The complementary medicine gingko biloba might also help increase your sex drive.
While there’s conflicting evidence on gingko’s effectiveness, one decades-old study suggested women were more responsive to the sexually enhancing effects of the medicine than men.
- Beware of taking a ‘drug holiday’
- Practise open communication and connection
- Post-SSRI Sexual Dysfunction
- What is post-SSRI sexual dysfunction?
- How common is PSSD?
- How long do sexual side effects last after stopping?
- Publications and studies
- Reporting your condition
- Other drugs and conditions
- See also
- As if Having Depression Isn’t Enough, It Can Also Ruin Your Sex Life. Here’s How to Deal.
- How Depression Affects Sex
- Depression and Hypoactive Sexual Desire Disorder
- How to Take Antidepressants and Still Have a Sex Life
- What are the sexual side effects of antidepressants?
- Low Sex Drive — Could It Be a Sign of Depression?
- How to Maintain Your Sex Drive, Even If You Have Depression
- Low Libido and Depression: What’s the Connection?
- What is depression?
- What does the research say?
- Treatments for low libido and depression
- The takeaway
- 8 Effective Ways to Reclaim Your Sex Life During Depression
Beware of taking a ‘drug holiday’
One method used by some antidepressant users to overcome sexual dysfunction side effects is taking a “drug holiday” and planning a few days off the drug to allow some respite from the side effects.
Taking a drug holiday is not recommended by experts.
It can lead to the recurrence of the mental illness you were originally being treated for, as well as possible discontinuation syndrome symptoms — which include anxiety, sensory changes, nausea, and occasionally psychosis — in certain drugs, particularly shorter-acting SSRIs.
It’s also important to note that sexual side effects won’t abate after just a day or two of taking a break from the medication.
Practise open communication and connection
Finally, it’s essential to maintain direct and honest communication with your partner about your side effects, says Sydney-based sex and relationship therapist Pamela Supple.
You might even consider seeing a sex and relationship therapist, who can help you work together as a team on your sex life.
Your action plan for tackling lowered libido might include blocking out a solid chunk of time as a couple (try an hour) to connect with one another.
The idea is that you will connect and eventually open up to physical intimacy and have sex.
Ms Supple recommends starting your hour by practising mindfulness together, which is about “being in the present moment with your partner and just appreciating each other”.
This time together might involve “the two of you talking about what turns you on, what you enjoy sexually, allowing your erotic mindset to come into play, or it could be you just thinking in your mind, ‘I’m loving you, I’m enjoying this’.”
It could also incorporate touch — either sexual touch or non-sexual touch — to assist you with arousal, which can then lead to more sexual touch, stimulation and arousal.
Acknowledging the problem and focusing on staying connected and intimate can help couples.(Image: Unsplash)
Tali says she and her partner have adopted this approach. Sometimes she’ll say: “Tonight we’re going to have a really nice long cuddle because I love you.”
Ms Supple suggests introducing any sex toys that you may like to try into the bedroom, particularly vibrators, if the antidepressants have dulled your genital or erogenous sensitivity.
If your hour of “couple time” leads to sex, then great — success! But if you’re still not into it and your partner is, consider being present while connecting or cuddling them while s/he masturbates.
“You can be present with them; it doesn’t mean you have to reciprocate by becoming sexually aroused,” Ms Supple says.
Tali says she’s not ready to go off her antidepressants yet, and for now she’s managing by changing her mindset when it comes to sex.
“Sometimes I’ve just got to manufacture it and create it,” she says.
“Sometimes you’ve got to, not so much go through the motions . I sort of consciously say, ‘I’m going to do all those things that I used to try to do, and even if it’s not quite as often, I’ll try to have fun with the foreplay fun stuff.’
“My expectations from sex have now changed. I don’t expect to reach climax now. It’s more of an exploration.”
* Names changed for privacy reasons.
This article contains general information only. It should not be relied on as advice in relation to your particular circumstances and issues, for which you should obtain specific, independent professional advice.
There’s another option as well, Collom noted.
“Changing to Wellbutrin (another antidepressant that works only on dopamine and norepinephrine receptors) or adding it to an SSRI can help counteract sexual side effects,” he said.
In other words, not all antidepressants have sexual side effects.
“Wellbutrin has been shown to have no sexual side effects due to its mechanism of action,” Collom said. In fact, “Wellbutrin can actually increase one’s sex drive.”
According to Collom, the key to dealing with antidepressants and the risk of sexual side effects is to “Always consult with your health care provider to get treatment options that will be the best fit for your symptoms of depression. Giving your provider a detailed history is essential in order to give him or her a clear and accurate picture leading to a treatment plan that’s right for you.”
Symptoms of depression are not something that should be ignored. So, don’t let this information keep you from seeking help from your health care professional. Instead, use it to prepare yourself when you do seek help. The more you know, the better.
A happy and healthy sex life starts with being informed and seeking professional care when you need it.
And don’t ever be afraid to ask questions. Your health care professional is there for you.”
Jenny Block is a freelance writer based in Dallas, Texas. She is the author of “Open: Love, Sex, and Life in an Open Marriage.” Her work also appears in “One Big Happy Family” edited by Rebecca Walker and “It’s a Girl: Women Writers on Raising Daughters” edited by Andrea Buchanan. Visit her Web site at www.jennyonthepage.com.
Post-SSRI Sexual Dysfunction
Written by the RxISK Team. Reviewed by Dr. David Healy.
Last updated: 2020
Close to 100% of people who take antidepressants experience some form of sexual side effects.
Most people who take a selective serotonin reuptake inhibitor (SSRI), a serotonin-norepinephrine reuptake inhibitor (SNRI), and some tricyclic antidepressants (clomipramine and imipramine) will feel some degree of genital numbing, often within 30 minutes of taking the first dose.
Common SNRIs include venlafaxine (Effexor), desvenlafaxine (Pristiq) and duloxetine (Cymbalta).
What is post-SSRI sexual dysfunction?
Post-SSRI sexual dysfunction (PSSD) is an iatrogenic condition which can arise following antidepressant use, in which sexual function does not completely return to normal after the discontinuation of SSRIs, SNRIs and some tricyclic antidepressants .
Some people develop sexual side effects on antidepressants which either remain in full, or don’t resolve completely, when the drug is stopped. For others, the condition only appears when they actually stop the medication, or begin to reduce the dosage.
PSSD affects both men and women. It can happen after only a few days exposure to an antidepressant and can persist for months, years, or indefinitely. There is no known cure.
Symptoms of PSSD can include:
- Reduced genital sensation / genital anesthesia
- Erectile dysfunction / decreased vaginal lubrication
- Delayed or inability to orgasm (anorgasmia)
- Pleasureless, weak or “muted” orgasms
- Decreased libido
- Reduced response to sexual stimuli
- Decreased or lack of nocturnal erections
- Premature ejaculation
- Reduced nipple sensitivity
- Soft glans
Some sufferers experience a noticeable reduction in tactile sensation – describing their genitals as feeling less sensitive or numb, as if exposed to an anesthetic. Others perceive little or no change in tactile sensation, but notice a reduction in sexual sensation. These problems can also be accompanied by reduced nipple sensitivity.
Orgasm is typically experienced with a decreased or loss of pleasurable feeling, often referred to as a pleasureless or muted orgasm. There can also be noticeably weaker muscle contractions. Although men and women with PSSD often have more difficulty in achieving orgasm, premature ejaculation can also develop after stopping an SSRI .
Although less commonly reported, some male sufferers develop an issue in which the shaft of the penis becomes erect but the glans remains flaccid.
There is no simple test to diagnose PSSD. A diagnosis is made by considering several factors including medication history, onset and profile of the symptoms, and by eliminating other possible causes.
Quantitative sensory testing (QST) of the genitals routinely detects genital changes in PSSD patients, but it’s not a widely available test.
While PSSD can often result in lower than normal testosterone levels, this is not responsible for the condition. Restoring hormone levels back to normal with medication fails to resolve the problem.
While many doctors are aware of PSSD, others are less familiar with the condition. This not uncommonly results in PSSD symptoms being misdiagnosed as a psychological problem, when it is actually pharmacological in origin. This is not only unhelpful for the sufferer, it can also lead to further prescribing of the medications that caused the condition.
Antidepressant sexual side effects are in no way related to depression, or any other psychological or psychiatric disorder.
How common is PSSD?
It isn’t known how many people regain 100% of their original sexual functioning and sensation after using an antidepressant. Based on the available data, PSSD may be quite common.
The condition can vary in severity between individuals. It is likely that some people don’t realize they are suffering from it. They might have had sexual side effects while on an antidepressant which seemed to resolve when they stopped, but they still notice that their sexual function isn’t the same as it used to be, or that sexual activity feels different.
For example, a person can find that they can now achieve orgasm after previously being unable to do so while on the medication, yet it now feels weaker and less intense compared to before using the antidepressants. As they are no longer on the drug, they might think they are imagining it or that it must be due to another reason such as a relationship issue.
PSSD can be extremely distressing to those affected. It can lead to marriage break-up, job loss and suicide. But for some sufferers, the lack of desire means they are no longer interested in sex, and are unconcerned that they have the condition.
There is currently no way of determining who will develop PSSD when the drug is stopped, or any way to actively prevent it. Stopping an antidepressant gradually (tapering) does not prevent the problem. There is no evidence that adding another drug to an antidepressant to combat sexual side effects eg. bupropion (Wellbutrin) will prevent PSSD when the antidepressant is stopped.
How long do sexual side effects last after stopping?
When sexual side effects persist after the antidepressant is stopped, there is no specific timescale for recovery.
Some people report a certain degree of natural improvement over a period of time – sometimes months or years after stopping the antidepressant. However, many sufferers fail to recover to any significant degree, with some having had the problem for over 20 years without any improvement.
For some people, PSSD may be permanent.
Publications and studies
In a study by Montejo et al, a group of patients who were experiencing sexual side effects on an SSRI were switched to the dopaminergic antidepressant, amineptine . After six months, 55% still had at least some type of sexual dysfunction. This is compared to only 4% in the control group who were treated with amineptine alone, and were not exposed to an SSRI.
Three large placebo controlled studies into the use of SSRIs as a treatment for premature ejaculation found that the ejaculation-delaying effect of the medication persisted for a significant number of participants, after the drug was discontinued .
Between 2006 and 2008, 8 cases of persistent sexual dysfunction following SSRI/SNRI treatment appeared in the medical literature .
In 2008 and 2009, there were published calls for epidemiological studies to investigate the prevalence of PSSD .
Since 2011, the US Prozac patient information sheet has warned: “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment” .
In 2012, the Netherlands Pharmacovigilance Center, Lareb, published a report with details of 19 reported cases of PSSD from their database . The findings were subsequently published in the medical literature .
Published in 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) stated: “In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued” . In the same year, a qualitative study investigated the impact of the condition .
In 2014, Hogan et al listed 91 cases of persistent sexual dysfunction linked to SSRIs or SNRIs, sourced from an internet portal for reporting adverse events . Waldinger et al described a case of persistent genital anesthesia following paroxetine treatment that responded to low-power laser irradiation .
In 2015, Ben-Sheetrit et al published a study of 183 possible cases of PSSD, including 23 high-probability cases, from an on-line survey .
Two review articles and a case report were published in 2017 .
Another review was published in 2018 followed by an article exploring commonalities between PSSD and post-finasteride syndrome . Healy et al published a study of 300 cases of enduring sexual dysfunction of which 221 were after the previous use of serotonin reuptake inhibitors . A published petition requesting warnings to be added to SSRI and SNRI products was submitted to the Food and Drug Administration and the European Medicines Agency .
In 2019, a case report described persistent sexual dysfunction after the use of citalopram which responded to a dietary supplement . The European Medicines Agency recommended changes to SSRI and SNRI product labels to include information about persistent sexual dysfunction after drug withdrawal . A study investigated the experiences of PSSD patients when engaging with healthcare professionals . An article in Epidemiology and Psychiatric Sciences outlined the main issues .
In 2020, a history of antidepressants and sexual dysfunction including PSSD was published in the Journal of the Royal Society of Medicine .
Treatment with fluoxetine has been shown to cause persistent desensitization of 5-HT1A receptors after removal of the SSRI in rats . In another study, the use of a 5-HT1A antagonist was shown to reverse and prevent sexual dysfunction in rats that were being administered with fluoxetine .
Therefore, hypotheses for PSSD have often focused on a possible neurological model involving persisting changes to brain chemistry. However, attempts by PSSD sufferers to manipulate the serotonergic and dopaminergic systems in an effort to resolve the condition, have proved unsuccessful.
Rodent studies have shown that treatment with SSRIs at a young age resulted in permanently decreased sexual behavior in adulthood , with the presence of long-term neurological changes . Maternal exposure to fluoxetine was also found to impair sexual motivation in adult male mice .
A systematic review of the literature on persistent sexual dysfunction in animals after early exposure to SSRIs concluded: “Our results showed substantial and lasting effects on sexual behaviour in rats after exposure to an SSRI early in life on important sexual outcomes.”
This raises the question of whether there might be long-term sexual consequences for human offspring exposed to antidepressants either during pregnancy or at a young age.
A brief exposure to an SSRI was found to induce long-lasting changes in the bioelectric cell properties of planarian flatworms (an important model for human neurophysiology and pharmacology) . It was suggested that this may contribute to the enduring effect seen in PSSD.
While on SSRIs, studies have shown side effects to include impaired semen quality and damage to sperm DNA , as well as issues that are often linked to the endocrine system such as hormone imbalances and breast enlargement . SSRIs have also been found to have effects on sex steroids . However, the role of the endocrine system in persisting problems such as PSSD is currently unclear.
Fluoxetine has been classified as a reproductive toxin by the Center for the Evaluation of Risks to Human Reproduction (CERHR), an expert panel at the National Institute of Environmental Health Sciences, part of the National Institutes of Health .
There is currently no viable treatment for PSSD.
A number of medications, herbs and related compounds can produce pro-sexual effects in some sufferers. However, the results are generally very limited, inconsistent and can come with their own risks.
PDE5 inhibitors often provide little or no benefit in PSSD. In some cases they have no effect at all, while in others they provide only a limited improvement in erectile function. They also offer no direct benefit to the other areas of sexual functioning that can be impaired in PSSD eg. sensation.
There is no evidence to suggest that the use of platelet rich plasma (PRP) is a suitable treatment for PSSD.
The typical strategies for managing sexual side effects usually only apply to problems that occur while on treatment, and are therefore unhelpful in PSSD. These would generally involve switching to a different antidepressant, lowering the dose, or potentially stopping the medication altogether.
On September 12, 2017, we launched our RxISK Prize campaign to raise $100,000 which will be offered to anyone who finds a cure for PSSD or related conditions involving finasteride and isotretinoin.
Reporting your condition
If you are suffering from PSSD, you can report it to us by completing a RxISK Report. Please provide as much detail as possible, including the dates that you started and stopped the drug.
You might also want to report your condition to your country’s drug regulator eg. FDA’s Medwatch in the US and MHRA’s Yellow Card Scheme in the UK.
Other drugs and conditions
A number of other medications can also cause persisting sexual side effects after the drug has been stopped:
- Antihistamines that are serotonin reuptake inhibiting
- Ziprasidone – an antipsychotic which is also a serotonin reuptake inhibitor
- Some antibiotics (that may be serotonin reuptake inhibiting) such as tetracycline and doxycycline
- FDA updated the product information for finasteride products in 2011 to warn of persisting sexual side effects after discontinuation of treatment, with further warnings added in 2012 .
- Isotretinoin (Accutane) which is used as a treatment for acne , and is also serotonin reuptake inhibiting.
The use of SSRIs or SNRIs, and often their withdrawal, has consistently been reported as one of the triggers of persistent genital arousal disorder (PGAD) . This is essentially the opposite of PSSD, causing a relentless sense of arousal and discomfort in the genitals, but without any accompanying feeling of desire. Watch our PGAD video.
- Media articles about PSSD and related sexual dysfunctions.
- Posts about sex and medications from our blog.
- Complex Withdrawal. Hypothesis about protracted withdrawal and PSSD.
- Bahrick AS. Post SSRI sexual dysfunction. ASAP Tablet. 2006;7(3):2-3,10-11.
- Bahrick AS. Persistence of sexual dysfunction side effects after discontinuation of antidepressant medications: Emerging evidence. The Open Psychology Journal. 2008;1:42-50.
- Adson DE, Kotlyar M. Premature ejaculation associated with citalopram withdrawal. Ann Pharmacother. 2003;37(12):1804-6. PMID 14632589.
- Montejo AL, Llorca G, Izquierdo JA, Carrasco JL, Daniel E, Pérez-Sola V, et al. Sexual dysfunction with antidepressive agents. Effect of the change to amineptine in patients with sexual dysfunction secondary to SSRI. Actas Esp Psiquiatr (in Spanish). 1999;27(1):23-34. PMID 10380144.
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- Safarinejad MR. Safety and efficacy of escitalopram in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. 2007;27(5):444–50. PMID 17873675.
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- US Prozac product information.
- Lareb, Netherlands Pharmacovigilance Center. SSRIs and persistent sexual dysfunction (2012).
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- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association, 2013. Page 449.
- Stinson RD. The impact of persistent sexual side effects of selective serotonin reuptake inhibitors after discontinuing treatment: a qualitative study. PhD (Doctor of Philosophy) thesis, University of Iowa, 2013.
- Hogan C, Le Noury J, Healy D, Mangin D. One hundred and twenty cases of enduring sexual dysfunction following treatment. Int J Risk Saf Med. 2014;26(2)109-16. PMID 24902508.
- Waldinger MD, van Coevorden RS, Schweitzer DH, Georgiadis J. Penile anesthesia in Post SSRI Sexual Dysfunction (PSSD) responds to low-power laser irradiation: a case study and hypothesis about the role of transient receptor potential (TRP) ion channels. Eur J Pharmacol. 2015;753:263-8. PMID 25483212.
- Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. J Clin Psychopharmacol. 2015;35(3):273-8. PMID 25815755.
- Reisman Y. Sexual Consequences of Post-SSRI Syndrome. Sex Med Rev. 2017;5(4):429-433. PMID 28642048.
- Bala A, Tue Nguyen HM, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev. 2018;6(1):29-34. PMID 28778697.
- Muquebil Ali Al Shaban Rodríguez OW, Álvarez de Morales Gómez-Moreno E, Fernández Fernández J, Fresno García C, del Mar Fernández Fernández M. Disfunción sexual persistente tras el tratamiento con inhibidores selectivos de la recaptación de serotonina: a propósito de un caso tras la retirada de paroxetina. Psiquiatría Biológica. 2017;24(2):70-72.
- Coskuner ER, Culha MG, Ozkan B, Kaleagasi EO. Post-SSRI Sexual Dysfunction: Preclinical to Clinical. Is It Fact or Fiction? Sex Med Rev. 2018;6(2):217-223. PMID 29463440.
- Giatti S, Diviccaro S, Panzica G, Melcangi RC. Post-finasteride syndrome and post-SSRI sexual dysfunction: two sides of the same coin? Endocrine. 2018;61(2):180-193. PMID 29675596.
- Healy D, Le Noury J, Mangin D. Enduring sexual dysfunction after treatment with antidepressants, 5α-reductase inhibitors and isotretinoin: 300 cases. Int J Risk Saf Med. 2018;29(3-4):125-134. PMID 29733030.
- Healy D. Citizen petition: Sexual side effects of SSRIs and SNRIs. Int J Risk Saf Med. 2018;29(3-4):135-147. PMID 29733031.
- Calabrò RS, De Luca R, Manuli A, Portaro S, Naro A, Quattrini F. Towards Improving Post-SSRI Sexual Dysfunction by Using Nutriceuticals: Lessons from a Case Study. J Sex Marital Ther. 2019 Jan 14:1-4. PMID 30640584.
- European Medicines Agency. PRAC recommendations on signals adopted at the 13-16 May 2019 PRAC meeting. Published June 11, 2019. Page 5.
- Healy D, Le Noury J, Mangin D. Post-SSRI sexual dysfunction: Patient experiences of engagement with healthcare professionals. Int J Risk Saf Med. 2019;30(3):167-178. PMID 31450514.
- Healy D. Post-SSRI sexual dysfunction & other enduring sexual dysfunctions. Epidemiology and Psychiatric Sciences 1–2. PMID 31543091.
- Healy D. Antidepressants and sexual dysfunction: a history. Journal of the Royal Society of Medicine. https://doi.org/10.1177/0141076819899299
- Raap DK, Garcia F, Muma NA, Wolf WA, Battaglia G, van de Kar LD. Sustained desensitization of hypothalamic 5-Hydroxytryptamine1A receptors after discontinuation of fluoxetine: inhibited neuroendocrine responses to 8-hydroxy-2-(Dipropylamino)Tetralin in the absence of changes in Gi/o/z proteins. J Pharmacol Exp Ther. 1999;288(2):561-7. PMID 9918559.
- Sukoff Rizzo SJ, Pulicicchio C, Malberg JE, Andree TH, Stack GP, Hughes ZA, et al. 5-HT(1A) receptor antagonism reverses and prevents fluoxetine-induced sexual dysfunction in rats. Int J Neuropsychopharmacol. 2009;12(8):1045-53. PMID 19435548.
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- Gouvêa TS, Morimoto HK, de Faria MJ, Moreira EG, Gerardin DC. Maternal exposure to the antidepressant fluoxetine impairs sexual motivation in adult male mice. Pharmacol Biochem Behav. 2008;90(3):416-9. PMID 18457868.
- Simonsen AL, Danborg PB, Gøtzsche PC. Persistent sexual dysfunction after early exposure to SSRIs: Systematic review of animal studies. Int J Risk Saf Med. 2016;28(1):1-12. PMID 27176752.
- Healy D, LaPalme J, Levin M. Post-SSRI Sexual Dysfunction: A Bioelectric Mechanism? Bioelectricity. 2019.
- Tanrikut C, Schlegel PN. Antidepressant-associated changes in semen parameters. Urology. 2007;69(1):185.e5-7. PMID 17270655.
- Safarinejad MR. Sperm DNA damage and semen quality impairment after treatment with selective serotonin reuptake inhibitors detected using semen analysis and sperm chromatin structure assay. J Urol. 2008;180(5):2124-8. PMID 18804223.
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- Jacobsen NW, Hansen CH, Nellemann C, Styrishave B, Halling-Sørensen B. Effects of selective serotonin reuptake inhibitors on three sex steroids in two versions of the aromatase enzyme inhibition assay and in the H295R cell assay. Toxicol In Vitro. 2015;29(7):1729-35. PMID 26162595.
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- FDA. Questions and Answers: Finasteride Label Changes.
As if Having Depression Isn’t Enough, It Can Also Ruin Your Sex Life. Here’s How to Deal.
A decade ago, Karen C.’s sex drive disappeared. The 39-year-old had recently started medication to deal with mood imbalances, but while her emotions stabilized, her libido bottomed out—and never returned.
“I have no interest in sex whatsoever; I literally just bend or roll over and silently endure whatever my partner needs in order to keep him satisfied,” she tells Health. “I don’t think he understands. I know he doesn’t understand. How do you communicate to someone how you’re feeling when they don’t experience it themselves? And sometimes you don’t even know how you’re feeling so you can’t communicate it correctly.”
RELATED: 12 Types of Depression, and What You Need to Know About Each
All the ways depression sinks desire
Dealing with depression can be tough in so many ways. The devastating effect it can have on sex makes the condition even worse. Researchers have definitively linked this mental health diagnosis to a number of intimacy challenges: difficulties with sexual self-esteem, feeling sexually distant from a partner, trouble communicating about sex, being unsure how to initiate sex, and a flatlining interest in sex in general, according to a new study in the Journal of Social and Personal Relationships.
“Issues with self-esteem are the hallmark of depression,” Christine Manley, PhD, a clinical psychologist based in Nashville, explains to Health. “The core diagnostic criteria of depression is chronic and pervasive feelings of worthlessness. So if that’s the foundation you’re coming from with a depressive episode, your self-esteem is going to be in the toilet—and that’s going to affect every major area of your life, including your sex life,” she says.
Depression itself can have ramifications in the bedroom, and it also brings on a number of side effects that also influence libido, adds Michael Salas, a sex therapist based in Dallas, tells Health. “Depression can make people lose interest in pleasurable things in their lives; it can increase irritability and pessimism. It’s also highly correlated with low energy and fatigue,” he explains. “All of this can lead to a loss of interest or even avoidance.” Who wants to get naked if they feel angry, defeated, or detached? Exactly.
While not everyone with depression experience a sad mood, the number one symptom that corresponds to almost every single case is fatigue, says Manley. “Like no matter how long you sleep or how many naps you take, you’re never enough,” she says. “Depressed people are exhausted all the time; they certainly don’t want to have sex at the end of the day.” Think about it like this: On the most basic level, depression diminishes your ability to experience pleasure; and what is sex about if not pleasure?
RELATED: 7 Anxious Thoughts Every Woman Has Had During Sex
Antidepressants play a role, too
Major depressive disorder affects more than 16.1 million American adults, or about 6.7% of the U.S. population age 18 and older in a given year. To treat all those people, the most obvious solution to depression is antidepressants; one in nine Americans of all ages reported taking at least one antidepressant medication in a given month, according to national survey data released by the Centers for Disease Control and Prevention (CDC).
But “the gold standard antidepressants—like Zoloft, Prozac, Paxil, and Celexa—are called selective serotonin reuptake inhibitors, and a ton of research shows that they completely demolish your sex drive,” says Manley. That’s because they increase the amount of the neurotransmitter serotonin in your brain, but too much of a spike can inhibit libido and make it harder to have an orgasm.
“I do wish things were different,” says Karen. “I wish I didn’t have to rely on medication to stabilize my moods, but I’ve tried repeatedly to get off of them and it literally makes me feel crazy. I long to feel like my old self so badly, I think it almost makes the depression worse.”
There are other types of antidepressants, like Wellbutrin, but those can sometimes increase anxiety or irritability, Manley says. “It’s crucial to talk to your doctor about the side effects of these meds: How will it affect your sex drive? Will you experience lubrication or have difficulty with arousal or desire? You may have to try a couple before you find the one that’s worth it,” she says.
It also may end up being a cost/benefit analysis: The medications that work best may be ones that do have some kind of effect on your sex life, so you and your partner should work with your doctor to determine what’s right for you.
RELATED: 12 Signs of Depression in Men
How to beat the sexual side effects
It’s very hard to get over the inertia of depression—not just in the bedroom, but in all aspects of your life. But there are things you can do even without medication that can make a difference when it comes to intimacy.
First, get moving. “I really encourage people to experiment with new types of exercise,” says Manley. “It’s so important that they start to feel connected to their bodies again, and that can really get the ball rolling.” If you wince at the idea of hauling yourself to the gym, go with activities that make you work up something of a sweat without any special gear or a gym membership: dancing, walking, chasing your kids around a playground.
Initiating non-sexual contact in and out of the bedroom can also help. “You can re-engage with your partner by touching, kissing, cuddling, fondling, etc.,” says Salas. “This can make people feel less pressured to follow the traditional sexual response cycle and practice enjoying the experience for what it is. When people do this, I encourage them to pay attention to what is most enjoyable and pleasurable and let the body and emotions respond to these sensations.” Often, that contact will become sexual, but you’ve taken away the performance pressure.
And talk. Talk, talk, talk about your feelings. “A lot of times, the problem isn’t sex, it’s intimacy. Partners aren’t sure how to connect or the connection they had before has been strongly influenced by depression,” explains Manley. “Actively attempt reconnection: Remind them how you felt when you first met, talk about a time you felt super connected. If someone has trouble with that level of basic vulnerability in a relationship, of course sexual intimacy is going to suffer.”
What if your partner is the one who’s depressed?
Even if you’re not the one suffering from depression, it can still wreak havoc on your sex life—and it can almost feel worse, because it’s hard to know how to bring the issue up. Whatever you do, tread gently. “People can have a lot of shame around feeling depressed, so if you just show curiosity, it will plant some seeds for the other person to consider depression as a problem,” says Salas.
Make sure they know that their quality of life is more important than your sexual gratification. But if you’re at your last straw with a partner who won’t talk about their depression or how it’s left your sex life circling the drain, you may want to find a couples therapist. “You’re going to need to be open that you need things to change to remain in the relationship,” says Salas. Sometimes, people can be too gentle and avoid these topics, adds Salas. But it’s best to be clear about your needs how your bond as a couple has taken a hit.
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How Depression Affects Sex
Depression can have a profound impact on sexual relationships. It can hamper our ability to feel emotionally secure with our partner, and it can rob us of our desire for and enjoyment of sexual connection.
Some of the most common problems that depression can cause:
Lack of pleasure – Depressed people don’t find pleasure in things they used to, including engaging in a sexual relationship that they might have previously really enjoyed.
Increased emotional sensitivity – When things go wrong in a sexual relationship, as they are bound to do from time to time, depressed people may misinterpret these temporary changes as due to their own inadequacies…which often leads them to avoid sex further.
Low energy – Fatigue can be a major symptom robbing them of sexual energy. Depression may result in too little or too much sleep, and even a great deal of rest doesn’t revive vitality to the person. Desire is often compromised by tiredness and sexual functioning too can decline. The energy to pleasure a partner may feel impossible to muster.
Difficulty with bonding – People living with depression often struggle to feel worthy of love. Furthermore, their partners can feel frustrated that they can’t break through with their efforts to love nor their invitations into the enlivening sexual relationship.
If you live with depression, there are some steps you can take to improve your sex life:
Consider a medication change – Ironically, the medication that is most often prescribed to alleviate depression is a class of drugs that often severely impact sex. For both genders, these drugs, called selective serotonin reuptake inhibitors (SSRIs), can reduce sexual desire and inhibit orgasm. For men, an SSRI may also impact their erections. No one should go off medication without a doctor’s supervision, if you’re on an SSRI and it’s affecting your sex life, you may want to consult a psychiatrist to see if other drugs are possible. Perhaps speak to your psychiatrist or treating physician about the addition of buspirone which studies show may relieve some sexual side effects in 58 percent people on SSRIs1 or the possible switch to a different sort of antidepressant – generically buproprion (Wellbutrin)n which has the “least sexual side effects of all antidepressants”2
Work on the depression itself – To help understand and heal the roots of your depression, it may be helpful to work with a psychotherapist. Doing psychological work can help stabilize your mood and may even help you get off medication. Therapy organizes the complex feelings of depression, allowing a person to mentally understand there are concrete action steps that will help. The psychotherapist’s empathy and understanding is internalized as comfort, which lays a new foundation for mood stability. And the steadfast relational experience in therapy helps a person form more secure attachments in the rest of their relationships.
Visit a sex therapist with your partner – Going to sex therapy with your partner may alleviate misunderstandings about the sexual process and increase a person’s confidence about their technique. Sex therapists know sex is a physical process that enhances a person’s attachment to their partner and can suggest ways to increase the sexual intimacy in a relationship. Most often, sex therapists help couples resolve the power struggle between them that is played out on the sexual realm. This resolution increases security in the partnership eliminating a frequent contributing source of depression.
Depression and Hypoactive Sexual Desire Disorder
Clinical depression is a medical illness, characterized by intense feelings of sadness, hopelessness, emptiness, and worthlessness that last for at least several weeks and interfere with your daily life — both at work and at home. It affects more than 20 million Americans. Dysthymia is a form of depression with less severe symptoms that keeps people from feeling good and functioning at the levels they normally do.
Though both clinical depression and dysthymia affect both physical and mental health in many ways, one commonly overlooked symptom of depression and dysthymia is reduced sex drive, or in more extreme cases, hypoactive sexual desire disorder (HSDD).
The relationship between depression and sex is often a complex one. “Depression and dysthymia have an impact on HSDD, and HSDD is also a common symptom of depression,” says Debra Laino, PhD, a board-certified sex therapist in San Francisco and author of Love for All Eternity, A Guide to Intimacy. “Many times, when individuals are depressed, a loss of sex drive is a symptom. Other times, loss of sex drive can lead to depression. It can go either way.”
Sex Drive and Depression: Know the Facts
Regardless of which comes first, depression and hypoactive sexual desire disorder seem to go hand in hand. Recent research has certainly shown a connection between depression and sexual complaints.
“According to the National Health and Social Life Survey, approximately 43 percent of women and 30 percent of men in the general population have sexual complaints. In patients with depression, the estimates are much higher at around 70 to 80 percent,” says Michael L. Krychman, MD, executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach. “Some estimate decreased libido to occur in 50 percent of women with major depression. Others have even increased the estimate.”
How to Treat HSDD and Depression
When it comes to hypoactive sexual desire disorder and depression in women, depression should be treated first. “Standard first-line treatment for depression today is an SSRI (selective-serotonin-reuptake inhibitor) such as Prozac, Zoloft, or Lexapro,” says Dennis K. Lin, MD, physician-in-charge of the Psychosexual Medicine Program at Beth Israel Medical Center in New York. “Psychotherapy can also help treat depression. But in cases of severe depression, psychotherapy is not sufficient, and medications are required.”
The reduced sex drive that accompanies depression can also be addressed, adds Dr. Krychman. “Often, a complex, multifaceted approach is needed for both depression and sexual desire changes. Excessive fatigue and psychosocial stressors are important to address first,” he says. “It is common for many people to request complementary and alternative methods to address depression and loss of libido. Yoga, relaxation techniques, and over-the-counter products may be the treatment of choice for some patients.”
The Role of Antidepressants
Contributing further to this problem is the fact that antidepressants, the medications that doctors use to treat depression, can actually cause reduced sexual desire. “One of the most common side effects of SSRI antidepressants is low libido,” says Dr. Lin. “However, this is not to be confused with HSDD, which is a separate and independent sexual disorder.”
The good news when it comes to antidepressants and low libido is that one of the newest ones actually seems to combat reduced sex drive in women and depression. “A newer antidepressant, Wellbutrin, is not associated with the sexual side effects often experienced by patients using SSRI antidepressants,” says Genie James, executive director of the Natural Hormone Institute and chief executive officer of Dr. Randolph’s Ageless and Wellness Medical Center in Jacksonville Beach, Florida. “Clinical studies have found that when Wellbutrin was used as a treatment for HSDD, one-third of the women showed increase in libido and sexual fantasies.”
If you’re on antidepressants and you think they might be contributing to reduced sexual desire, James recommends asking your doctor about Wellbutrin.
How to Take Antidepressants and Still Have a Sex Life
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“Another thing that can be tried by both men and women are vibrators because they’re so stimulating,” Sadock says. “A man can use it on his perineum and a woman around the clitoral area, and that may be intense enough .”
All these issues can and do occur across the board, but as dudes skew a little more toward anorgasmia, (the chronic inability to orgasm despite what would be considered adequate stimulation) women skew more toward decreased libido, Sadock tells me.
“It can be a little more of a desire issue for women than men, dampening down the libido,” says Chelsea Holland, a sex and relationship therapist at The Intimacy Institute. “Women tend to be more sensitive to blocks in general, since they have less testosterone kind of boosting them past that.” (Aside from that, none of this stuff is much affected by gender identity, sexual orientation, and so forth; mostly comes down to what bits you have.)
Women are all supposed to now be chill and precisely as adapted for fucking-for-sport as men, but I’ve never seen much value in quashing down characteristically feminine traits if you have them, for the sake of chasing equality. Emotion and sex drive are often tangled up for a lot of women, Holland says, and that’s fine. Like mental illness itself, this side effect is a combination of biological factors and your environment, not any personal failure.
If the issue is your inclination to have sex rather than your ability to orgasm when you do, Sadock tells me one of the most proactive steps you can take is (when possible) to schedule it, whether you initially feel like it or not. Holland doubles down on the scheduling of sex dates with the scheduling of date dates, something she says she recommends for most couples she works with, medicated or not.
“It does sound cliche, but life isn’t a movie,” Holland says. “And it doesn’t necessarily sex—it might just mean closeness, it might mean showering together or naked cuddling or cuddling while watching a movie.”
Beyond advice that’s specific to the root mechanism of your sex problems here, everyone I spoke to for this column agreed your most promising options are to talk to your doctor about lowering your dosage, then about switching to a non-SSRI (if you’re on one) or adding Wellbutrin, an antidepressant that does not manipulate serotonin.
Wellbutrin is so consistently evangelized as the go-to treatment for sexual side effects that it’s probably one of the few things everyone in the field can agree on; every doctor I interviewed also brought it up of their own accord. You can take it on its own, but it’s often prescribed as an add-on treatment to complement the SSRI you already have going, and it can help with sexual dysfunction no matter the variety.
If you try Wellbutrin but it doesn’t help or you can’t tolerate it—some people get edgy—there are other SSRI alternatives that are less common but that may still help. Marra Ackerman, a clinical assistant professor of psychiatry also at NYU Langone, suggests Buspar, which is usually prescribed for anxiety. Her next suggestion would be Viibryd, the trial results of which she says are generally more variable than her first choices but still promising. Sadock suggests your doctor might also be able to prescribe something you can take before sex to briefly suspend your medication’s serotonergic effect, in theory counteracting its inhibition of your much-deserved orgasms, but same caveats would tend to apply.
The sex stuff, both mental and physical, is going to be trial and error. Most things having to do with psychiatric drugs are. With time and patience—maybe a lot of patience—you’ll figure out which medications are worth it and which are not. In the meantime, try to focus on what the right treatment is doing for your mental health. And how it affects not just the sex, but the actual people you’re having it with.
“When people are depressed, it’s like their emotions are sucked into themselves, like a black hole. It doesn’t mean they don’t love their partner, but they don’t necessarily have that much to give,” Sadock says. “There’s an almost universal inclination to withdraw into oneself and not communicate. And so it’s still worse for the one who’s suffering, but the person who’s with them may feel alone, and to some degree they are alone. So as the depression improves, the relationship should improve and you can be more connected.”
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What are the sexual side effects of antidepressants?
Sexual dysfunction does not have to be a permanent side effect of taking antidepressants. In some cases, patients experience these symptoms within the first few weeks or months of taking their prescription, and then the symptoms become less severe.
Many people on antidepressants may also find success through managing their sexual side effects in one or more ways.
If the side effects caused by antidepressants are severe or very persistent, it may be possible to switch medications to try out results on another medication.
Working with their doctor, an individual will gradually come off their current medication and move to a new one. After a suitable trial period, the doctor may evaluate the person to see whether to change the dosage of the medication.
The dosage of the medication may also have an effect on the sexual side effects the patient experiences. If a patient feels their dosage is too high, they can have it evaluated by their doctor.
The doctor will begin putting the patient on lower doses of the drug. They will then monitor their progress to determine the lowest dose of the drug the person can take for it to be effective. Dosage is a very individual thing, and should not be adjusted without guidance from a doctor.
Share on Pinterest Foreplay may help to stimulate the body and mind and allow natural arousal.
There are also ways to raise the libido without adjusting medications.
For many people, it is the will to have sex that is most affected by antidepressant medications. They may be physically able to be aroused, yet lack the willpower to carry out the act.
In these cases, it may be helpful to allow the body to go through the motions that usually make the person feel sexually aroused. Engaging in foreplay can stimulate the body and may help to influence the mind and increase the libido naturally.
Doctors may also recommend that people who take their medication on a daily basis, engage in sexual activity before taking their medication. In some cases, adding a sexual stimulant drug may help improve sex drive. As always, people should discuss these options with a doctor.
Because antidepressants may also decrease the amount of dopamine in the body, it is important for people taking them to boost their natural levels of dopamine. This can be as simple as getting plenty of rest and exercise, while also reducing stress levels.
Many of the antidepressants on the market are linked to sexual side effects. The symptoms vary from person to person, but can greatly affect an individual’s life.
Managing these side effects can require a mixture of lifestyle changes, different medication, and dosage corrections. Working directly with a doctor, patients can help to reduce or eliminate sexual side effects caused by antidepressants.
Low Sex Drive — Could It Be a Sign of Depression?
“Change in sex drive is a key symptom we look at when deciding if someone fits the diagnosis for major depressive episodes,” Payne says. “A primary symptom of depression is the inability to enjoy things you normally enjoy, like sex. People with depression also have decreased energy, feel badly about themselves and might view their partners through a negative filter, all of which impacts sex drive.”
Other symptoms of depression include feelings of sadness, appetite or weight changes, decreased energy and trouble concentrating. Talk to a doctor if you have been experiencing these symptoms. Treatment can help you manage depression.
A depression-related sexual slump is usually temporary. So if you’re dealing with depression, you don’t have to resign yourself to a sexless existence.
How to Maintain Your Sex Drive, Even If You Have Depression
Even if you’ve been diagnosed with major depressive disorder, it’s possible to maintain a healthy sex life. Payne offers several tips:
- Get help for the depression. Payne recommends a combination of antidepressants and cognitive behavioral therapy (CBT). CBT helps treat depression by teaching people to recognize and reframe unhealthy thought patterns. Though this combination is very effective, it can take time to find the right balance, since some antidepressants can cause a reduced sex drive. “Your doctor might need to fiddle with finding the right medication for you. And they can take up to two months to work,” she says. Common antidepressant medications include selective serotonin reuptake inhibitors (serotonin is a neurotransmitter that affects mood) and bupropion, which affects neurotransmitters dopamine and norepinephrine in addition to serotonin.
- Keep doing it. Even if sex is the last thing on your mind, it’s important to keep those flames burning. “Sometimes I write prescriptions for my patients that tell them to go home and have sex with their partner,” Payne says. “If you don’t do it, it becomes a self-fulfilling prophecy: You’ll do it less and less. Having sex increases the chances that you’ll return to a regular sex life once you feel better.” Plus, she says, intimacy might give you a mental break from the depression.
- Don’t compare yourself to others. There’s no “right” amount of sex. “Some 80-year-olds have sex multiple times per week. Some 20-somethings might have sex once a month,” she says. Do what feels right for you and your relationship.
- Get buy-in from your partner. It can be difficult to recognize depression as a valid reason for decreased sex drive, Payne says, because mental illness is still stigmatized. It’s also invisible, unlike, say, a broken leg. “People don’t see depression as a serious illness,” she says. “I try to educate about how serious it is. I compare it to a medical illness, like diabetes. If your partner was having trouble sexually due to diabetes, you’d be understanding. Think about it from that perspective.”
- Redefine intimacy. You don’t need a hot and steamy tangle in the sheets to reap the benefits of a close physical relationship. If you’re not up for going all the way — or even part of the way — simply holding hands, snuggling or laughing together is helpful.
Sometimes the most important thing you can do is remember that there’s a light at the end of the tunnel.
“Depression affects every aspect of a person’s life, including sex,” says Payne. “But once a doctor figures out the right medication, most people get completely better.”
Low Libido and Depression: What’s the Connection?
Sexual desire, or “libido,” is an important part of most romantic relationships. When sexual desire fades, or disappears completely, it can impact your quality of life and your relationship with your partner. Both women and men experience low libido, but women often don’t seek treatment. It’s not unusual for a woman to be embarrassed to admit that she wants to improve her libido. Many women also assume there are no treatments available.
But low sexual desire can be a sign of a health condition. Hypoactive sexual desire disorder (HSDD) —now known as female sexual interest/arousal disorder — may be diagnosed if you have little or no desire for sexual activities. You may also have an absence of sexual fantasies that causes you serious distress or interpersonal difficulty. Low libido can also be a symptom of a mental health problem, such as depression.
For most people, sexual desire fluctuates over time. It’s natural to go through phases when you don’t crave sex as much. But, if your libido has been low for an extended time, and if it’s causing you stress or sadness, it might be time to talk to your doctor.
Researchers are still investigating the connection between low libido and mental health. But, they know it’s common for HSDD and depression to overlap. Whether occurring together or not, both HSDD and depression can have a big impact on your life and deserve medical attention.
What is depression?
Major depressive disorder is often referred to as “depression.” It’s a condition that causes a person to experience depressed mood, lack of enjoyment in everyday life, or both. Everyone experiences slumps from time to time, but depression generally lasts longer. Some of the symptoms of depression include:
- feelings of sadness
- loss of appetite
- weight loss or gain
- trouble sleeping
- difficulty concentrating
- low energy levels
Another symptom associated with depression is a change in sex drive. If you’re depressed, you may feel like you don’t have enough energy for sex. Since depression can also cause you to enjoy activities less, you may find that you don’t enjoy sex the way you once did.
The process can also work in reverse. It’s possible for a low libido to trigger feelings of depression.
For example, HSDD can cause depression-like symptoms, which may be connected to your relationship or lack of sexual desire. At the same time, having HSDD doesn’t mean that you’ll be diagnosed with depression. It’s possible for a person with HSDD to experience low mood related to sexual activities, but to feel positive about other aspects of life.
What does the research say?
Several research studies have looked at the connections and overlap between low libido and depression. Researchers have considered how common it is for women to experience both conditions, and what factors may increase the risk. Here’s a look at some of the major studies and the findings so far:
It’s more common than you think
An article in the Journal of Clinical Psychiatry found that about 40 percent of women with a sexual disorder also experience depression. The researchers found that an estimated 10 percent of U.S. women experience a “desire disorder.” An estimated 3.7 percent have problems with both desire and depression.
Risk factors include stressful life events and addiction issues
An article in American Family Physician found that risk factors for depression and low libido include stressful life events, such as a divorce or a lost job. Major life transitions — whether positive, negative, or neutral — may also be triggers. For example, a new baby or a child leaving home would be considered major life transitions. Ongoing relationship stressors are also a risk factor. Abuse of alcohol, drugs, or both, is also associated with increased risk for low libido and depression.
Depression may worsen HSDD symptoms
A study in Psychosomatic Medicine found that women who were depressed and had HSDD were less happy in their relationships. They also had sex with their partner less frequently. Plus, they had greater difficulty forming and maintaining relationships. Additionally, one-third of premenopausal women with HSDD also experienced depression.
Depression and low libido can have many contributing factors, along with a range of symptoms. Having one condition doesn’t mean you have the other, but it’s possible to have both at the same time. In either case, there are treatment options that may help.
Treatments for low libido and depression
When it comes to treating low libido, depression, or both, there isn’t a one-size-fits-all approach. At-home strategies, relationship or marital counseling, sex therapy, and medical treatments are all options. Depending on your condition, the main goals of treatment may include restoring sexual desire, effective communication, reducing any symptoms of depression, and improving your ability to enjoy your day-to-day activities. Here are some common starting points:
Talk to a professional
For many women, the first step in seeking treatment is to speak with their family doctor.
If you prefer more specialized help, you can consult with a psychiatrist or a sex therapist. Any of these professionals should be qualified to discuss treatment options with you, or refer you to another expert who can. Therapy, such as mindfulness-based cognitive behavioral therapy (MB-CBT), is one treatment option.
This approach may help you to recognize thoughts and behaviors that are interfering with your sex drive and overall happiness, as well as increase body awareness. Another option is prescription medication, which is designed to reduce the incidence of depression.
Communicating openly with your partner is an at-home strategy that may help with low libido and difficult emotions. If you aren’t sure how to get started, talk therapy or self-help books offer a way to build your communication skills. Couples therapy is another option. Finding ways to open up the lines of communication with your partner may help you feel less alone and improve the intimacy in your relationship. In turn, for some people, this improves sexual desire.
Take steps to relieve stress
In some cases, stress contributes to feelings of low libido and depression. This can lead to a cyclical pattern, where having a low libido causes even more stress. Taking time for stress-relieving activities often makes a difference. Consider meditating, journaling, exercising, or listening to music. Finding ways to relax as much as possible may help reduce symptoms of both conditions.
Although most people experience ups and downs in their sex drive, a low libido can be a cause for concern. Women may be quicker than men to dismiss their own symptoms, instead of seeking support. But talking to a doctor can help you get a better understanding of the treatment options available. It’s not uncommon for low libido and depression to overlap. Take the time to tell your doctor if you’ve had symptoms, such as feelings of sadness or a depressed mood.
If you prefer to try an at-home approach, consider working on your communication skills and making more time for stress-relieving activities. Spending quality time talking and relaxing with your partner may be the first steps you take toward feeling better.
8 Effective Ways to Reclaim Your Sex Life During Depression
You CAN do it!
Over nearly my entire life, at least since going through puberty at an early age, there’s been a cold war brewing in my mind and body between sex, stress, and depression. There is a seemingly never-ending battle between my libido and the physical and hormonal effects of stress and depression.
5 Ways To Stay Sex Positive Even When You’re Depressed
My own depression would take me falling from the ecstatic highs of a healthy sex drive to frustrating lows that made me feel like my body just flipped a dampening switch.
I also had those pesky libido reducing hormones that come out only when a woman becomes pregnant and has children. My depression and stress worsened over time, so about two years ago I delved into learning more about how stress and depression affect your ability to feel any interest in sex or even find it enjoyable.
I learned that depression releases hormones and chemicals that pretty much chase away your sex drive and even diminish your ability to enjoy sex when/if you finally get around to it.
And not only does depression release these chemicals that have a negative effect on you, but it also packages them along with negative thoughts. Mentally and physically, you can become your own worst enemy when it comes to sex.
There are two factors to look at when assessing depression’s effect on your sex drive
- How the neurotransmitters and hormones released by depression lower your libido.
- The mental state of mind in which your brain thinks you out of wanting or enjoying sex.
Stress and anxiety often increase significantly at the same time.
Research suggests that all this can trigger the release of hormones that can suppress your sex drive, in a way similar to how stressful situations release chemicals that produce the same reaction.
Basically, it’s like the stress of the holidays — feeling overwhelmed, over-scheduled and stressed out by family, work or events which can be accompanied by severe depression — all year long.
Researchers have noticed that the release of the neurotransmitters serotonin, norepinephrine, and dopamine have something to do with depression, but they’re still not exactly sure what or why.
Antidepressants work for some people because they regulate these neurotransmitters
- Reuptake inhibitors (reuptake is when the released substance is reabsorbed) work to keep these chemicals in your body longer
- SSRIs regulate serotonin reuptake and are the most common
- SNRIs regulate serotonin and norepinephrine reuptake, while NDRIs regulate norepinephrine and dopamine reuptake (this category is only represented by one drug, Wellbutrin)
- There are also SARIs, MAOIs, Tricyclics and Tetracyclics. I simply have no space here to go over them all, but each works in a different way to prevent reuptake
Of course, while medication may work for some people, it doesn’t work for everyone.
An even more disappointing fact is that while anti-depressants may make some feel people better, most of these suppress sex drive, so arousal and orgasm may remain difficult, if not downright impossible while taking medication.
When you experience stress and anxiety, your hormones, hypothalamus, adrenal cortex and pituitary gland all play a part in releasing hormones.
Some hormones, like cortisol and adrenaline (or epinephrine), can be helpful to you in small doses, as they increase heart, blood pressure, and metabolic rates. Basically, part of your fight or flight response.
Cortisol suppresses low-priority functions that make you less effective in times of crisis to help you focus and save energy for things needed to survive. Cortisol will actually inhibit sex hormones. So depression is probably triggering reuptake of chemicals you need to feel better and once you add stress to the menu you are releasing chemicals that suppress your libido.
Welcome to my world, the magical world of stress + depression
On top of all this, you have the subjective issues that accompany depression, those things that you can’t really assign to a chemical or hormonal imbalance.
Depression comes with a reduced, or completely removed, ability to experience any kind of pleasure.
You simply stop enjoying everything, including sex
You may also experience other issues affecting your desire. People with depression may lose connection with their partners or feel no arousal with new partners due to their feelings of disconnection or their desire to withdraw from the world.
This can even mean the lack of physical touch of any kind, which results in the loss of certain chemical releases that accompany touch, especially prolonged touch such as hugging or kissing. (Hello oxytocin!)
Depression can also trigger anger or anxiety, both enemies of fun in the hormonal/chemical release and reuptake battlefield.
And anxiety, a stressor, can, in turn, deal out things such as a lack of sleep, an inability to concentrate, irritability, lack of energy and constant worry. These problems can then turn into highly negative thoughts about yourself and may keep you in a worst-case scenario mindset.
None of this is conducive to feeling sexy or fostering positive feelings about sex
A combination of these things puts a great strain on any relationship.
This may lead you into a nonstop cycle in which you feel depressed and so stop having sex, after which the lack of sex and intimacy creates tension and/or strife in your relationship, which then triggers more depression and stress, which keeps you from wanting or enjoying sex even more than you already didn’t, which triggers more anxiety/depression/stress, and on and on and on…
7 Crazy Things That Happen To Your Mood When You Stop Having Sex
It can be a frightening non-stop carousel of negative emotions and consequences, but working on your depression and trying to your remove stressors can help.
Here are 8 ways to go about doing so:
- Talk to your partner and your doctor about ways to minimize these effects.
- Taking time for yourself, even if it’s just 10 minutes a day can really help.
- Practice meditation or meditative breathing to help calm you and increase the amount of oxygen you’re receiving.
- Take a look at your diet, as poor choices can actually decrease your sex drive. Watching what you eat and daily exercise (as little as 20-30 minutes a day) can decrease the effects of depression and stress, which can then lead to an increase in desire.
- Find time to connect with your partner without the stress of sexual performance involved. Hugs, simple kisses, even just holding hands can help to release those feel good chemicals.
- Sometimes, attempting to have the sex you want, even when your brain tells you it’s not interested sparks your body to overrule your mind.
- Talk these ideas over with your partner and see if you can both come up with some ideas that might work for you.
- If you don’t have a partner, look for these connections elsewhere with family, friends or at a local cuddle party.
Non-sexual touch can help you feel more connected with yourself and others, while in turn luring your libido back so it will be there when needed
Note that a hug releases oxytocin after 20 seconds, so hold on a little longer if you can.
Making time to talk, share stories, have a laugh, make eye contact (another hormone releaser), and do anything that connects you with others and with your partner will help to undo some of the destructive effects of depression and stress.
Your brain is your largest sex organ but it can also be your biggest enemy
While the cold war may never actually end, you can remove yourself from the battlefield and remind your brain and body how to have sex in a way that makes you fulfilled and satisfied with your sex life again.
This guest article originally appeared on YourTango.com: 8 Ways To ‘Trick’ Your Brain Into Sexy Thoughts When Struggling With Depression.
8 Effective Ways to Reclaim Your Sex Life During Depression
Depression is typically characterized by sadness, hopelessness, and feeling discouraged, unmotivated, or indifferent about life. This is the depression most people know. But the disorder can manifest itself in some subtle and surprising ways, and some of the symptoms are more easily recognizable than others.
Clinically speaking, if a person has at least five of a certain set of symptoms—like a persistently sad mood, low energy, problems concentrating, insomnia, weight loss, or irritability—for two or more weeks, it’s classified as major depression, according to the Anxiety and Depression Association of America. One of the symptoms you don’t always hear about is a loss of interest or pleasure in sex. While all the effects of depression can all be tough to deal with, this one can be especially difficult to talk about—and it can sometimes be tricky to treat. But for people with depression, it’s a common experience, and one that deserves attention as much as the more “classic” signs of the disorder.
“There’s a brain-body connection, so it’s not unusual at all that when people have depression, they can have a lot of physical manifestations,” Jamil Abdur-Rahman, M.D., board-certified ob/gyn and chairman of obstetrics and gynecology at Vista East Medical Center in Waukegan, Illinois, tells SELF. That certainly extends to your sex life—in fact, that’s often an early sign of depression rearing its head. “Sex drive can be one of the first things to go,” Gary Brown, Ph.D, a licensed marriage and family therapist in Los Angeles, tells SELF.
Depression can impact your sex drive in a number of different ways. First, and most directly, that’s because it involves neurotransmitters like serotonin and dopamine, the latter of which plays a role in both mood regulation and libido, says Abdur-Rahman. When your brain is struggling to properly use these chemicals, it can make you crave and enjoy sex (among other of life’s pleasures) less.
There’s a symptom trickledown effect, too, which can influence the situation. For example, your energy levels might take a dive, and fatigue isn’t conducive to wanting to have sex. In his patients who happen to be depressed, Abdur-Rahman also sometimes sees what he calls “a compromised sense of self,” or a feeling of worthlessness that may make them feel less comfortable being intimate with other people. On top of everything, feeling stressed or ashamed of having depression can exacerbate the situation, says Brown.
There’s also a particularly awful link between depression and childhood sexual abuse, Abdur-Rahman says, pointing to research that shows an association between the two. If you’ve experienced childhood sexual abuse, you may be more likely to deal with depression. And, he adds, “People can have a subconscious aversion to sex or sexual acts,” which can just cause more depressed feelings. The two can basically feed off each other in a vicious cycle.
Even if your libido isn’t affected by the depression itself, it could be dampened by antidepressants. “There are certain types of depression medications that have demonstrable sexual side effects, including diminished libido,” says Brown. Abdur-Rahman notes that serotonin reuptake inhibitors (SSRIs, such as Prozac, Celexa, and Paxil), a popular treatment for depression, are known for influencing people’s sex lives, whether by decreasing their sex drives or making it harder (or impossible) to orgasm.
This shouldn’t stop you for getting treatment for your depression. Many people don’t seek help, and it’s a shame, because depression is treatable, and there are options for working around any negative side effects of prescription drugs. Talking through the issue with a mental health professional can help you figure out a treatment plan.
If you’re in a relationship, the experts recommend trying to be as honest as possible about your depression and the way it’s changed your feelings about sex or your experience during it, even though that’s hard sometimes. “When partners can be involved in that conversation, they can see as a manifestation of depression instead of a reflection on themselves,” says Abdur-Rahman. You can do it one-on-one, or you can see a counselor or therapist together.
“You’re entitled to have a healthy, satisfying sex life,” says Brown. “If your depression is getting in the way of that, it’s worth getting some help.”
If you or someone you know is struggling with depression, visit Mental Health America or the ** Anxiety and Depression Association of America for valuable resources and to find help and support.
Watch: This Is What It Feels Like To Live With A Mental Health Issue
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