autonomous in their decision making—should be permitted,” in principle, “to
modify themselves pharmacologically in the ways we have described, it does not follow that
there are no other reasons why societies might justifiably seek to manage (or restrict access to)
certain mind- and self-altering substances” (Earp, Sandberg, & Savulescu, 2014, p. 11).
Nevertheless, a sober discussion about the ethics of such technology should not be put off
until tomorrow. For, even if it could be shown that the development of relationship-affecting
neurointerventions would be “too fraught with risk to be worth pursuing deliberately,” or would
have negative consequences, on balance, for society, “it still might not be possible to avoid
having to deal with their eventual existence.” This is because advances in other areas, such as the
development of novel treatments for brain disorders that affect socio-sexual functioning, might
leave us “with the very same neuroscientific insights and/or technological capabilities that we
would have ended up with had we sought them out for love-altering purposes directly.” In such a
scenario, “we would still have to ask ourselves whether, when, or to what extent to use the
powers we had (inadvertently) created” (Earp, Sandberg, & Savulescu, 2014, p. 5).
This is a precautionary approach. It emphasizes the prudence of “thinking ahead” about
possible future scenarios, so that we might be prepared, socially and ethically, for their eventual
occurrence, without taking a stand on whether the purposive investigation of relationship
4
neuroenhancement3 is actually desirable. In this paper, however, we take a stand. Specifically,
rather than merely suggesting that we should develop a robust moral framework concerning love
drugs and anti-love drugs—just in case they are inadvertently developed—we will argue instead
that scientists should deliberately pursue a research program into relationship-affecting
neurotechnologies, and that this should be a funding priority.
Motivation
Our call for research is motivated by two key issues. First, as we will argue, it is likely
that a number of pharmaceuticals already in use (i.e., for therapeutic purposes) are having
unintended, and largely unrecognized, effects on human romantic relationships, and perhaps
even experiences of love,4 some of which are bound to be detrimental. Scientists should study
these effects, we argue, by broadening their attention from pathologies occurring, ostensibly, at
the level of the individual (and their specific treatment in terms of associated symptoms), to the
consequences of therapeutic drug use for relationships, considered in a socially-embedded
context.5
Second, and related to this issue, is the fact that the quality of people’s relationships,
including their romantic relationships, is one of the most powerful known predictors of good
health and subjective well-being (see Wudarczyk et al., 2013 for a review). Indeed, “close
personal relationships” also feature prominently in objective-list theories of well-being (e.g.,
Parfit, 1984; Griffin, 1986), calling attention to the fundamentally social character of human
nature (Aronson, 2003; Adolphs, 2003). And as Nyholm (2015) has recently emphasized, such
relationships may even be intrinsic goods or ends in themselves. Insofar as scientific and
intellectual resources should be directed at increasing the likelihood of human flourishing, then,
it seems to us that investigations into the causal determinants of relationship quality—including,
3 There is ambiguity in our use of the word “neuroenhancement” in this sentence. As we argued in a recent paper,
the definition of “enhancement,” neuro- or otherwise, should be tied to the normative goal of the intervention being
analyzed—typically, the promotion of individual (or couple) well-being (Earp, Sandberg, Kahane, & Savulescu,
2014). On this account, the diminishment of a lower-level feeling, function, or capacity, such as might be
accomplished by the use of an “anti-love” drug (in cases where such use would be appropriate), could plausibly
improve—or “enhance”—the person’s overall well-being. In that case, the “diminishing” intervention would
actually count as a form of welfare enhancement on our preferred definition of the term (see also Savulescu,
Sandberg, & Kahane, 2011; Zohny, 2014).
4 See Appendix for further discussion.
5 Such a shift, we believe, would have important implications for pharmaceutical research going far beyond this
specific debate concerning love drugs and anti-love drugs. Indeed, there are many good arguments, coming from a
range of perspectives, that would favor the establishment of a research norm that prioritizes the investigation of
interpersonal, social, and population-level effects of pharmaceuticals and other similar interventions—not just their
effects on individuals and their symptoms.
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but by no means limited to, those which may be understood6 at the level of psychobiology—
should be a top priority.
For example, if it were shown that certain commonly used pharmaceuticals presented a
high risk of degrading relationship quality (as a side-effect of the intended outcome), then their
widespread prescription should be re-examined. Similarly, if other drugs, or the same drugs
under different conditions, were shown to improve relationship quality on balance—as assessed
in terms of the considered values of the couple in question, ideally in consultation with a trained
therapist, and in the context of a structured counseling program—then their potential for
therapeutic use should be looked into as well (Wudarczyk et al., 2013).7
To develop these points, we will proceed as follows. First, we will discuss a class of drug
that is currently in widespread use, primarily for individual-level therapeutic purposes, but which
is also likely to have ramifications for romantic relationships, namely selective serotonin
reuptake inhibitors (SSRIs), commonly used as anti-depressants. Then we will discuss hormonal
birth control, often referred to as “the pill,” although we will not explore that example at length.
Along the way, and continuing into a concluding section, we shall draw some lessons from these
examples for the debate on the neuroenhancement of relationships, and discuss what we see as a
need for a broader shift in scientific research norms.
Discussion
It is well established that drug-based treatments can have side-effects (see Etkin, 1992,
for a thoughtful discussion). These are typically understood as unintended, and usually unwanted,
physical or mental outcomes that affect the individual taking the drug (Stedman, 1982). Some of
these potential side-effects may be known to the drug manufacturer; others may occur without
having been formally documented, much less studied in a systematic manner. As Neil Levy and
his colleagues (2014) have recently shown, “there are a number of pharmaceuticals already being
6 As Ferraro (2015) notes, love in the context of romantic relationships is not “an ahistorical ‘thing’ within a neural
and physiological domain, but rather, its points of reference [are] cultural, symbolic, linguistic, and contextual” (p.
487). We agree. Yet while the neural and physiological dimensions cannot wholly encompass love, they are not
irrelevant to it either, as we discuss in the Appendix. Understanding the effects of various drugs on love and
relationships, therefore, will require looking across domains and contexts: neural, psychological, interpersonal,
cultural, historical, philosophical, and so on. Indeed, it is the interaction—and causal and conceptual bridges—
between these variables that will be necessary for making predictions about the implications of any given drug for a
given type of relationship, and there will be, as well, an irreducibly subjective element to consider (i.e., in terms of
the individuals’ own experiences and interpretations of love, and the meanings, etc., they ascribe to those
experiences).
7 Here, we are using the term “therapeutic” in its sense of having a positive effect on the body or mind, or
contributing to a feeling or state of well-being. This is as opposed to the sense of “healing a disease” whereby a
specific pathology must be present. For further discussion, see Earp, Sandberg, and Savulescu (2015).
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used on a large scale which affect human cognition and emotion” in ways that have not been
adequately researched. Analyzing how these pharmaceuticals might alter our psychology, they
argue, is “a pressing task, yet it is a task on which surprisingly little effort has been expended”
(pp. 111-112).
We agree with this perspective.8 However, we suggest that it needs to be taken even
further. Not only is there an urgent need, we argue, to study the effects of pharmaceuticals and
other brain-level interventions9 on individual-level psychological processes—such as moral
judgment and decision-making, as emphasized by Levy et al.—but there is also a need to study
the effects of such neurotechnologies on relationships.
To make this point, we draw on the work of Helen E. Fisher and J. Anderson Thomson Jr.
(2007), who have published a detailed chapter discussing just this issue. As they argue, some
widely-used pharmaceuticals can have “serious psychological, social, and genetic consequences”
for human romantic relationships, in part “through their effects on several … neural mechanisms
that evolved to enable mate assessment, mate choice, mate pursuit, feelings of romantic love, and
expressions of attachment to a long term partner” (Fisher & Thomson Jr., 2007, p. 245).
We shall start with the example emphasized by these authors—namely, SSRIs—and then
follow with a brief discussion of hormonal birth control.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are typically prescribed for the treatment of depression as well as a wide range of
anxiety disorders. Their name is derived from the fact that they block the re-uptake of serotonin
in the presynaptic nerve terminal, thereby increasing its activity at the synapse. According to
Laura Pratt and colleagues (2011), between 2005 and 2008, approximately 11% of Americans
ages 12 and older were on some form of anti-depressant, with SSRIs being the most commonly
prescribed form (Mayo Clinic, 2013). While these drugs can be helpful, in many instances, in
treating individuals’ symptoms of depression, thereby allowing them to function more effectively
in their day to day lives, including in some cases in the context of their relationships (see later
discussion), they may also have negative interpersonal effects that are not very well understood.
For example, it has long been known that SSRIs can lower libido, which is centrally
relevant to many romantic partnerships (although the specific implications for any particular
8 Indeed one of us, Savulescu, is a co-author on the paper in question.
9 Such as so-called non-invasive brain stimulation: see, e.g., Davis and van Koningsbruggen (2013), Maslen et al.
(2014).
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couple will differ from case to case; see Box 1), but there is now emerging evidence that they
can, in addition, dull what might be considered higher-level emotional states, such as caring
about the feelings of others (e.g., Opbroek et al., 2002; Read et al., 2014). As Dixie Meyer
(2007) has argued, the “overall lack of emotional stimulation” produced by SSRIs in some
patients “may produce a blandness that overwhelms the romantic relationship” (p. 395). Nikki
Graham (2010) has made the point somewhat more bluntly: “Aside from ruining your sex life,”
she writes, “antidepressants could also be responsible for breaking your heart” (p. 20).
Box 1. What are the implications of a diminished libido on romantic relationships?
Fisher and Thomson Jr. (2007) highlight several potential mechanisms by which SSRIs
can negatively affect romantic relationships. These include the development of adverse sexual
side effects (such as impotence) via interference with testosterone levels, which can lead to
“performance anxiety” and thereby the avoidance of intimate situations. In addition to higher-
level psychological consequences and changes in the couple’s dynamic, such avoidance can also
lead to chronically lowered levels of oxytocin, a neuropeptide which is normally released
through kissing, sensual touch, and orgasm, and which is strongly implicated in the formation
and long-term maintenance of attachment bonds in humans and other animals (e.g., Feldman,
2012). Moreover, increased levels of serotonin caused by SSRIs can directly suppress activity in
pathways for dopamine and norepinephrine, neurotransmitters which are involved in the
production of subjectively reportable “feelings of romantic love” (Fisher & Thomson Jr., 2007, p.
257)
To illustrate some of these potential effects in a more relatable manner, Fisher and
Thomson Jr. share a number of “case studies.” Consider the following apparently real-life
What are the implications of a lowered libido for romantic relationships? Plainly, it depends upon the details. Consider,
for example, that SSRIs have been prescribed off label as a treatment for what is sometimes referred to as “premature
ejaculation,” due to their ability to delay orgasm in some individuals (e.g., Balon, 1996; Waldinger et al., 2005). For
couples for whom an extended period of intercourse or other sexual activity prior to ejaculation is judged to be
desirable, and who struggle to achieve this goal by other means, SSRIs that mak e it harder to ejaculate may, in some
cases, have a welcome effect all else being equal. For other couples, the very same outcome, namely, a delay or
difficulty in achieving orgasm, may be judged to be undesirable, for any number of reasons. Speaking generally, then, a
“diminished libido” (or other similar outcome), considered as a potential side-effect SSRIs, is neither inherently
pathological nor even necessarily problematic. Rather, the character, intensity, and expression of people’s sexual drives
and capacities range widely even without the influence of medication (see Gupta, 2012, for a nice discussion). Whether
a given alteration to those factors is likely to frustrate, or facilitate, one’s relationship goals, therefore, will depend upon
the type and degr ee of alteration, the means by which it is achieved, the nature of the relationship and the relationship
goals themselves, etc.—all considered within the context of other possible means by which those goals could be
achieved, the sexual and other preferences of the couple in question, and their shared values. For related discussions,
see Earp (2016) and Earp and Darby (in press).
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account of a 26-year-old man who had panic attacks that required high doses of an SSRI:
He soon experienced diminished libido and impotence. A handsome, personable,
intelligent man, he was readily sought after by women. However, he ended several
relationships because he was too embarrassed about his inability to perform sexually.
Although he tried several other medications, he was able to control his panic disorder
only with high doses of serotonin enhancers. Eventually he retreated into a social life in
which he avoided serious dating. When last evaluated he still confined himself to non-
sexual relationships with women. (Fisher & Thomson Jr., 2007, p. 267)
Elsewhere, they quote from a letter published in the New York Times (Frankel, 2004):
After two bouts of depression in 20 years, my therapist recommended I stay on serotonin-
enhancing antidepressants indefinitely. As appreciative as I was to have regained my
health, I found that my usual enthusiasm for life was replaced with blandness. My
romantic feelings for my wife declined drastically. With the approval of my therapist, I
gradually discontinued my medication. My enthusiasm returned and our romance is now
as strong as ever. I am prepared to deal with another bout of depression if need be, but in
my case the long-term side effects of antidepressants render them off limits.
Not everyone reports similar experiences, however. Consider this very different account
from a couple that was recently profiled for a story in Elle magazine (Kamps, 2012):
Before they got on antidepressants, Susan's tendency to rail at length (about whatever
happened to be irking her) exacerbated Will's "extremely self-critical" tendencies:
"Whereas in her depression she'd tend to lash out, in mine I'd tend to sink inward," he
says. … "We were heading down a bad path." Now, though, they agree their marriage is
much better balanced. Susan's rough edges have "softened," as Will puts it, and with
this—plus the boost medication has given his own confidence—he's become more
forthcoming: They're able to work together to solve problems. "We really are each other's
best partners," Will says. "To call us soul mates I think would be accurate."
The lesson from these contrastive cases—which we acknowledge are merely
anecdotes10—is that SSRIs (or other drugs) might put some relationships in jeopardy, while in
other instances, they might serve as relationship enhancers. In this context, it should be noted
that the connections between the sex drive, the attachment system, and higher-level experiences
of romantic love, are complex and not entirely well understood. As Fisher and Thomson Jr.
10 Anecdotes are among the least reliable forms of evidence for establishing clear causation. But that is consistent
with our overall argument: our call is precisely for additional, more systematic research into the effects of
pharmaceuticals on relationships, paying attention to the personal, interpersonal, and contextual variables that allow
for the prediction of different outcomes (i.e., for different couples under different circumstances).
9
explain, the interrelationship between these factors differs from person to person; it is also “dose
dependent [and] varies depending on the quantities, timing, and interactions among several
hormones.” Thus, under some circumstances, “serotonin-enhancing antidepressants that suppress
the sex drive [can actually] strengthen feelings of attachment in a long-term relationship,” rather
than weaken them, as discussed above (Fisher & Thomson Jr., 2007, pp. 261-262).
A similar analysis is given by Levy et al. (2007) in their discussion of the effects of
SSRIs on people’s moral psychology. “Whether using a particular pharmaceutical induces
morally better or worse decisions and behavior,” they write, “depends, crucially, on the
individual’s pre-existing dispositions and the circumstances in which they act, as well as what
the drug is used for and the effect of any underlying condition on moral decision-making and
behavior” (p. 122).
Of course, it also depends on what is assumed, or argued, to be morally “better” versus
“worse” in the first place, which is fundamentally a question of values. Thus, it is a question with
respect to which different people will reach different conclusions—as Levy et al. acknowledge
elsewhere in their paper. Likewise for love and relationships. In other words, even if a complete
description of the physical and psychological effects of a given pharmaceutical (on an individual
or couple with X, Y, and Z characteristics) could be “scientifically” determined, the question of
whether it counted as a “love drug”—or as a relationship “enhancer” as opposed to the
opposite—would still be open: it would depend upon, among other things, the couple’s
conception of love, their relationship goals, and their values (see Appendix for further
discussion).
That said, scientists are currently nowhere close to a “complete description” of the
“physical and psychological effects” of SSRIs—or any other widely-used drug—on either
individuals or couples, much less over a range of conditions, personality traits, and relationship
characteristics. All that is known at this point, as Fisher and Thomson, Jr. argue, is that the
“flexible nature of [the] brain mechanisms for reproduction and their complex, dynamic
interactions suggest that any medication that changes the chemical checks and balances is likely
to alter an individual’s courting, mating, and parenting tactics,” with potentially wide-ranging
implications for relationships (Fisher & Thomson, Jr., 2007, p. 269).
To say that further research is needed would be an understatement. And this research
needs to be “fine-grained.” As Levy et al. (2014) note, “we need to know not only the average
effects of pharmaceuticals, but also how they interact with pre-existing dispositions of agents and
the underlying condition for which they are being used.” Problematically, however, “we lack
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sufficient knowledge of these factors with regard to an enormous number of widely used
pharmaceuticals” (p. 122).
Hormonal birth control—a.k.a. “the pill”
One such pharmaceutical is “the pill.” According to the U.S. Centers for Disease Control
and Prevention, between 2006 and 2010, 62% of American women of reproductive age were
using contraception. The most common form of contraception employed—typically to prevent
unwanted pregnancy—was hormonal birth control, used by 10.6 million women (CDC, 2012).
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost
all methods consist of steroid hormones, and there are two main types: combined methods, which
contain both estrogen and progestin, and progestin-only methods. Combined methods work by
suppressing ovulation and thickening cervical mucus, while progestin-only methods reduce the
frequency of ovulation (Storck, 2014).
Common side effects of progestin-only hormonal birth control include menstrual cycle
disruption, headaches, weight gain, and breast tenderness (McCann & Potter, 1994). Some forms
of hormonal birth control can also cause nausea and mood swings, and may affect libido in some
women as well (Littleton, 2015). While the latter of these effects could have indirect
consequences for relationships (see Box 1), in recent years, a body of research has emerged
which suggests—but by no means conclusively demonstrates—a more direct connection between
hormonal birth control and so-called “mating preferences” in women (e.g., Alvergne, & Lummaa,
2010).
According to one common theory, hormonal variation over women’s menstrual cycles
changes their preferences for outward indicators of men's genetic or parental quality (however,
see the meta-analysis by Wood et al., 2014, which is largely non-supportive of this view),
including signals that might be communicated unconsciously via pheromones (Grammer et al.,
2005). Since hormonal contraceptives suppress this variation, the theory goes, different mate
preference patterns might develop such that women who are using oral contraception in the early
stages of dating could end up choosing a less genetically “fit” or compatible partner than they
would do if they were not on birth control (see, e.g., Roberts & Little, 2008).
In a recent study, S. Craig Roberts and colleagues (2012) tested this idea, looking for
differences in relationship quality and eventual break-up between women who were or were not
using oral contraception (OC) when they initially partnered with the man who fathered their first
child. They found that women who were on hormonal birth control at the time “scored lower on
11
measures of sexual satisfaction and partner attraction, experienced increasing sexual
dissatisfaction during the relationship, and were more likely to be the one to initiate an eventual
separation if it occurred.” Curiously, however, “the same women were more satisfied with their
partner's paternal provision, and thus had longer relationships and were less likely to separate.”
As they concluded, “our results demonstrate that widespread use of hormonal contraception may
contribute to relationship outcome, with implications for human reproductive behaviour, family
cohesion and quality of life” (p. 1430). Just as with SSRIs, however, these implications are only
barely beginning to be researched.
Conclusion
In this essay, we have emphasized a number of potential “downsides” that two widely-
used pharmaceuticals may have for romantic relationships. But we have also hinted at possible
“upsides” as well, depending upon the drug, the dose, the individual, and the particular couple
involved. Given the centrality of close relationships to both subjective and objective accounts of
human well-being, we suggest that scientists and funders should11 prioritize the investigation of
these effects, so that we might “avoid the worst dangers” posed by pharmaceuticals to our
romantic relationships, as well as perhaps “harness them to better ends” (Levy et al, 2014, p.
123).
To do this would require a shift in research norms. With respect to the effects of SSRIs,
for example, as Kamps (2012) has noted: “Many standard measures of depression focus on
mood-based symptoms such as sadness, withdrawal, and loss of appetite rather than on how
respondents are getting along with spouses, coworkers, and kids.” At the same time, negative and
potentially harmful emotions such as (maladaptive) anger are “common in depression—and
spouses tend to bear the brunt.” Indeed, scientists' failure to appreciate this interpersonal
dimension could be one reason why some studies suggest that “antidepressants don't work
terribly well … the data [don’t] capture their ability to reduce volatility [in romantic
relationships] because researchers don't ask about it in the first place.”
11 A reviewer asks what we mean by “should” here. We are fine with more than one interpretation. One way to read
this is as a conditional: if scientists and funders think it is important to direct their resources toward improving
human health and well-being, then they would be remiss to ignore the interpersonal dimensions of pharmaceutical
and other medical interventions. Another way to read it is like this: scientists and funders have an obligation, all else
being equal, to improve human health and well-being—and to minimize harm—when and insofar as they can.
Therefore, they have an obligation to study the effects of widely-used drugs on relationships, since these may be
causing significant harm and/or failing to provide as much benefit as they could.
12
Our suggestion, quite simply, is that researchers should start to ask such questions. This
could happen in a number of ways. Researchers could, themselves, decide to alter—or add to—
the protocols they use to assess the outcomes of the drugs being tested. Funding agencies could
encourage a greater emphasis on studying the interpersonal dimensions of drug-use when making
decisions about grants. Pharmaceutical companies could be held to task for advertising drugs
without first evaluating their social implications. Doctors could include questions about positive
and negative effects on relationships when checking up on their patients’ progress—and so on.
At bottom, we suggest that interpersonal health and well-being should be regularly
assessed, using both qualitative and quantitative measures, as primary outcomes of interest in
studies on the effects of pharmaceutical interventions. It is not enough to study individuals and
their symptoms: each of us is embedded in at least some kind of social context, and if certain
drugs are going to continue to be prescribed for therapeutic purposes, it is imperative that we
understand their implications for our relationships.12
12 A reviewer suggests that we have left an ambiguity ‘lurking’ behind our paper. Specifically, it is not clear whether
the further research we are advocating “should aim at developing drugs that could intentionally be used to affect
romantic relationships,” or whether our concern “is just with understanding the side-effects [for relationships] of
current drugs” that are being used for other purposes. For the sake of this paper, our concern is only the latter. For
arguments in support of the former aim, readers can turn to our earlier papers (see footnote 1).
13
Appendix – What is a love drug, really?13
When we give our lectures on “love drugs,” someone usually sticks up her hand asks,
“But what do you mean by ‘love’?” Usually we demur, saying something like “Look, what we
are focusing on here are the neurobiological underpinnings of human lust, attraction, and
attachment, and how those systems relate to ‘love’ is going to depend on the specific theory of
love one prefers.” We don’t want to be prescriptive, and say that we know what love “really is,”
nor do we want our ethical analysis to be tied to any single conception (see below). So we tend to
use the term informally, not to mention expansively, to cover a wide range of possible definitions.
In fact, in our view, there is no Platonic definition of love, floating out there for someone
to discover. Love has different meanings. As Karin Weis (2006) states, “Love is not a uniform
phenomenon. There are countless variations on the forms [loving] relationships can take [and]
just as diverse as the appearances of love are the theories of love that try to fathom it” (pp. 2–3).
As the Oxford English Dictionary (2015) would have it, love is “a feeling or disposition of deep
affection or fondness for someone, typically arising from a recognition of attractive qualities,
from natural affinity, or from sympathy and manifesting itself in concern for the other's welfare
and pleasure in his or her presence.” To poets like Charles Burkowski, “Love is a fog that burns
with the first daylight of reality” (see Popova, 2012). Ambrose Bierce (1911/1996) takes a more
cynical view: “Love, n. A temporary insanity curable by marriage” (p. 162).
We confess that we see something of value in each of these definitions, as well as many
others that could be given. That said, for the bulk of our research, we tend to focus on a psycho-
biological account of love (for a justification of this focus, see Earp, Sandberg, & Savulescu,
2016, Box 1). This account suggests that the complex feelings, motivations, and interpersonal
attachments that one would typically associate with the word “love” in a Western context are
actually grounded in, and in fact emerge from, a suite of neurochemical and behavioral
subsystems that evolved to promote the reproductive success of our ancestors (e.g., Kenrick,
2006; Carter, 1998; Fisher et al., 2006). How, precisely, these underlying systems relate to
“higher level” conceptions and subjective experiences of love is not yet fully understood, and
again, this relationship will depend almost entirely upon the specific higher-level conception one
prefers. At the same time, unless one subscribes to a dualistic theory of the world, according to
which love exists in something like a disembodied “soul,” what is clear by now is that there is a
13 Portions of this Appendix are adapted from Box 1 of the essay, “If I Could Just Stop Loving You: Anti-Love
Biotechnology and the Ethics of a Chemical Breakup” (Earp, Wudarczyk, Sandberg, & Savulescu, 2013).
14
relationship between these levels, and a significant one at that. Mess with the underlying
systems—in a sufficiently disruptive way—and you mess with love, on almost any definition.
An analogy might be the Mona Lisa. There is a sense in which a technically complete
description of this painting could be given in terms of splotches of paint occurring at various
coordinates on a two-dimensional canvas. But most people would say that a really robust
understanding of the Mona Lisa requires a whole range of different levels of analysis: how she
appears to the person looking at her, something about the emotion expressed by her peculiar
smile, what we know about the artist who made the painting, and so on. There are also different
ways of understanding the painting based on the theory of art one subscribes to; these theories
appeal to different people for different reasons, and they are not always entirely compatible.
At the same time, the low-level splotches of paint can’t just be dismissed. For example,
we know that changing those splotches of paint in certain ways—say, by coating all of the green-
colored splotches with shades of hot pink—will also change the Mona Lisa. This is likely to be
the case regardless of the higher-level theory of art one favors, although the precise way in which
the painting can now be said to be different will depend on the particular theory (as well as on
the chosen level or levels of analysis). In a similar vein, consider the issue of artistic restoration.
As masterpieces like the Mona Lisa fade with time, they can sometimes be “touched up” to
maintain their essential character. Just as with the green-to-pink transformation, this sort of
alteration would have occur, on at least one level of description, by virtue of making concrete,
physical changes to those lower-level splotches of paint—even though the particular changes that
would be made in this new case would be quite different (no hot pink should be used for
restoration). And here, too, there will be subjective value judgments as to what is really
“essential” about the painting, and therefore what specific changes are needed to preserve the
relevant features.
So too with love. Supplementing a marriage counseling session with oxytocin or MDMA
(for practical details, see Wudarczyk et al., 2013, and Earp, 2015)—both of which work directly
on the brain—might be judged by some couples to be a legitimate means of maintaining what is
essential about the love between them. For other couples, however, the same intervention might
be viewed as inauthentic means of doing so, resulting in a pseudo-love at best. Similarly, some
theories of love will acknowledge that the loss of sexual interest in one’s partner brought about
by an SSRI—or the blunting of one’s ability to feel sad about that partner’s misfortune—is a
bona fide “anti-love” effect. Other theories will reject this conclusion, saying that the love for
15
one’s partner has not changed, but only some low-level motivational state or emotional capacity
that, while relevant, is not essential.
It has not been our interest to adjudicate such questions, nor to defend a “one size fits all”
account of love. As we explained in a recent essay, we are much “less concerned about whether a
given a given state of desire, attraction, etc., is deserving of the label ‘love,’ than with whether it
is causing net harm to oneself or someone else, and, if it is, whether the application of a medical
technology could ethically play a role in preventing or alleviating that harm” (Earp & Savulescu,
2016, p. 94). Nevertheless, while talk of brain chemicals only gets us so far—in terms of getting
a hold of what we really care about when we experience love, or attempt to describe it—there
can be no doubt that such chemicals play a fundamental role in shaping, or giving rise to, those
very same experiences and descriptions.14 More importantly, changing them (in the right kind of
way) will also change the higher-level “love” accordingly—depending upon the particulars of
the couple in question, along with their physical, social, and historical context—however one
wishes to define it.
14 Similarly, our experiences, beliefs, and conceptions about love have the power to change our brain chemistry: just
think about the sudden increase in adrenaline, for example, that might occur when one’s beloved is seen,
unexpectedly, in the arms of someone else. Think, too, about how that brain-level response might differ as a partial
function of one’s higher-level commitments: if one is passionate about polyamory, for example, or has carefully
invested in an “open” relationship, then the very same perceptual event might not have the same effect on her lower-
level neurochemistry.
16
References
Adolphs, R. (2003). Cognitive neuroscience of human social behaviour. Nature Reviews
Neuroscience, 4(3), 165-178.
Alvergne, A., & Lummaa, V. (2010). Does the contraceptive pill alter mate choice in humans?
Trends in Ecology & Evolution, 25(3), 171-179.
Aronson, E. (2003). The social animal. New York: Macmillan.
Aurenque, D., & McDougall, C. W. (2013). Amantes sunt amentes: Pathologizing love and the
meaning of suffering. The American Journal of Bioethics, 13(11), 34-36.
Balon, R. (1996). Antidepressants in the treatment of premature ejaculation. Journal of Sex &
Marital Therapy, 22(2), 85-96.
Bierce, A. (1911/1996). The devil's dictionary. Ware: Wordsworth Editions.
Carter, C. S. (1998). Neuroendocrine perspectives on social attachment and love.
Psychoneuroendocrinology, 23(8), 779-818.
CDC (2012, October 18) Current contraceptive use in the United States, 2006–2010, and
changes in patterns of use since 1995. National Health Statistics Reports, 60, 1-25. Available at
http://www.cdc.gov/nchs/data/nhsr/nhsr060.pdf
Davis, N. J., & van Koningsbruggen, M. G. (2013). "Non-invasive" brain stimulation is not non-
invasive. Frontiers in Systems Neuroscience, 7(76), 1-4.
Earp, B. D. (2012). Love and other drugs. Philosophy Now, Issue 91 (July/August), 14-17.
Earp, B. D. (2015). Drogen nehmen – um Wohl unserer Kinder? GEO Magazine, 10(1), 62-63.
17
Earp, B. D. (2016). Infant circumcision and adult penile sensitivity: Implications for sexual
experience. Trends in Urology & Men’s Health, 7(4), 17-21.
Earp, B. D. & Darby, R. (in press). Circumcision, sexual experience, and harm. University of
Pennsylvania Journal of International Law, in press.
Earp, B. D., Douglas, T., & Savulescu, J. (in press). Moral neuroenhancement. In S. Johnson &
K. Rommelfanger (Eds.), Routledge Handbook of Neuroethics. New York: Routledge.
Earp, B. D., Foddy, B., Wudarczyk, O. A., & Savulescu, J. (in press). Love addiction: Reply to
Jenkins and Levy. Philosophy, Psychiatry, & Psychology, in press.
Earp, B. D., & Hauskeller, M. (2016). Binocularity in bioethics—and beyond. American Journal
of Bioethics, 16(2), W3-W6.
Earp, B. D., Sandberg, A., Kahane, G., and Savulescu, J. (2014). When is diminishment a form
of enhancement? Rethinking the enhancement debate in biomedical ethics. Frontiers in Systems
Neuroscience, 8(12), 1-8.
Earp, B. D., Sandberg, A., Savulescu, J., & Andersen, R. (2013, January 31). The case for using
drugs to enhance our relationships (and our break ups). The Atlantic. Available at
http://www.theatlantic.com/technology/archive/2013/01/the-case-for-using-drugs-to-enhance-
our-relationships-and-our-break-ups/272615/.
Earp, B. D., Sandberg, A., & Savulescu, J. (2012). Natural selection, childrearing, and the ethics
of marriage (and divorce): Building a case for the neuroenhancement of human relationships.
Philosophy & Technology, 25(4), 561-587.
18
Earp, B. D., Sandberg, A., & Savulescu, J. (2014). Brave new love: The threat of high-tech
“conversion” therapy and the bio-oppression of sexual minorities. American Journal of
Bioethics: Neuroscience, 5(1) 4-12.
Earp, B. D., Sandberg, A., & Savulescu, J. (2015). The medicalization of love. Cambridge
Quarterly of Healthcare Ethics, 24(3), 323–336.
Earp, B. D., Sandberg, A., & Savulescu, J. (2016). The medicalization of love: Response to
critics. Cambridge Quarterly of Healthcare Ethics, 25(4), 759-771.
Earp, B. D., & Savulescu, J. (2016). Is there such a thing as a love drug? Reply to McGee.
Philosophy, Psychiatry, & Psychology, 23(2), 93-96.
Earp, B. D., Wudarczyk, O. A., Sandberg, A., & Savulescu. J. (2013). If I could just stop loving
you: Anti-love biotechnology and the ethics of a chemical breakup. American Journal of
Bioethics, 13(11), 3–17.
Earp, B. D., Wudarczyk, O. A., Foddy, B., & Savulescu, J. (in press): Addicted to love: What is
love addiction and when should it be treated? Philosophy, Psychiatry, & Psychology, in press.
Etkin, N. L. (1992). “Side effects”: Cultural constructions and reinterpretations of western
pharmaceuticals. Medical Anthropology Quarterly, 6(2), 99-113.
Feldman, R. (2012). Oxytocin and social affiliation in humans. Hormones and Behavior, 61(3),
380-391.
Ferraro, D. (2015). On love, ethics, technology, and neuroenhancement. Cambridge Quarterly of
Healthcare Ethics, 24(4), 486-489.
19
Fisher, H. E., Aron, A., & Brown, L. L. (2006). Romantic love: A mammalian brain system for
mate choice. Philosophical Transactions of the Royal Society of London B: Biological Sciences,
361(1476), 2173-2186.
Fisher, H. E., & Thomson Jr., J. A. (2007). Lust, romance, attachment: Do the side effects of
serotonin-enhancing antidepressants jeopardize romantic love, marriage, and fertility? In S.
Platek, J. Keenan, and T. Shackelford (Eds.), Evolutionary cognitive neuroscience, pp. 245-283.
Cambridge: MIT Press.
Frankel, J. (2004, May 11). Reviving romance. The New York Times, p. F4, Letters.
Graham, N. (2010). Sex, love and serotonin. Health Intelligence: The Science of Health, 2, 20–
24.
Grammer, K., Fink, B., & Neave, N. (2005). Human pheromones and sexual attraction.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 118(2), 135-142.
Griffin, J. (1986). Well-being: Its meaning, measurement, and moral importance. Oxford:
Clarendon.
Gupta, K. (2012). Protecting sexual diversity: Rethinking the use of neurotechnological
interventions to alter sexuality. AJOB Neuroscience, 3(3), 24-28.
Jones, B. C., Perrett, D. I., Little, A. C., Boothroyd, L., Cornwell, R. E., Feinberg, D. R., ... &
Burt, D. M. (2005). Menstrual cycle, pregnancy and oral contraceptive use alter attraction to
apparent health in faces. Proceedings of the Royal Society of London B: Biological Sciences,
272(1561), 347-354.
Kamps, L. (2012, April 18). The couple who medicates together. Elle. Available at
http://www.elle.com/life-love/sex-relationships/advice/a14208/the-couple-who-medicates-
together-654677/.
20
Kenrick, D. T. (2006). A dynamical evolutionary view of love. In: R. Sternberg & K. Weis
(Eds.), The new psychology of love, 15-34. New Haven: Yale University Press.
Levy, N., Douglas, T., Kahane, G., Terbeck, S., Cowen, P. J., Hewstone, M., & Savulescu, J.
(2014). Are you morally modified? The moral effects of widely used pharmaceuticals.
Philosophy, Psychiatry, & Psychology, 21(2), 111-125.
Littleton, M. W. (2015). The truth about “the pill” and your sex drive. Web MD (reviewed by
Traci C. Johnson, MD, FACOG). Available at http://www.webmd.com/sex/birth-
control/features/the-pill-and-desire.
Mayo Clinic Staff (2013, July 9). Depression (major depressive disorder). The Mayo Clinic.
Available at http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-
20044825.
Maslen, H., Earp, B. D., Cohen Kadosh, R., & Savulescu, J. (2014). Brain stimulation for
treatment and enhancement in children: An ethical analysis. Frontiers in Human Neuroscience,
8(953), 1-5.
McCann, M. F., & Potter, L. S. (1994). Progestin-only oral contraception: A comprehensive
review: X. Common side effects. Contraception, 50(6), S114-S138.
Meyer, D. (2007). Selective serotonin reuptake inhibitors and their effects on relationship
satisfaction. The Family Journal, 15(4), 392-397.
Nyholm, S. (2015). The medicalization of love and narrow and broad conceptions of human
well-being. Cambridge Quarterly of Healthcare Ethics, 24(3), 337-346.
Opbroek, A., Delgado, P. L., Laukes, C., McGahuey, C., Katsanis, J., Moreno, F. A., & Manber,
R. (2002). Emotional blunting associated with SSRI-induced sexual dysfunction. Do SSRIs
21
inhibit emotional responses? The International Journal of Neuropsychopharmacology, 5(02),
147-151.
Oxford English Dictionary. (2015). Love, n. Oxford English Dictionary. Available at
http://www.oed.com.
Parfit, D. (1984). Reasons and persons. Oxford: Oxford University Press.
Pratt, L. A., Brody, D. J., & Gu, Q. (2011). Antidepressant use in persons aged 12 and over:
United States, 2005-2008. NCHS Data Brief, 76, 1-8.
Popova, M. (2012, January 3). Charles Burkowski on what love is. Brain Pickings. Available at
https://www.brainpickings.org/2012/01/30/charles-bukowski-on-love/.
Read, J., Cartwright, C., & Gibson, K. (2014). Adverse emotional and interpersonal effects
reported by 1829 New Zealanders while taking antidepressants. Psychiatry Research, 216(1), 67-
73.
Roberts, S. C., Klapilová, K., Little, A. C., Burriss, R. P., Jones, B. C., DeBruine, L. M., ... &
Havlíček, J. (2012). Relationship satisfaction and outcome in women who meet their partner
while using oral contraception. Proceedings of the Royal Society B: Biological Sciences,
279(1732), 1430-1436.
Roberts, S. C., & Little, A. C. (2008). Good genes, complementary genes and human mate
preferences. Genetica, 132(3), 309-321.
Savulescu, J., & Earp, B. D. (2014). Neuroreductionism about sex and love. Think: A Journal of
the Royal Institute of Philosophy, 13(38), 7-12.
Savulescu, J., & Sandberg, A. (2008). Neuroenhancement of love and marriage: The chemicals
between us. Neuroethics, 1(1), 31-44.
22
Savulescu, J., Sandberg, A., & Kahane, G. (2011). Well‐Being and enhancement. In: J.
Savulescu, R. ter Meulen, & G. Kahane (Eds.), Enhancing human capacities, 1-18. Hoboken:
Wiley-Blackwell.
Stedman, T. (1982). Stedman’s medical dictionary. Baltimore: Williams and Wilkins.
Storck, S. (2014). Birth control pills – overview. A.D.A.M. Medical Encyclopedia – U.S.
National Library of Medicine. Available at
https://www.nlm.nih.gov/medlineplus/ency/article/007460.htm.
Vierra, A., & Earp, B. D. (2015, April 21). Born this way? How high-tech conversion therapy
could undermine gay rights. The Conversation. Available at https://theconversation.com/born-
this-way-how-high-tech-conversion-therapy-could-undermine-gay-rights-40121
Waldinger, M. D., Schweitzer, D. H., & Olivier, B. (2005). On-demand SSRI treatment of
premature ejaculation: Pharmacodynamic limitations for relevant ejaculation delay and
consequent solutions. The Journal of Sexual Medicine, 2(1), 121-131.
Weis, K. (2006). Introduction. In: R. Sternberg & K. Weis (Eds.), The new psychology of love.
New Haven: Yale University Press.
Wood, W., Kressel, L., Joshi, P. D., & Louie, B. (2014). Meta-analysis of menstrual cycle effects
on women’s mate preferences. Emotion Review, 6(3), 229-249.
Wudarczyk, O. A., Earp, B. D. , Guastella, A., & Savulescu, J. (2013): Could intranasal oxytocin
be used to enhance relationships? Research imperatives, clinical policy, and ethical
considerations. Current Opinion in Psychiatry, 26(5), 474-484.
Zohny, H. (2014). A defence of the welfarist account of enhancement. Performance
Enhancement & Health, 3(3), 123-129.
