What You Need to Know About Sex and Depression

Depression affects all aspects of life, from appetite to ability to shower, robbing people of the will to do and feel very basic things. Sex, naturally, becomes complicated, fraught with anxiety and disappointment. And now, as the sun sets earlier and earlier and the depression-prone find themselves sulking around in pajamas at 5 p.m., sex lives suffer.

What is Seasonal Affective Disorder?

Seasonal affective disorder, a subset condition of depression in which sufferers are affected by changes in the seasons (usually the onslaught of winter), can affect interpersonal relationships, romantic and otherwise.

"People who are depressed can shut down and be less interested in conversation, less motivated to socialize. And yes, they can be less interested in sex," Colette Dowling, a New York psychotherapist who specializes in women's mental health, tells Bustle. "It's important to remember that Seasonal Affective Disorder is depression. It's no less impairing than any other depression."

How does it Affect Our Sex Lives?

The sexual side effects of depression medication are widely known, as anyone who's ever half-listened to the lightning fast end of an anti-depressant ad will tell you. Less known (and discussed) are the disease’s subtler, more private symptoms, exacerbated both by medication and the illness itself. Feelings of depression and anxiety can make a man or woman feel numb, gross, even entirely un-sexual. During the act itself, orgasm can become near to impossible — minds consumed with depression wander and wind down negative paths, destroying the possibility of being present and in the moment, a universal prerequisite to orgasm.

Depressed people no longer take the pleasure they once took in activities they found enjoyable: eating, exercising, seeing friends, having sex, to name a few. Again, these symptoms can be exacerbated by changes in the season. SAD is estimated to affect roughly 10 million people.

"I'm married and I think it can be rough on my husband because in these months, I'll come home from work and want to go right to bed," SAD sufferer and mental health counselor Christian O'Keefe told WDBJ7 in an interview. "Usually by February, I'm so depressed and over winter."

O'Keefe, like many other people who struggle with SAD, is on medication, which can further reduce already-reduced sex drives.

As David S. Baldwin notes in The British Medical Bulletin , “It can be difficult to separate drug-induced adverse effects from consequences of illness, particularly in psychiatric disorders with major effects on interpersonal relationships.” In the article, Baldwin cites the four main components of the human sexual cycle: desire, excitement, orgasm, and resolution. Depression interferes with all of these. The DSM-IV found that experiences with sexual dysfunction vary along gender lines; women encounter more dissatisfaction with the subjective elements of sex (interest, excitement, enjoyment), while men experience the frustrating lack of biological responses, like erections.

“In 132 patients with depressive disorders, loss of sexual interest, characterised by loss of libido or decrease of sexual desire or potency, was reported by 72% of patients with unipolar depression, and 77% of patients with bipolar depression,” Baldwin writes, citing a landmark 1985 study in Arch Gen Psychiatry. “Conversely, loss of sexual desire may be the presenting complaint of some patients, who only after direct questioning are found to have significant depressive symptoms. In others, low sexual desire may precede the onset of depression.”

What Steps Can You Take To Improve SAD's Effect On Your Sex Life?

There first step to overcoming the problem is to address it; this demands active communication — with your partner, a therapist, and, most importantly, yourself.

In a paper on depression and sexual desire for American Family Physician , authors Robert Phillips and James Slaughter note that psychiatric patients underreport sexual dysfunction, particularly those caused by medication or anxiety. Worse, physicians rarely ask, and sometimes, neither do the partners.

1. Communicate

Communication — with an expert, and with the sexual partner — is perhaps the most important step anyone whose sex life is suffering from depression can take. "It's important to communicate about the side effects of your depression, with both your partner — who may not fully understand what's going on — and with your health care provider," writes Ian Kerner, a sexuality counselor and founder of Good in Bed, for CNN. "And the road will be much easier than it would have been if you were going it alone."

"Those who are in a relationship with someone who's depressed will be better off if they find out as much as they can about the illness," Dowling tells Bustle. "It's very easy to feel that the depressed person is reacting to something about you. Learning about the illness will help to de-personalize what's going on."

2. Work On Your Self Esteem

Just as important as improving communication — identifying the problem, exploring it, and talking about it — is boosting self-esteem, depression's mortal enemy. Getting comfortable with your body and your self is a lifelong process, for both the depressed and non-depressed, but there are exercises to boost feelings of self-worth and body confidence. That's right, regularly staring at your naked body can work wonders. And talking to yourself. "Say aloud what you like about what you see. My experiences have shown me that it’s rare that a woman won’t find at least one thing she dislikes or even hates," Sex Therapist Kyla Black tells Bustle. "So the work here, in addition to vocalizing gratitude for your body, is also to resist the temptation to delve into self-criticism."

3. Consider the role your medication plays

If your SSRI medication seems to be the cause of your decreased libido, inability to orgasm, or general indifference towards all things sexual, consider talking to your psychiatrist about taking a break from your medication (known as a "drug holiday") or switching up the type of medication you take (not all SSRI's have the same amount of sexual side effects.)

Above all, don't go it alone — especially if you're in a relationship. “Sex is a communication tool that partners use to connect with each other in good times and in tougher times,” says Sara Benincasa, author of the memoir “Agorafabulous!: Dispatches from my Bedroom,” in an interview with CNN. “When you're depressed and feel a lack of sexual desire, it's almost as if a voice has been silenced.”

Image: Fotolia