Bipolar disorder is a mood disorder. People who have bipolar disorder experience high levels of both euphoria and depression. Their moods can go from one extreme to the other.
Life events, medication, and drug misuse can trigger mania and depression. Both moods can last from a few days to a few months.
Bipolar disorder can also affect your sexuality and sexual activity.
During a manic episode, you may experience hypersexuality, or an increase in sexual activity. It may place you at an increased risk for actions that may have negative effects, such as contracting a sexually transmitted infection (STI).
During a depressive episode, you may lose interest in sex. These sexual issues can create problems in relationships and may lower your self-esteem.
During a manic episode, your sex drive and sexual impulses can often lead to sexual behavior that’s atypical for you when you aren’t experiencing episodes of mania.
Examples of hypersexuality during a manic episode can include:
- greatly increased sexual activity without a feeling of sexual satisfaction
- sex with multiple partners, including strangers
- excessive masturbation
- continuous sexual affairs, despite the potential risk to relationships
- sexual behavior that increases the likelihood of actions that can result in negative effects, such as contracting an STI
- preoccupation with sexual thoughts
- increased use of pornography
Hypersexuality can be a challenging symptom if you have bipolar disorder.
More studies that look at prevalence of this condition are needed.
A 2016 study published in Psychiatry Journal compared the sexual behavior of two groups:
- people with bipolar disorder who were treated as outpatients in private practice
- people treated as outpatients who didn’t have affective disorder or schizophrenia
At the beginning of the study, the authors also highlighted the available data on people with bipolar disorder and hypersexuality.
Researchers have found that anywhere from 25 to 80 percent of people with episodes of mania also experience bipolar hypersexuality. Additionally, the condition also appears in women more often than in men.
Some adults with bipolar disorder may have a hard time managing their sexual urges.
Teens and younger children with bipolar disorder may display inappropriate sexual behavior toward adults as a symptom of their condition. This can include inappropriate flirting, inappropriate touching, and heavy use of sexual language.
You may experience the opposite of hypersexuality during a depressive episode. This includes low sex drive, which is called hyposexuality. Depression very commonly causes a lack of interest in sex.
Hyposexuality can often create relationship problems because your partner may not fully understand your sex drive issues.
This is especially true if you have extreme mania with hypersexual behavior and then suddenly experience depression and lose interest in sex. Your partner may feel confused, frustrated, or rejected.
Bipolar depression may also cause sexual dysfunction. This includes erectile dysfunction (ED) in men and high levels of sexual distress for women.
Sexual distress may also trigger mania or depression in people with bipolar disorder, according to a small 2017 study where researchers looked at sexual distress and quality of life in women diagnosed with the mood disorder.
Medications prescribed to treat bipolar disorder might also lower sex drive. They may cause sexual side effects.
Examples of these medications include:
- antidepressants, including duloxetine (Cymbalta), fluoxetine (Prozac), and sertraline (Zoloft)
- benzodiazepines, including alprazolam (Xanax) and clonazepam (Klonopin)
- lithium
What the research says
A recent study looked at 114 people with bipolar disorder and stable moods. All of the study participants were being treated with mood stabilizers as opposed to antipsychotics or antidepressants.
The researchers found that people who took the anticonvulsants valproate or lamotrigine (Lamictal) had better sexual function scores than people who took lithium or a combination of lithium and benzodiazepines.
In comparison with people who took anticonvulsants alone:
- People who took lithium or a combination of lithium and benzodiazepines had worse sexual desire.
- People who took lithium had worse sexual arousal.
- People who took a combination of lithium and anticonvulsants, or lithium and benzodiazepines had worse sexual orgasm.
Keep taking your medication
Don’t stop your bipolar medication because of sexual side effects. Stopping your bipolar medication can trigger a manic or depressive episode.
Talk with your doctor if you think your medication is lowering your sex drive too much. They may be able to adjust your dosage or help you choose a different medication.
There are things you can do to better understand and deal with sexual issues that bipolar disorder can cause.
Managing the sexual side effects of bipolar disorder involves multiple modalities, including lifestyle changes, psychotherapy, and having a support system.
Recognize your symptoms and triggers
Figure out which situations may trigger your shifts in mood so that you can avoid them whenever possible. For example, stress and alcohol might bring on depressive episodes.
Learn the side effects of your medication
Ask your doctor about medications that are the least likely to have sexual side effects. There are also medications available that help people, with or without bipolar disorder, to have a healthy sex life.
They include:
- the antidepressant bupropion (Forfivo XL, Wellbutrin SR, Wellbutrin XL)
- ED pills such as sildenafil (Viagra) and tadalafil (Cialis)
Bupropion may assist with low libido. The Food and Drug Administration (FDA) hasn’t approved bupropion for the treatment of low libido. However, your doctor may prescribe it anyway. This is known as off-label drug use.
OFF-LABEL DRUG USEOff-label drug use is when a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.
However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients.
So your doctor can prescribe a drug however they think is best for your care.
Medications used to address the sexual side effects of bipolar disorder come with their own side effects, too.
According to case studies, bupropion may worsen hypersexuality in some
Side effects of ED pills are mostly mild, but they may include headache, flushing, and a stuffy or runny nose.
Understand sexual health issues
Understanding what can happen as a result of sexual activities is important, as it relates to events that may be unintended, such as an unplanned pregnancy.
Having clarity about your sexual actions can also help to reduce your chances of contracting STIs, such as HIV.
This is especially important during periods of hypersexuality.
Consider behavioral or sex therapy
Behavioral therapy or sex therapy can help you manage sexual issues caused by bipolar disorder. Individual and couples therapy are both effective.
During a manic phase of bipolar disorder, you may take sexual risks and be less concerned with the consequences of your actions. During a depressive episode, you might feel apathetic about sex or upset by a loss of libido.
Managing your bipolar disorder is the first step toward improving your sex life. It’s easier to address these issues when your mood is stable.
Many people with bipolar disorder have healthy relationships and satisfying sex lives. The key is working with your doctor to find the right treatment and talking with your partner about any sexual issues that you may experience.