Sexual Health

Depression affects virtually every aspect of a person’s life, and his or her sex life is no exception. As they say, the brain is the most important sex organ of all. Since depression is a disorder centered in the brain, it’s no wonder sexual dysfunction and depression are often linked together.

By definition, people with depression experience a reduction in, or absence of, pleasure or interest in activities that formerly interested them or gave them pleasure. While this can refer to simple things, like engaging in hobbies, interest in sex and enjoyment of sexual relations are also likely to be affected by depression. And, needless to say, when a person is no longer interested in sex, or is unable to experience pleasure, the person’s sexual partner will also be affected.

Unfortunately, depression often strains relationships, which only makes sexual relations more challenging.

Gender, Depression & Sex

The loss of ability to experience pleasure may lead to a decreased desire for sexual relations. This loss of libido is not uncommon.

In men, loss of libido may be linked to erectile dysfunction. Sexual activity depends on a working relationship between the body and mind. Depression may interrupt this relationship. Men with depression may experience impotence, which can trigger a vicious cycle of sexual performance anxiety, followed by renewed erectile dysfunction, which only makes performance anxiety worse.

Depression and sexuality may be intimately entwined in other ways, as well. For example, victims of sexual abuse, or sexual violence, are more likely to experience serious depression. Research suggests that some depressed people are more likely to engage in risky sexual behavior, such as having unprotected sex, or engaging in sex with multiple partners. Of course, this type of behavior puts a person at risk of contracting any number of sexually transmitted diseases. 

Menopause offers another example of the link between depression and sexuality. Women undergoing menopause are more prone to developing depression, while changes in sexual desire and activity are also common among this group. Some of the physical and hormonal changes during menopause can undermine a woman’s libido and her ability to engage in pleasurable sex.

Depression & Sexual Dysfunction

Experts estimate that about 70 percent of people with depression will experience sexual dysfunction. Men may experience erectile dysfunction (impotence), a decline in sexual desire, and difficulties with ejaculation. Among men, the rate of sexual dysfunction is estimated to be 23-50 percent.

Among depressed women, the rate of sexual dysfunction is estimated to be as high as 33-90 percent. Depression related sexual dysfunction among women usually takes the form of difficulties with becoming aroused (such as uncomfortable vaginal dryness), and an inability to achieve orgasm or delayed orgasm.

Sometimes the Solution Is Part of the Problem?

Modern antidepressant medications—primarily of the selective serotonin reuptake inhibitor (SSRI) class—have transformed depression treatments. These drugs are often effective at relieving the symptoms of depression, with the added benefit that they tend to have fewer side effects than older medications, such as the tricyclic antidepressants.

Modern antidepressant medications have helped to bring major depression out of the shadows and into the light. For better or worse, their widespread popularity has helped bring attention to depression as a treatable illness, and has played a role in removing the stigma long associated with this common psychiatric disorder.

But when it comes to sexual health, modern antidepressants (especially SSRIs) are also all-too-often part of the problem for the patients who take them, because sexual dysfunction is a common side effect of these drugs. The most common sign of this side effect is an adverse effect on sexual desire, and delayed or absent orgasm, among both men and women. Men may also experience difficulty achieving and maintaining an erection due to this side effect. Higher doses of medication tend to be linked to greater sexual dysfunction.

From the perspective of the treating physician, the biggest problem presented by this side effect is that it may lead patients to discontinue therapy. This can cause patients to relapse into depression before successful treatment can be achieved. If you or someone you know has been prescribed antidepressant medication, it’s crucial that you discuss such concerns with your doctor before stopping medication.

Side effects such as sexual dysfunction can often be addressed by adjusting the dosage or switching to another, similar medication. Some antidepressant drugs are associated with fewer sexual side effects than others. It can also be dangerous to abruptly stop taking certain antidepressants, for a number of reasons.

The treating physician may also recommend medication that can help men achieve and maintain an erection. Drugs such as sildenafil (Viagra) and tadalafil (Cialis) may help men counteract the sexual dysfunction associated with SSRI use.