Chronic depression affects every part of daily life, including sex. It curbs sex drive, yet sex can boost your mood and is important for relationships. And some depression medicines can curb your libido.
Breaking this cycle can be hard.
How to get out of this funk? There's no one-size-fits-all approach. But there are some tried-and-true ways to successfully treat depression without ruining your sex life.
What’s most important, experts say, is to never stop depression treatment out of fear that your relationships and sex live will suffer. That’s because depression itself can hurt relationships and may cause loved ones to take these problems personally.
“In depression, the chemical soup often isn’t right,” says Russell Stambaugh, PhD, a sex therapist in Ann Arbor, Mich., and a spokesman for the American Association of Sexuality Educators, Counselors, and Therapists. “The brain is important for sexuality because of the chemistry, but it’s also important for ideas. It helps how you experience pleasure and how you define it.”
Treat the Depression First
Whatever is happening with your sex life, it's important to treat depression first. Address any sexual side effects later.
Depression is the top cause of disability in the U.S. for people aged 15-44. Men and women struggle equally with sexual problems during depression.
People with chronic depression can experience a loss of desire, take longer to orgasm, and simply find sex less enjoyable.
“The whole process of sexual arousal starts with the ability to anticipate pleasure, which is lost with depression,” says Frederick K. Goodwin, MD, who serves on the scientific council for the National Alliance for Research on Schizophrenia and Depression. “People who are depressed are locked in the moment of their suffering.”
Drugs that treat depression, Goodwin says, “can release sexual function from the grips of depression.” Still, many antidepressants can affect sex drive.
“Medications can change sexual function,” says J. Michael Bostwick, MD, a psychiatry professor at the Mayo Clinic in Rochester, Minn. “But it’s a mistake for patients or physicians to immediately assume a difference in sexual function is bad. It’s different, and then you have to figure out if it’s bad or good. In fact, once the depression is treated, they may have a different view about sex altogether.”
Work With Your Doctor
Antidepressant drug side effects can be tied to the dose prescribed. So sometimes simply lowering the dose will treat the depression without blocking sexual desire, says Goodwin.
But don't tweak the dose yourself. Talk with your doctor if you have sexual side effects from antidepressants (or any other drug).
Goodwin says patients often don't start enjoying sex more until after being on an antidepressant for a few months. And there are antidepressants that don't affect sex drive.
St. John’s wort, an herbal remedy, has also been studied as a treatment for mild to moderate depression. A recent study showed that it helped patients’ depression without curbing libido. But many experts still stand by antidepressant drugs as the best way to manage chronic depression.
If you're taking St. John's wort, or any other herbal remedy, tell your doctor so they can watch out for drug interactions. St. John's wort can have dangerous drug interactions with some antidepressants. Also, keep in mind that, unlike prescription drugs, the FDA doesn't require safety and efficacy tests of herbal products and supplements.
Breaking the Pattern
“The big challenge for doctors treating patients with chronic depression is that the person has been thinking about himself or herself that way for so long that it becomes a habit,” Goodwin says.
“Just correcting the brain chemistry isn’t going to fix the problem," Goodwin says. "Some things need to be unlearned with psychotherapy." That unlearning, he says, can help people bond with loved ones in new and exciting ways.
Talking about depression with your partner, understanding the treatment options, and exploring new ways to enjoy sex, such as extended foreplay if reaching orgasm is a problem, can help strengthen strained relationships, experts say.
Talk to Your Partner
Stambaugh says the key to improving one’s sex life is to start talking with your partner.
He also notes an exciting sex life doesn’t always mean wearing sexy lingerie or watching pornography together. He doesn’t routinely recommend erotica or sex toys or role playing or that people need to be more acrobatic in bed to achieve enjoyable sex.
That’s because what’s pleasurable, Stambaugh says, depends entirely on the couple. What’s important, he says, is that it appeal to both partners and they are both comfortable with what they want out of sex.
"Just the having the conversation about what you want sexually reduces the negative feelings that are folded into the depression,” he says. “Arriving at the right answer to these things means working with your partner.”
It’s also important for patients with depression and their partners to understand there’s no standard for how often you should be having sex or how you should enjoy sex.
Too often, Stambaugh says, people turn to society or the media to define their sexual identities. “They really should ask themselves ‘Do I want this?’ or ‘Am I truly expressing what I am feeling?’ That’s key.”