Depression affects people in many ways, both mentally and physically and it can have a really significant impact on your libido or sexual drive. To put it simply, when in a depression, a person is usually less likely to feel sexually aroused or even care about sexuality — let alone want to enjoy their sex life. Depression itself, the stresses of managing it, or even sometimes the side effects of antidepressants can all affect sex drive and performance.
Research in the past has found that depression can lower or paradoxically even raise the sex drive in some people. Depression can affect the ability to get aroused and have an erection in men. In women, depression can affect the ability to become aroused, make it difficult to orgasm or even affect the menstrual cycle itself.
Not surprisingly depression extinguishes libido, makes the person resistant to arousal, and may actually impair the physiological vasocongestive sexual response. Erection in the male is especially vulnerable to depression. There is some evidence to indicate that endocrine as well as psychological factors may play a role in the diminished sexuality of depressed patients (Reynaert et al 2010)
How does depression affect sex?
Overall, sexuality is most often affected in these general ways with depression:
- The levels of hormones and neurotransmitters involved in depression (like serotonin, norepinephrine, and dopamine) may also lower the libido, decreasing your want for sex and may also decrease your actual physical sexual performance. Also when someone is depressed or anxious, the levels of the stress hormones, like cortisol, increase significantly and the body effectively goes into a fight-flight response. In the fight-flight response, the mind and body become solely concerned with basic survival matters and sexuality isn’t even an afterthought. In fact, excessive stress and cortisol may even lower the body’s level of sexual hormones; so no wonder stress has such an effect on sex!
- Depression causes fatigue and an overall lack of interest in living life, and of course, sex is not an exception. Strong feelings of disinterest in the
world, overwhelming fatigue and tiredness often don’t leave much room for sexuality. Secondly, people who are depressed often withdraw and isolate themselves from others — withdrawal and isolation do not fit well together with sexuality.
- Depression can make also make the sufferer feel crappy about themselves and this affects self-esteem and how they “see” themselves, both physically and mentally. If someone sees themselves in this negative light, it’s hard to be vulnerable, open and literally “naked” with someone else.
- The medications used to treat depression, the SSRI’s and SSNRI’s, can have side effects that can seriously affect sexual function. These side effects present themselves in two main ways. One, some people have a significantly reduced desire for sexuality and two, some people report having a side effect that involves the delay of orgasm. Some people on certain antidepressants may even lose the ability to orgasm altogether! Here’s a good article on the sexual side effects of antidepressants: Managing Antidepressant Sexual Side Effects
So, what can you do if you or a loved one is struggling with the complicated issue of sex and depression?
Access Therapy
One of the best ways to deal with all of the issues around sexuality and depression is to access therapy with a professional like a Psychologist or Clinical Social Worker. Accessing therapy can help you “work on” the depression overall and there are literally mountains of research showing that therapy works to help people with depression. Particularly, there is a lot of research showing that two types of therapy are particularly helpful for depression. From the American Psychological Association:
Two of the most common evidence-based therapies for depression are cognitive behavioural therapy and interpersonal therapy.
- Cognitive Behavioral Therapy (CBT) is a type of therapy in which patients learn to identify and manage negative thought and behaviour patterns that can contribute to their depression. CBT helps patients identify unhelpful or negative thinking, change inaccurate beliefs, change bbehavioursthat might make depression worse, and interact with others in more positive ways.
- Interpersonal Therapy (IPT) is a form of therapy in which patients learn to improve their relationships with others by better expressing their emotions and solving problems in healthier ways. IPT helps patients resolve or adapt to troubling life events, build social skills and organize their relationships to increase support for coping with depressive symptoms and life stressors.
Therapy has been proven to be as effective, if not more effective than using antidepressant medications, and without the side effects! As well, research shows that using therapy may be more effective in the long term than using antidepressant medications.
Explore medications and other treatment options
If you are on antidepressants and you find they are working for your depression but causing sexual side effects like loss of libido or delayed ejaculation/orgasm — you may want to consult with your GP or Psychiatrist to try a different antidepressant medication that may affect you less when it comes to sexuality. If you are on antidepressant medications and they don’t seem to be helping with the depression and they are causing sexual side effects, you may want to try another option like psychotherapy or even something new like neurofeedback strategies, vagus nerve stimulation or even significantly changing your diet and exercise plans. Take the time, be honest with, and consult with your doctor and explore the other options that may be available.
And of course, never stop using an antidepressant medication without first consulting a medical professional!
Self-care
Self-care is crucial to anyone suffering from depression. Self-care first of all means being kinder to yourself and becoming aware of your needs. Self-care also means doing the things in your life that are healthy and positive. Eating well, hydrating, taking medications that are helping, going to therapy, getting plenty of fresh air and exercise are all part of caring for yourself. If you take better overall care of yourself you may actually find some relief from the depression and in turn, an increased interest in our sexuality. Here are some links to effective self-care strategies:
Work on your sexuality & relationship!
As simple as it sounds, actually taking the time and effort to work on the sexual relationship with your partner (regardless of the depression) can pay off with big returns. Sexuality can even have a positive effect in lessening depression as it creates a sense of human connection and lowers our levels of overall anxiety and stress! The warm afterglow of sex gives you an endorphin/hormone boost that can often help alleviate depressive symptoms, even if only for a short while.
To work on a sexual relationship there has to be connection and communication. Here are some ways to start to do that:
- Learn to connect with your partner without the stress of sexual performance expected or involved: A good way to improve the connection with our partner is to keep physically connected to them without expectations of sex. Holding hands, hugging, kissing and cuddling are great ways to help us reconnect. We can also go for walks together, give each other massages, or maybe even cooking a meal together can be a great way to start connecting.
- Communicate with your partner: Sex is really a form of communication between partners and often depression’s tendency towards isolation and solitude can really affect this ongoing communication with your partner. There has to be an effort made to connect and share your thoughts with your partner if we want our relationship to improve sexually and otherwise. Partners need to share with each other the details of their sexual needs and interests. Interestingly too, creating this increased “sense of connection” with our partner can also even help with your depression. There is a great deal of research showing that increased human connection can have a great effect in helping someone lessen their depression. As well, making an effort in the areas of communication and empathy for each other may take some of the sexual pressure off the relationship. Like any other part of a relationship, it’s truly on both partners to take the time to negotiate and accommodate the how, when, where and why of sex.
- Prioritize your sexuality: Make the time for sexuality in your life, even schedule it if you have to! You may also find it helpful to have sex even if you’re not completely feeling in the mood. Of course, you shouldn’t force yourself to do anything you don’t want to, but sometimes pushing yourself a wee bit can have a great payoff. Sometimes the “hardest part” of sex is the getting started part! Often many people realize mid-sex that sex is actually way more fun than they remember.
- Expectations and Compromise: Like any other part of a relationship, sexuality is about having realistic expectations and compromising. If depression is limiting your sexuality to some degree? Maybe it may be a good thing to keep an open mind and experiment a little with the kinds and types of sexuality that we have in our relationship. For instance, if in the past, sex sessions lasted hours long and were very physical in nature — maybe if there is depression involved now, it’s okay to experiment with a different kind of sexuality that may be less intense or requires less energy and intensity? One that may be shorter in length or more about connection and passion, or may include sexual different acts that make both partners content? As long as both partner’s needs are made paramount, its okay to experiment with different kinds of sex acts that take into account the effects of depression.
- Seek the help of a professional: If you’ve tried some different strategies and you and your partner are still struggling with sex and depression you may want to seek the services of a psychologist, sex therapist or a couples therapist to help you navigate and improve this area of your life.
Depression doesn’t necessarily have to be the end of sexuality in a relationship. We may have to change some expectations on ourselves, our partner or in other areas like frequency or type of sex, but it doesn’t have to be the end. If both partners make an effort to be caring and empathic with each other, sexuality can continue to be a way to connect and show our partner our love for them, regardless of the depression.
This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.
References
Christine Reynaert, Nicolas Zdanowicz, Pascale Janne & Denis Jacques DEPRESSION AND SEXUALITY Psychiatria Danubina, 2010; Vol. 22, Suppl. 1, pp 111–113 Conference paper
OVERCOMING DEPRESSION HOW PSYCHOLOGISTS HELP WITH DEPRESSIVE DISORDERS — American Psychological Association Fact Sheet 2016
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9(10), 788–796. http://doi.org/10.1038/nrn2345
Leuner B, Glasper ER, Gould E (2010) Sexual Experience Promotes Adult Neurogenesis in the Hippocampus Despite an Initial Elevation in Stress Hormones. PLoS ONE 5(7): e11597. https://doi.org/10.1371/journal.pone.0011597