This edition of HH101 addresses the perilous links between sex and mental health
By Jasmine Decosta

Depression adversely affects many Americans and their families; 1 in 10 US Adults report having a depressive disorder (CDC, 2013).
As a clinical therapist, I do find that both women and men suffer silently with depression in general and even more with how it can be damaging to their relationships. It can be particularly difficult when either partner does not understand depression and its effect on interpersonal relationships including sex drive. One partner may feel neglected and the other embarrassed about their lack of desire to be pleased and or perform sexually. Depression is very common whether formally diagnosed or just described as “The Blues”; and it should be communicated as openly as possible to your partner.
Depression has many symptoms, including low or sad mood; changes in appetite, sleep and energy; difficulty concentrating; feelings of worthlessness, shame or guilt; and or loss of interest in activities. The last symptom listed can be one of the leading issues related to changes in intimacy, including sexual activity.

There are a number of articles and resources available about the effects of depression on sex drive; additionally the effects of anti-depressant medication on sex drive. In reviewing the literature available, it may feel as though the Depression itself and treatment of can have the exact same adverse effect on one’s sex life. To find the “loop hole”, I checked in my medical consultant, Michelle Wan, MD. Dr. Wan shares, “simply put, it is difficult to feel sexy or desirable if you are unhappy. However, many of the pharmaceutical therapies for depression are very well known to CAUSE low libido. It can be very frustrating for both patients and clinicians when the very symptom you aim to treat is exacerbated by the medication.”

Many people with clinical depression recover from the disorder; while there may always be a risk of depressive episodes they can find many ways to cope and or shake off depression through strategies learned in clinical therapy, personal or professional support groups, and often times the help of medication therapy. With a focus on libido, or sex drive, people can in fact look forward to the return of this desire and enjoyment in the absence of depression. Dr. Wan and I both agree in the importance of prioritizing depressive symptoms and then working on those areas that depression may be affecting, including sexual intimacy. “The risks and benefits of antidepressant medication as it pertains to libido must be weighed and discussed on a case by case basis. If depression is so severe that day to day life activities and interpersonal relationships are suffering, then prompt treatment is certainly necessary” Dr. Wan.

So how should one approach libido with the use of pharmaceutical drugs? “This is where a very honest and open line of communication between patient and physician is key” Dr. Wan. She shares that are in fact some ways that clients, therapist and medical providers can work together to control depression and medication side effects, please take time to discuss with your health provider before making any changes to your current regiment:

• Although tried and true as a mainstay of depression treatment, “traditional” anti-depressants such as SSRIs (selective serotonin reuptake inhibitors), TCAs (tricyclic antidepressants) and MAOIs (monoamine oxidase inhibitors) are well known to cause low libido. Changing to newer antidepressants, such as Wellbutrin, can help to counteract unwanted sexual side effects. You should discuss with your health care provider

These options will allow you to continue to treat depression while addressing the adverse effects the medicine may have on your libido. “In sum, there are many ways to circumvent the challenge of anti-depressant induced low libido. Sexual health is a part of our general health and well-being and should not be neglected. Do not be embarrassed! If you are considering seeking treatment for depression, good for you! Ask questions about the treatment options best for you, and what changes to anticipate as it pertains to your sexual health and libido” Dr. Wan.

I require my clients to prioritize their treatment goals, and we work together to address them in the order of importance. In most cases, we work to reduce the symptoms of depression—returning to a state of emotional safety, balance and wellness and then work closely on specific areas of concern. While the ultimate goal may be to jump back into being a confident sex wild woman; we focus on the steps necessary to not only get back to sexual wellness but maintain overall wellness. This may include confidence building, recognizing triggers for depression, and tactics to work through a depressive episode. In cases where my client has a significant other, we work to educate the partner on the symptoms of depression, side effects of medication, and tools to stay engaged and supportive.

Without including your partner in what you are experiencing with depression and treatment for depression; you may leave him or her feeling neglected and or helpless. We want to reassure our partner that they are not the problem but can be a part of the healing process. The more
support you have in your inner circle, the better able you will be to work through the depression and toward you goals. If you are seeing a therapist, it may be a great idea to ask for their help in including your partner and working together on ways to maintain a level of intimacy until you libido is back in full gear.

Remember, Depression and treatment for Depression are very serious and you should be commended for getting the help you need. You sound like a very thoughtful and insightful person that deserves a happy and healthy life, including sex life! Continue to work with your medical provider on tweaks to keep the medication from compromising your sexual desires and work closely with your partner on ways to stay connected and supportive while you work through coping with Depression.

-Jasmine Decosta(@jetsettingjasmine)