Clinical depression can affect all aspects of your life, including your sex life. Not only can depression dampen your sex drive, but some medications for depression may affect your libido and sexual function.
But don’t despair—doctors and therapists are aware of these issues and have strategies that can help. We talked to UNC Health psychiatrist Mary Kimmel, MD, about the effects depression can have on your sexual health and what to do about it.
“Sexual health is a measure of overall health and you don’t want to ignore it,” Dr. Kimmel says. “Problems caused by depression or antidepressants can be mitigated, and it’s important to discuss your sexual health with your doctor and discuss if your sexual health is not what you would want.”
The Depression-Sexual Health Connection
Both men and women can experience difficulties initiating and enjoying sex because of depression. As many as half of people with untreated depression have symptoms of sexual dysfunction, which can include erectile dysfunction and anorgasmia, an ongoing difficulty reaching orgasm.
Stress, anxiety, guilt and low mood are common symptoms of depression. These symptoms can lead to decreased libido (the desire to have sex) and can physiologically affect your ability to become aroused, maintain arousal and reach orgasm.
If you are depressed, it can be hard to be mindful and present with your partner in the moment. Negative thoughts and feelings can prevent your body from responding physically.
Fatigue is a common symptom of depression and another impediment to sex, Dr. Kimmel says. “When you are feeling exhausted, you’re not feeling as connected, and it’s hard to be enthusiastic about your partner, who then doesn’t feel as connected to you. Lack of connection can impact intimacy as well as many components of our interactions.”
Sexual dysfunction can result in feelings of low self-esteem and worthlessness, which may foster increased anxiety about sex. This leads to reduced sexual enjoyment for yourself and your partner while also contributing to symptoms of depression.
The Effects of Antidepressants on Sexual Health
Complicating sexual health problems for people with depression is this: A diminished libido, erectile dysfunction, delayed ejaculation and anorgasmia are also common side effects of antidepressants. But antidepressants are often highly effective and even lifesaving for treating depression.
“If you’re not treating your depression, that’s going to impact your physical health, your mental health and your relationships,” Dr. Kimmel says. “You deserve to be treated and feel better. There are things that can be done about the sexual side effects.”
To help address these side effects, your provider may try to put you on the lowest effective dose of an antidepressant. Or your provider may try switching to a different medication with less likelihood to affect sexual health or add a medication, such as a different antidepressant or an erectile dysfunction drug, that can counteract the side effects.
For example, if you are taking Lexapro or Zoloft and having good results with your depression symptoms but experience a decreased libido, your doctor may suggest adding Wellbutrin, a different class of antidepressant, to counteract the sexual side effects.
In addition, your provider can determine if there are other factors affecting your sexual health, such as hormonal imbalances like decreased testosterone, or other medications you are taking, including birth control. Finally, your provider can help you have open conversations with your partner to discuss sexual health and also to identify other relationship stressors that may be affecting intimacy.
Include Your Partner in Finding a Solution
It can be helpful to include your partner in discussions about your depression and its effect on your sex life.
“It’s helpful when partners don’t take the sexual challenges personally,” Dr. Kimmel says. “It’s important to have conversations so each person can talk about their needs.”
This can be done informally, or, if you and your partner need help, a therapist can guide the conversations.
Partners who are open to talking about these issues and problem-solving together can help reduce pressure the depressed person might be feeling. That support can sometimes pave the way for sexual function to improve because the situation becomes less stressful.
On the contrary, if you suffer from a diminished libido and then feel judged by your partner or your partner has high expectations about performance, it can be really challenging to live up to those expectations.
In these situations, people sometimes stop their depression medication, which can be a mistake.
“It’s critical to treat the depression, which can impair every aspect of your life and hurt your relationships,” Dr. Kimmel says. “And once you’re feeling better, we can troubleshoot sexual side effects and find solutions that work for you and your partner.”