Decreased libido disproportionately affects patients with depression.
The relationship between depression and decreased libido may be blurred,
but treating one condition frequently improves the other.
Medications used to treat depression may decrease libido and sexual function.
Frequently, patients do not volunteer problems related to sexuality,
and physicians rarely ask about such problems.
Asking a depressed patient about libido and sexual function
and tailoring treatment to minimize adverse effects on sexual function
can significantly increase treatment compliance
and improve the quality of the patient's life.
(Am Fam Physician 2000;62:782-6.)
(Am Fam Physician 2000;62:782-6.)
Yes, depression adversely affects every aspect of the people lives – including their relationships – and when one partner is depressed, the relationship may suffer badly. This is a great shame because a good relationship is very therapeutic for somebody with depression.
When you are low you especially need love, support and closeness from the people you love and respect.
How big the problem is?
Symptomatic loss of libido is a common problem in the United States. In a national survey conducted in 1994, 33 percent of women and 17 percent of men reported sexual disinterest. In another survey, one third of women 18 to 59 years of age reported feeling a lack of sexual desire within the previous year. Patients with major depressive disorder or bipolar disorder have an even higher prevalence of sexual dysfunction, including lowered libido, than the general population.
In one study it was found that more than 70 percent of depressed patients had a loss of sexual interest when not taking medication, and they reported that the severity of this loss of interest was worse than the other symptoms of depression. In this same study, libido declined with increasing severity of psychological illness. The complex association between depression and lowered libido is further illustrated in a case control study in which increased lifetime prevalence rates of affective disorder were found among patients with inhibited sexual desire.
Regardless of the cause-and-effect relationship, depression and decreased libido are associated, and the treatment of one condition may improve the other.
What is likely to happen if your partner has depression?
Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive. This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.
Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural. Being the partner of a depressed person is very difficult. So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.
Sex and performance
We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex. From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.
Depression has been linked to:
- A decrease in libido. A study of depressed patients showed that more than two-thirds of respondents reported a loss of interest in sex. The decrease in their libido grew worse as their depression grew more severe.
- Erectile dysfunction. Depression and anxiety are leading psychological factors interfering in a man's ability to have and sustain an erection.
- Inability to enjoy sex. Depression can limit or eliminate the pleasure normally drawn from sex, says David MacIsaac, PhD, a licensed psychologist in New York and New Jersey and a faculty member of the New York Institute for Psychoanalytic Self Psychology. Depressed men, he says, "feel disconnected from any sexual experience. It's a dehumanization kind of situation."
This effect is most marked with regard to sleep, which is invariably disrupted.
But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex. So, many people who are depressed tend to lose interest in sex.
Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives – sometimes even finding that sex is the only thing that gives them comfort and reassurance.
- In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
- In women, this diminished brain activity tends to be associated with lack of interest in sex and very often with difficulty in reaching orgasm.
All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.
Sex and antidepressants
It's not just the illness that affects a person's sex-life – antidepressant medicines such as Prozac can interfere with sexual function. One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all. If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.
In one of the recent studies it was found that patients taking selective serotonin reuptake inhibitors (SSRIs) were four times more likely to reveal sexual dysfunction if asked directly by their physician. Several antipsychotic agents, including haloperidol (Haldol), thioridazine (Mellaril) and risperidone (Risperdal) can also decrease sex drive. Cimetidine (Tagamet), in contrast to ranitadine (Zantac), has been found to lower libido and cause erectile dysfunction.
Women in their late reproductive years who take oral contraceptives and postmenopausal women who are given estrogen replacement therapy may experience an improvement of depressive symptoms but a lowering of libido. Libido lowering is attributed to estrogen-induced deficiency of free testosterone. Testosterone testing and supplementation should be considered in women who experience a decline in libido after starting estrogen therapy. Testosterone testing should also be considered in men who have a gradual loss of libido and no improvement despite adequate treatment for depression.
It is important to assess the patient for psychological and interpersonal factors that commonly affect depression and sexual desire. These factors include stressful life events (loss of job or family trauma), life milestones (children leaving home) and ongoing relationship problems.
Alcohol and narcotics are known to decrease libido, arousal and orgasm. Because the use of alcohol and other drugs is more common in patients with psychological disorders, alcohol and drug abuse should be considered when investigating libido problems in patients with depression.
An anti-depressant that boosts sex drive
You should definitely consider switching your antidepressant to bupropion (Wellbutrin) or taking bupropion along with your Paxil. A study of 30 non-depressed men and women taking bupropion at University of Alabama Birmingham found significant improvements in sexual function and satisfaction compared to placebo. A small Brazilian study (20 subjects) showed highly significant improvements in sexual function in women taking bupropion.
Bupropion is not an SSRI. Instead, it increases levels of dopamine and norepinephrine. These chemicals also raise mood, but without the sexual side effects. Bupropion is now the fourth most widely prescribed anti-depressant in the U.S., and it is often prescribed along with an SSRI.
Of course, bupropion also has side effects. Some are emotional: Some male users reported increased anger and jealousy. Other possible effects include nausea, restlessness, and changes in eating and sleeping patterns (too much or too little sleep or appetite.) So, as with any drug, be careful with it.
How depressed people can help themselves and their relationship
Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.
- Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood. And there's increasing evidence to suggest that exercise can be as good for combating depression as any antidepressant.
- Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
- You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
- Listen to music that matters to you.
- Have faith that the depression will pass and that you will enjoy your life again.
- Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.
How to help your depressed partner
- Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
- Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
- Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
- Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to antidepressants. Cognitive behavior therapy (CBT), for example, is becoming much more readily available on the NHS. Many GP practices can also provide CBT by means of Internet programs. These can have a good effect quite quickly in many cases.
- Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
- Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
- Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
- Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.
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