Sexual Problems Related to Depression

If you live with clinical depression and your sex life has taken a hit, you have a lot of company. Depression ranks as the leading cause of disability in the U.S. among people aged 15 to 44, and the sexual difficulties that come with it land on men and women in roughly equal measure. The reassuring part: physicians can usually treat these problems, whether that means erectile dysfunction or trouble reaching orgasm. A connection between depression and sexual trouble clearly exists. Pinning down what that connection actually is takes a little explaining.

Start with the organ that drives sexual response in everyone, regardless of sex: the brain. Desire originates there. The pleasure of arousal and anticipation begins as brain activity and travels down through the body as physical sensation. The brain relies on chemical messengers called neurotransmitters, and during arousal these chemicals ramp up the back-and-forth signaling between brain cells and the sex organs, which triggers the increased blood flow that arousal requires.

Depression throws a wrench into that signaling. When the neurotransmitters stop firing correctly, desire often drops to very low levels or disappears entirely, and again this shows up in both men and women. For a couple, the strain of that can be heavy.

Then there is a second complication. The medications used to treat depression, particularly the SSRIs (selective serotonin re-uptake inhibitors), can themselves dampen sexual function. It sounds backwards. Antidepressants do lift mood and rebuild a sense of self-worth, which is exactly why they get prescribed. But they operate by adjusting how neurotransmitters work, and those are the same chemicals that carry sexual signals. The adjustment is not surgical. It spills over into the sexual response and flattens it.

Raising the dose can make the sexual side effects more pronounced rather than less. The specific problems people report include erectile dysfunction, delayed ejaculation, lower desire, and difficulty reaching orgasm.

None of this is a dead end. The sexual problems tied to depression and to the medications treating it respond to treatment. The first move is a conversation with your doctor to figure out what is actually driving the trouble. Is it the depression itself? The antidepressant? Some other medical condition entirely? If the drug turns out to be the culprit, you do not necessarily have to abandon treatment. Your doctor might switch you to a different medication, adjust the dose, or add a second medication alongside the first to counter the side effect.

What this really depends on is talking, both to your doctor and to your partner. Nobody can help with a problem they have not been told about. Push past the embarrassment and keep in mind how many other people are dealing with the exact same thing. Over the course of a life, almost everyone hits stretches where arousal, orgasm, or simply enjoyable sex becomes difficult for one reason or another, often having nothing to do with depression or medication at all. Whatever the cause, working through it asks for patience from both people.

When couples stop talking and the difficulty grows, the relationship itself can be the thing that breaks. So keep the conversation going. Reduced sensitivity is stressful, but it is frequently temporary, and ignoring it is what lets a small issue harden into a large one. Mild problems sometimes resolve on their own; the more stubborn ones almost never do. Don't surrender your life to a sexual challenge, and if you feel yourself slipping, remember there are doctors, friends, and family ready to help. Plenty of couples find that the act of speaking openly about what they feel, and working toward a fix together, brings back a connection they thought they had lost.

Try to stay positive. Sexual difficulty is a common feature of depression, not a private shame to bury between you and your partner. Keep communicating, and get the depression itself treated as quickly and thoroughly as you can. The sexual problems that come with antidepressants can be managed.

Once you accept that the brain is the primary sexual organ for both men and women, you can start to see how chronic depression works its way into intimacy and relationships. The effect is often damaging. Layer on top of that the way certain medications disturb the brain's neurotransmitters, and the unwanted side effects pile up. There is a nasty feedback loop lurking here: sex is a natural antidepressant, so when SSRI-related blunting takes sex off the table, the original depression can deepen.

One thing has shifted in our favor. Depression and sexual dysfunction are no longer subjects nobody will say out loud. Counseling used to read as a character flaw; now choosing therapy looks more like a sign of strength. Communication keeps individuals and couples afloat, which is why couples' therapy can be a real path toward closer intimacy. Topics the Greatest Generation refused to name are discussed openly by the Baby Boomers, to the point where that openness has become something relationships need to survive. Honest communication is now central to mental, physical, and emotional stability, sex very much included.

Source: Depression. (n.d.). Retrieved December 3, 2014, from WebMD, sexual problems and depression.