Sex And Depression

Depression is a very common mental disorder impacting the lives of millions of Americans every year.1 In addition to affecting a person’s mood, energy, and physical health, depression can also impact an individual’s sex life, both in terms of desire and function.2 Fortunately, depression can be treated and there are resources available to ease the burden of depression.

Symptoms of Depression

Depression is very different from feeling sad or grieving. Although the symptoms of both conditions may overlap, there are several important differences. Depression is a constant feeling lasting for over two weeks without relief, while sadness and grief are typically more variable in duration and intensity. Additionally, depression is commonly associated with decreased self-esteem, whereas sadness and grief do not usually involve feelings of worthlessness. It is important to note that personal tragedy can trigger depression and that grief and depression can occur simultaneously. When this happens, the grieving process is often more severe and long-lasting.3

Depression affects each person differently, but the following are some common symptoms associated with most forms of depression:3

  • Feelings of sadness, anxiety, or guilt for a prolonged period of time, often for inexplicable reasons
  • Decreased self-esteem
  • Decreased sex drive
  • Fatigue
  • Having difficulty sleeping or waking up
  • Irritability
  • Persistent headaches, body pains, or digestive issues
  • Extreme changes in weight
  • Having thoughts of self-harm or suicide

An individual can experience some of these symptoms without having depression; however, when a person exhibits multiple symptoms of depression for longer than two weeks, this is cause for concern.

Types of Depression

There are several different types of depression. It is important to identify which form of depression a person has in order to determine the most effective form of treatment.

Persistent Depressive Disorder

Persistent depressive disorder, also known as dysthymia, is characterized by a depressed mood for the majority of two years or longer.4 This means an individual is in a depressive state for the majority of the day most days per week for over two years. Individuals with persistent depressive disorder typically do not experience relief from their symptoms for more than two months at a time. Persistent depressive disorder can manifest as early as childhood. When diagnosing a child, the criteria for length of depression is shortened to one year or longer.5 Individuals with persistent depressive disorder may experience lack of sex drive for months at a time, which often negatively impacts their relationships.4

Bipolar Depression

Bipolar depression is a type of depressive disorder experienced by individuals with bipolar disorder. Bipolar disorder is an illness characterized by extreme changes in mood, from mania to depression.6 The manic periods of bipolar disorder involve intense feelings of happiness and self-confidence as well as reckless actions and fast-paced behaviors. 6 The depressive periods of bipolar are the exact opposite. They are characterized by extreme lows, unexplained sadness, indifference, fatigue, and self-isolation.6 Bipolar depression resembles other forms of depression; however, it is more likely to lead to thoughts of suicide. Bipolar depression is typically treated with mood stabilizing medications in addition to antidepressants. Bipolar depression can lead to loss of interest in many activities that are typically enjoyable, including sex.7 To learn more about bipolar disorder, click here.

Seasonal Affective Disorder

Seasonal affective disorder occurs when an individual’s depression coincides with the seasons, typically increasing in severity in the winter and becoming more manageable in the spring and summer.8 Seasonal affective disorder is the same disorder as depression; however, it follows a distinct pattern as opposed to a constant level. An individual with winter seasonal affective disorder may experience fatigue, feelings of indifference, weight gain, and loss of interest in social interaction.8 Winter seasonal affective disorder is colloquially referred to as “hibernating” because people tend to withdraw from their relationships, favoring isolation over social interaction.8 Seasonal affective disorder can have adverse effects on one’s sex life because social withdraw can leave partners feeling distant and decrease levels of intimacy.

Psychotic Depression

Psychotic depression is a severe form of depression in which a person experiences symptoms traditionally associated with depression accompanied by delusions, hallucinations, and loss of touch with reality.9 For example, a person might hear voices instructing them to kill themselves. The risk of suicide is higher in individuals with psychotic depression than those with other forms of depression and treatment typically includes antidepressants and antipsychotics.9 Individuals with psychotic depression are often consumed with their delusions and exhibit no interest in sexual activity.10

Postpartum Depression

Postpartum depression is a type of depressive disorder that affects females following pregnancy and childbirth.11 Postpartum depression can occur anytime from before the birth of the baby to weeks after childbirth. Symptoms of postpartum depression include extreme sadness, worry, anger, withdrawal from relationships, and lack of attachment to the baby.12 In extreme cases of postpartum depression, a mother may have thoughts of harming herself or others, including her baby. Some mothers experience “baby blues” in which she feels overwhelmed, exhausted, and irritable; however, postpartum depression is far more severe and lasts weeks or even months, while “baby blues” tend to improve more quickly.12 Partners of females with postpartum depression can also be affected by this disorder. Often the partner of a female with postpartum depression may feel helpless and worried for the family’s safety.13 They might also feel angry and upset that their partner is not taking care of the baby or the family as they had previously. Postpartum depression can create distance between partners, negatively impacting their sex life.13 Fortunately, postpartum depression is temporary and treatable through counseling and antidepressants.12 To learn more about postpartum depression, click here.

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder is a form of depression affecting menstruating females and is considered both a depressive disorder and a severe form of premenstrual syndrome (PMS).14 PMDD is far less common than PMS and is characterized by extreme depression, irritability, and body aches beginning a few days before menstruation.15 PMDD has both emotional and physical symptoms, such as swollen breasts, headaches, muscles pain, bloating, and/or weight gain. These symptoms can contribute to a female feeling disinterested in sex. To learn more about PMDD, click here.

 

Situational Depression

Situational depression, also known as adjustment disorder, occurs when a person experiences an extreme emotional response to a stressful event or life change.16 Situational depression is often difficult to diagnose because many people have emotional disturbances following a significant life event such as a career change, death in the family, physical illness, or other stressful situations.16 Situational depression is officially diagnosed when the typical emotional response to such events is more extreme and long-lasting. Like other depressive disorders, situational depression can cause a person to lose interest in sex and relationships.16

Atypical Depression

Atypical depression is a common type of depression with atypical features. Symptoms of atypical depression include improved mood in response to positive events, increased sleep and appetite followed by weight gain, feelings of paralysis in limbs, and extreme sensitivity to rejection from peers.17 This type of depression is atypical because the majority of people with depression do not experience significant mood improvement following a positive event. Additionally, a person with typical depression does not necessarily suffer from extreme anxiety surrounding rejection. A person with atypical depression may have an extreme reaction to being rejected, leading to social ostracization. This fear of rejection can affect a person’s sex life and make them unwilling or uninterested in the vulnerability and potential for rejection that sex provides.17

Antidepressant Medications and Sexual Side Effects

Antidepressants are very effective in the treatment of depression; however, sometimes the side effects of such medications can negatively impact one’s sexual functioning

Selective Serotonin Reputake Inhibitors (SSRIs)

Fluoxetine, citalopram, and paroxetine are all selective serotonin reuptake inhibitors (SSRI) medications that help treat depression. SSRIs work by blocking serotonin reuptake, increasing the levels of serotonin in the brain. Higher levels of serotonin help to improve a patient's mood.18 SSRIs can cause most forms of sexual dysfunction, but most commonly patients taking an SSRI experience dysfunctions involving sexual arousal, orgasm, and libido.19 These medications cause sexual dysfunction by inhibiting the production of nitric oxide, which is the main mediator of both the male and female sexual arousal response. Nitric oxide is a neurotransmitter that widens blood vessels to allow more blood flow into the penis and clitoris, the erectile tissues of males and females, respectively. This leads to complaints of vaginal dryness, diminished genital sensation, and often times orgasmic difficulty.19

Potential treatments for SSRI-induced sexual dysfunction include the following19

  • Decreased dosage regimens: Decreasing the daily dosage may resolve or significantly reduce the sexual side effects. If the patient's complaint is delayed orgasm or anorgasmia, the patient can be instructed to time intercourse either soon before or soon after taking their SSRI dosage. This timing allows for the drug level to be at its lowest during intercourse, hopefully decreasing sexual side effects.

  • Drug holiday: A drug holiday is taking a two-day break from medication in order to lessen sexual side effects and plan intercourse during that period of time. The idea first emerged when patients informed their physicians that they had tried stopping their medication for a day or two and that this resulted in an improvement of sexual functioning without a worsening of depressive symptoms. Due to this finding, a study was performed to determine whether drug holidays were effective strategies for treating SSRI-induced sexual dysfunction. The patients taking sertraline and paroxetine reported improved sexual functioning, while the patients on fluoxetine did not. None of them experienced a worsening of their symptoms.

  • Pharmacological antidotes: Although not approved by the FDA for this particular use, numerous pharmacologic agents have been successfully used for treatment of sexual dysfunction caused by SSRIs. However, most of the information obtained regarding these antidotes has come from anecdotal case reports and not double-blind comparative studies, which means the data is significantly less reliable.

Some patients report that sexual dysfunction decreases over time, a phenomenon also known as spontaneous remission. However, this data is limited and it seems as though improvements occur when the initial complaints are mild and associated with delayed orgasm, rather than desire or arousal disorders.

Tricyclic Antidepressants

Similar to SSRIs, tricyclic antidepressants work by altering the chemistry of the brain to regulate a person’s mood. Tricyclic antidepressants block the reabsorption of serotonin and norepinephrine. Tricyclic antidepressants such as amoxapine, desipramine, and doxepin can sometimes treat a person’s depression when other methods fail.20 Unfortunately, tricyclic antidepressants can cause significant side effects, including orthostatic hypotension (drop in blood pressure upon standing), constipation, urinary retention, dry mouth, and blurry vision.18 Another side effect in males is erectile dysfunction. Among 60 males who had taken a tricyclic antidepressant in the last month, nearly half also qualified as having erectile dysfunction. In contrast, one quarter of the males who had not taken a tricyclic had erectile dysfunction.21

Having a sexual dysfunction is very common and is nothing to be embarrassed about. Mental health care is just as important as physical health care and people should not be afraid to take these beneficial medications due to their side effects.

Concluding Remarks

Depression can negatively impact sexuality by both decreasing a person’s sexual desire and also by inhibiting the sexual response cycle. Depression is a serious mental illness that should not be handled alone. Fortunately, depression can often be managed through medications and/or therapy, and individuals affected by depression can go on to have healthy and happy lives.

If you or a loved one are experiencing any symptoms of the depressive disorders mentioned in this article, contact your doctor or mental health care provider. Here are some resources:

United States National Suicide Hotline: 1 (800) 273-8255 crisis call line 24 hours a day 7 days a week, or visit https://suicidepreventionlifeline.org/.

United States National Institute of Mental Health Information Center: 1 (866) 615-6464 Monday through Friday, 8am-8pm (EST) or visit https://www.nimh.nih.gov/site-info/contact-nimh.shtml.

References

1. Major Depression Among Adults. National Institute of Mental Health: 2015.

2. Cherney, Kristeen. Depression and Sexual Health. Healthline: 2016.

3. What is Depression? American Psychiatric Association: 2017.

4. Reynolds, Cecil. Persistent Depressive Disorder (Dysthymia). DSM-5 Diagnostic Criteria: 2013.

5. Persistent Depressive Disorder (dysthymia). Mayo Clinic: 2017.

6. Bipolar Disorder. Depression and Bipolar Support Alliance: 2016.

7. Bipolar Disorder. National Institute of Mental Health: 2016.

8. Seasonal Affective Disorder. National Institute of Mental Health: 2016.

9. Major Depression with Psychotic Features. Medline Plus: 2016.

10. Legg, Timothy. Depression and Sexual Health. Healthline: 2016.

11. Postpartum Depression. Medline Plus: 2017.

12. Postpartum Depression Facts. National Institute of Mental Health: 2016.

13. Villano, Matt. When You Are Worried Your Wife Has Postpartum Depression. Seleni: 2016.

14. Premenstrual Dysphoric Disorder (PMDD). National Center for Biotechnology Information: 2016.

15. Premenstrual Dysphoric Disorder. Medline Plus: 2017.

16. Patra, Bichitra. Adjustment Disorder: Current Diagnostic Status. National Center for Biotechnology Information: 2013.

17. Sing, Tanvir. Atypical Depression. National Center for Biotechnology Information: 2006.

18. Medication. Anxiety and Depression Association of America: n.d.

19. Sexual Side Effects, Potential Treatment Strategies of SSRI Medications for Depression. Berman Sexual Health: n.d.

20. Tricyclic Antidepressants and Tetracyclic Antidepressants. Mayo Clinic: 2016.

21. Grens, Kerry. Benzodiazepines, Antidepressants Linked to Impotence. North American Center for Continuing Medical Education: 2013.

Last Updated: 27 October 2017.