Depression and Sex

How does depression affect sex?

Depression can affect every aspect of your life, including sex. Low self-esteem, feelings of hopelessness and physical fatigue can lower your libido (sex drive). Depression can also lead to:

• Anorgasmia, or trouble having an orgasm.
• Erectile dysfunction, or problems getting an erection.

Why is sex tied to depression?

Depression affects sex because of biology. It starts with chemicals in the brain called neurotransmitters. Neurotransmitters communicate between your brain, where sexual desire starts, and your sex organs. When your brain thinks desire, your body responds by increasing blood flow to the sex organs. Increased blood flow triggers arousal through an erection or vaginal lubrication.

In a person with depression, the sex-related chemicals are out of balance. As a result, sexual desire is low or missing. Low levels of some of these chemicals can also dull pleasurable feelings.

What are the different ways that depression can cause sexual dysfunction?

The biology behind depression and sexual dysfunction is clear. But the ways depression affects our relationships and outlook on life are more complicated. Sexual challenges may follow certain symptoms of depression:

• Inability to experience pleasure.
• Loss of interest in activities.
• Low energy levels.
• Mood swings.
• Reduced self-esteem.

Do antidepressants cause sexual side effects?

Antidepressants, or depression medicines, are highly effective in easing depression. But many of these drugs come with sexual side effects.

Selective serotonin reuptake inhibitors (SSRIs) are an example. SSRIs work by boosting levels of the brain chemical serotonin. Increased serotonin can help improve mood. But it can also prevent normal communication between the brain and sex organs. SSRIs may make it difficult for a man to get an erection or ejaculate. These drugs can also prevent a woman from having an orgasm.

Other antidepressants focus on different chemicals in the brain. Drugs that increase dopamine or norepinephrine are less likely to have sexual side effects.

How are depression and sexual problems diagnosed?

If you think you’re experiencing sexual problems because of depression, talk to your healthcare provider. In some cases, sexual problems can actually cause depression, rather than the reverse. A thorough review of your health history, symptoms and current medications can shed some light.

It’s important to rule out other health conditions that can contribute to depression or sexual dysfunction. Your provider may perform a physical exam or run tests to check for:

• Gynecologic conditions in women.
• Hormone imbalances.
• Nutritional deficiencies.
• Thyroid disease.
• Urologic conditions in men.

How are depression and sexual dysfunction treated?

Depression is often treated with antidepressants. But certain antidepressants, such as SSRIs, can actually make sexual dysfunction worse. Before starting an antidepressant, talk to your healthcare provider about its sexual side effects.

Antidepressants affect everyone differently, so it’s important to find the right medicine and the right dosage for you. Always consult your healthcare provider before:

• Adjusting the dose of an antidepressant.
• Changing antidepressants.
• Stopping antidepressants.

Which antidepressants have sexual side effects?

Antidepressants known to negatively affect desire, arousal or orgasm include:

• Citalopram.
• Escitalopram.
• Fluoxetine.
• Paroxetine.
• Sertraline.
• Venlafaxine.

Antidepressants that are less likely to cause sexual side effects include:

• Bupropion.
• Mirtazapine.
• Nefazodone.
• Vilazodone.

Can I treat depression without medication?

Some people may find relief from depression without medication. If you’re concerned about the sexual side effects of medication, talk to your healthcare provider. Alternative therapies for depression include:

• Acupuncture.
• Exercise.
• Herbal or dietary supplements.
• Psychotherapy.
• Yoga.

Can I prevent sexual problems if I’m depressed?

The best ways to prevent sexual problems from depression or antidepressant medication include:

• Avoid drugs, alcohol and tobacco, all of which can affect sexual function.
• Stay healthy by exercising, eating a balanced diet and maintaining a healthy body weight.
• Talk openly and honestly with your partner about what you’re feeling, mentally and physically.
• Work with your healthcare provider to choose medications with the fewest known sexual side effects.

Can I manage my depression and still enjoy sex?

With the right treatments, most people can successfully manage depression and still enjoy a healthy sex drive. Start by treating the depression, then focus on improving sexual function

When should I call the doctor about depression?

Contact a healthcare provider right away if you experience severe depression or thoughts of suicide. You can call the Suicide and Crisis Lifeline at 988. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911.

A note from Cleveland Clinic

Your physical and mental health go hand in hand. Depression can not only affect your sex life, but also your ability to be intimate and open in relationships. If you’re experiencing depression, try to keep the lines of communication open. Talk with your sexual partner, friends and family members. A strong support system is an important part of any mental health treatment plan.