Depression and low libido

Depression is a serious mental health condition that the World Health Organisation tells us affects over 264 million people worldwide, impacting people of all ages, races and educational backgrounds. It is not a sign of weakness or lack of intellect; instead, people from absolutely any background or walk of life can be diagnosed with the condition.

Depression can be scary and debilitating, impacting both the individual and their family or partner. One of the areas that can often be hugely impactful, but is all too often not discussed, is the possible impact on sexual functioning. 

Sexual desire or “libido” is an important component in many relationships. Although it is common for sexual desire to fluctuate over time when this desire fades it can cause distress both to the individual and those that they are in a relationship with. This can be particularly true if people don’t understand the underlying cause of this waning.  In one article published by the Journal of Clinical Psychiatry, it was reported that 40% of people with a sexual disorder of desire, arousal, or orgasm have concurrent depression, highlighting the correlation that can exist between these two conditions.

Lack of libido can be caused by the depression itself, or in some cases, by the type or dose of antidepressant taken, in particular with SSRIs. An article on Harvard Medical School’s website states, “In addition to reducing interest in sex, SSRI medications can make it difficult to become aroused, sustain arousal, and reach orgasm. Some people taking SSRIs aren't able to have an orgasm at all. These symptoms tend to become more common with age”. If you are unaware of this particular side effect, it can certainly cause significant concern.

The challenge for both therapists and patients is that the level of sexual dysfunction can vary considerably from none at all, to significant. Different studies give differing levels of incidence or prevalence, so it can be hard to forecast in advance what the impact may be. But what we do know is when it occurs, it can significantly impact on our enjoyment of life, leaving people asking "Why?", "Why don’t they want to sleep with me anymore?", "What does that mean?".

In the 1960s and 70s, reports of sexual dysfunction were rare, possibly due to underreporting. As a result, the understanding of this important side effect was less. Fortunately, today there is more of an understanding by GPs and mental health professionals of depression generally and its associated impact on sexual function.

Low libido can affect both men and women, especially where depression is present. However, my experience as a therapist shows that all too often people don’t reach out for support until things become very bad. Individuals are reticent to discuss the problem, with both their partner and with their GP or therapist. They may see the topic as taboo or embarrassing, choosing to suffer in silence rather than ask for help. In some cases, relationships may break down, further adding to the strains on wellbeing and mental health.

Reaching out for support really is worthwhile and can have a huge impact, simply understanding what is happening can be reassuring. Your therapist and GPs can help you understand whether the lower libido is due to the underlying depression, or caused by the medications you are taking to treat it.

Doctors are able to discuss alternate forms of antidepressants or modified doses. This can be particularly helpful as most cases of antidepressant usage are relatively short term, meaning that people can often reach peace with the situation if they understand it and know it will be short-lived. However, GPs and mental health professionals are happy to discuss the issue and will help explore a number of areas. In the case of sex, this may range from ruling out any comorbid or concurrent condition that could be affecting things, through to assessing dosage or switching medication. Also, sometimes GPs are able to discuss adjunct treatments that can support sexual dysfunction in various forms.

Treatment options such as cognitive behavioral therapy (CBT) may be used in a bio-psychosocial approach to sexual dysfunction. CBT helps us focus on current issues and how we relate to them. It is recommended by the National Institute of Clinical and Health Care Excellence (NICE) for a number of psychiatric disorders including depression. This can offer the opportunity to discuss the psychological affect of depression and sexual disorder, whilst also exploring ways to work with the underlying depression itself. NICE recommend a blended approach of both CBT and antidepressants in more severe cases, which should be discussed with your GP or mental health advisor.

In addition to clinical treatment, your doctor can also advise you on small lifestyle changes you can make to lessen the impact of SSRIs on your libido. For example, you may find it easier to become aroused if you wait for several hours after taking your medication. Alternatively, you may find that exploring new approaches to sex can help you identify ways to reach orgasm, even while taking your medication.

Counselling professionals regularly work with people that experience depression and its associated side effects and they recognize that reaching out can be hard. But getting help really can be the first step to understanding and treatment. Treating depression and sexual dysfunction often requires a holistic approach. An exploration of psychosocial factors, cognitive factors, and life events, among others, can be the starting point for understanding and recovery. A recent client of mine said: “I thought that my whole relationship had come to an end. Now I understand.” And another who said: “Thank you so much for supporting me through what was a terrible time in my life.”

 We also know that approaches like mindfulness-based cognitive therapy (MBCT), can be supportive of many with depression in helping with relapse prevention. There is no easy answer, but the starting point is recognizing that there is hope and reaching out for support is the first step.