Depression and Sex

Depression affects sex by changing how the chemicals in your brain work. All sensations start in your brain, even the sexual ones. Chemicals called neurotransmitters communicate between your brain and your sex organs. When your brain senses desire, your body responds by increasing blood flow to these organs. This helps prepare you for sexual activity by triggering arousal through erection or vaginal lubrication.

If you have depression, some sex-related chemicals are out of balance. This can lead to sexual dysfunction. You may experience changes in:

• Your interest in sex
• The way your body responds to sexual touch and movement
• Your level of satisfaction with sex and ability to orgasm

Is depression linked to lack of sex?

Yes, it’s quite common for people with depression to have low sexual desire (low libido) or none at all. Your body may not respond to sexual situations in the same way, so males may have trouble getting an erection. Females may experience vaginal dryness. And low levels of some brain chemicals can dull feelings of pleasure.

These symptoms tend to improve as your depression eases. But some medications used to treat depression can make it worse. In fact, one study found that between 37% and 65% of people with depression developed antidepressant-associated sexual dysfunction.

Can depression cause high sex drive?

Some people with depression have increased interest in sex. It’s much less common, so there’s not a lot of research about what causes it. It may be your experience of depression itself. Or it could be the way your body responds to antidepressants. Or you may be more interested in sex because you’re starting to feel better.

Some symptoms — like acting without thinking or having trouble controlling urges — can make you more likely to engage in high-risk sexual activity. Be sure to let your healthcare provider know about any change in your sex drive or sexual behavior.

What signs might indicate that depression is impacting my sex life?

If you have depression, you may experience the following changes in your sex life:

• Loss of libido — or lack of interest — in sex
• Vaginal dryness
• Erectile dysfunction or problems getting an erection
• Delayed ejaculation
• Weak or no orgasm (anorgasmia)
• Potentially high-risk sexual behaviors

Risk factors

Although anyone can experience sex-related symptoms in depression, certain people are more likely to have them. You’re at higher risk if you:

• Have a penis
• Have other physical health conditions
• Take multiple medications
• Drink more alcohol than recommended
• Have other relationship issues

Do antidepressants cause sexual side effects?

Many antidepressants are highly effective in easing symptoms, but they often have sexual side effects. Medications frequently used to treat depression — like selective serotonin reuptake inhibitors (SSRIs) — can prevent normal communication between your brain and sex organs. But other antidepressants that focus on different brain chemicals may be less likely to have sexual side effects. Talk to your provider if your current antidepressant causes side effects. There may be a different option available.

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

• Citalopram (Celexa®)
• Escitalopram (Lexapro®)
• Fluoxetine (Prozac®)
• Paroxetine (Paxil, Pexeva®)
• Sertraline (Zoloft®)
• Venlafaxine (Effexor XR®)

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

• Bupropion (Wellbutrin®)
• Mirtazapine (Remeron®)
• Nefazodone (Serazone®)
• Vilazodone (Viibryd®)

How are sexual difficulties diagnosed?

Your healthcare provider will do a thorough review of your health history, symptoms and current medications. They’ll also want to make sure that another condition isn’t affecting your sexual health or causing these changes. To do this, they may perform a physical exam or run tests to check for:

• Conditions affecting the female reproductive system or the male reproductive system
• Hormone imbalances
• Nutritional deficiencies
• Thyroid disease

How do healthcare providers treat depression-related sexual difficulties?

Your mental healthcare team will work with you to develop a treatment plan that manages your depression with the least amount of side effects — sexual and otherwise. Your healthcare provider might:

• Adjust the dose of your medication
• Switch to a different medication
• Recommend talk therapy to help manage your emotions
• Recommend lubricants or stimulation devices that may help you reach orgasm

Will medications help?

It depends on the kind of sexual problems you’re experiencing. Your healthcare provider will consider medications that target your specific sexual symptoms. You may see near-immediate results from some treatments. But you may need to take other treatments regularly for a while to notice a real difference. For example:

• To help improve low libido, your provider may recommend bupropion. If you’ve experienced menopause, hormone replacement therapy may help.
• To increase vaginal lubrication, vaginal creams or suppositories may help.
• To treat erectile dysfunction, your provider may prescribe medications like sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) and avanafil (Stendra®), among others.
• To help with delayed ejaculation, your provider may prescribe medications like buspirone (BuSpar®) or cyprohepatadine (Periactin®).

Can I prevent sexual problems if I’m depressed?

Since depression itself can cause sexual problems, you may not be able to completely prevent them. But there are things you can do to increase your enjoyment of sex:

• Talk with your healthcare provider. Let them know if you’re experiencing sexual side effects.
• Be open and honest with your partner(s). Let them know what you’re feeling, mentally and physically.
• Avoid drugs, alcohol and tobacco. All of these can affect sexual function.
• Try to work some physical activity into your day. When you exercise, your heart beats faster, which increases blood flow everywhere in your body. This may help you feel more aroused.
• Dedicate time to nonsexual touching. Holding hands and cuddling can help you connect with your partner without the pressure of sexual activity.
• Spend more time on foreplay. It may take longer to get aroused.
• Use water-based lubricants. This helps if you’re experiencing vaginal dryness.