Depression - Sexuality And Health Problems: Womens Sexual Health

Content provided by the Faculty of the Harvard Medical School

Depression

A complicated relationship exists between depression and sexuality. Depression can be both the cause and the result of sexual problems. For example, loss of desire can be a symptom of depression. Or it may appear first and provoke depression. A lack of interest in sex can lead to relationship problems, feelings of inadequacy, and other emotional issues, which in turn can result in depression. Libido isn't the only aspect of your sexuality affected by depression. Women may be less likely to have orgasms when they are depressed. And in one study, depressed men were twice as likely to experience erectile dysfunction as those who weren't depressed.

Two studies suggest that hormones may be one source of the connection between depression and sex. Data from the Harvard Study of Moods and Cycles, published in 2003, revealed that women with a history of depression were 20% more likely to enter perimenopause sooner than their nondepressed counterparts. For the most severely depressed women, early onset of perimenopause was twice as likely. Another study described a similar effect in men: The depressed men secreted lower levels of testosterone than those without depression.

Further complicating the issue are the sexual side effects of many frequently prescribed antidepressant drugs. Medications called selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) — can dampen desire and make it difficult to become aroused, sustain arousal, and achieve orgasm. Antidepressants can also cause vaginal dryness. An article in Psychiatric Annals suggests that as many as half of all people taking SSRIs experience some sexual problems.

But you don't need to sacrifice your sex life in order to treat depression. Some newer antidepressants — including bupropion (Wellbutrin) and mirtazapine (Remeron) — are less likely to cause sexual problems. There are reports that bupropion may boost sexual drive and arousal, as well as the intensity or duration of an orgasm. Older medications, known as tricyclic antidepressants and monoamine oxidase inhibitors, don't usually cause sexual problems, but they have other potentially dangerous side effects. Your doctor can help you sort out which medication is right for you.

If you're taking an SSRI, other approaches may help offset or eliminate sexual problems:

• Lowering the dose. Sexual side effects may subside at a lower, although still therapeutic, dose.

• Taking a drug holiday. Depending on how long the antidepressant medication usually remains in your body, you might stop taking it for a few days before a weekend, if that's when you hope to have sex. This is hardly spontaneous, but it can work if you carefully follow your doctor's directions about how to stop and resume your medication. However, there is always a chance that this might cause a relapse.

• Adding a drug. In both men and women, Viagra may counteract the negative sexual effects of SSRIs. A study published in the Journal of the American Medical Association in 2003 found significant improvement in erectile function, arousal, ejaculation, orgasm, and overall satisfaction among men who took Viagra to counteract sexual problems stemming from SSRI use. Adding bupropion to your treatment may also offset the sexual side effects of SSRIs.

Last updated:	January 23, 2007