Depression's Impact on Sexual Desire and Function

Comorbid symptoms of depression (desire, function) disorders?

Hello, doctor.
I recently visited a mental health specialist but did not discuss certain related issues at that time.
I find these problems to be very private and personal, and there is also the concern of "face" as a patient, so I would like to inquire here.
If this is inconvenient, I apologize.

Regarding the symptoms of depression (mild to moderate) accompanied by anxiety, I would like to know if this condition can reduce attraction to the opposite sex (regardless of my original sexual orientation).
For example, if a man sees an attractive woman on the street, he might only glance at her without much emotional response or impulse towards her.
In contrast, in the past, I would have felt attraction and briefly focused my attention on that person, followed by some normal sexual impulses (which I believe are part of human behavior), such as sexual fantasies, etc.
Additionally, I would find it easier to become aroused.
Similarly, these feelings would also occur while watching adult films, where I would typically experience sexual impulses, fantasies, associations with attractive individuals, and genital arousal.
However, now I feel numb, indifferent, uninterested, and even repulsed, avoiding any contact.

I would like to ask the doctor if these conditions can be treated with psychiatric medication.
Regarding the reproductive aspect, one could say there is erectile dysfunction, but I believe this is due to a lack of stimulation in the brain.
Should this condition be assessed by a urologist? If psychiatric medication can be used for treatment, will it directly affect reproductive capability? (Not through sexual fantasies, but rather through visual stimuli leading to arousal.) Or must one first take psychiatric medication to resolve symptoms (depression, anxiety) before any improvement in overall well-being occurs?
I sincerely request your time, patience, and assistance in answering these questions.
Thank you very much for your expertise and kindness.

Nìmíng, 20~29 year old female. Ask Date: 2021/01/25

Dr. Lin Mianzhang reply Psychiatry

Hello, thank you for your question.
I can sense your concern about your health, and you have described your situation clearly.
Depression can indeed affect a person's interest in various aspects of life, including libido and sexual function.
Therefore, a decrease in interest in the opposite sex and lack of physiological response could very well be manifestations of depression.
Generally, these sexual desires and functions can recover once the symptoms of depression improve.
However, if you are taking antidepressants that may impact sexual function, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), it is possible to still experience sexual function issues even after your depression improves.
If this is a significant concern for you, you might consider discussing with your physician the possibility of prescribing medications that have less impact on sexual function, such as bupropion or mirtazapine.
In fact, sexual function is a concern for many patients, and I encourage you to openly discuss this with your doctor, who should be understanding of your feelings.
Wishing you a speedy recovery!

Reply Date: 2021/01/25

More Info

Depression can significantly impact sexual desire and function, and your concerns are valid and shared by many individuals experiencing similar symptoms. When someone is dealing with depression, it is not uncommon for their interest in sexual activity to diminish. This can manifest as a lack of attraction to potential partners, reduced sexual fantasies, and even physical responses such as erectile dysfunction or anorgasmia.
From a physiological perspective, depression affects the brain's neurotransmitters, particularly serotonin and dopamine, which play crucial roles in regulating mood, pleasure, and sexual function. When these neurotransmitters are imbalanced, it can lead to a decreased libido and an overall disinterest in sexual activities. Additionally, the psychological aspects of depression, such as low self-esteem, feelings of worthlessness, and anxiety, can further exacerbate the situation. Individuals may feel disconnected from their bodies and their desires, leading to a cycle of frustration and emotional distress.

Your observation about the change in your reactions to attractive individuals is a common experience among those suffering from depression. The emotional numbness or indifference you describe can be a direct result of the depressive state, where even stimuli that would typically elicit a response fail to do so. This can extend to viewing adult content, where the expected arousal is replaced by apathy or even aversion.

Regarding treatment, it is essential to approach this issue holistically. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are often prescribed to help alleviate the symptoms of depression. However, it is important to note that some SSRIs can also contribute to sexual dysfunction as a side effect. If you find that your medication is impacting your sexual health negatively, it is crucial to discuss this with your prescribing physician. They may be able to adjust your medication or suggest alternatives that have a lower risk of sexual side effects.

In terms of whether these issues can be resolved solely through medication, the answer is often more complex. While medication can help address the underlying depression and anxiety, additional therapeutic approaches may be beneficial. Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can provide tools to manage negative thought patterns and improve self-esteem, which can, in turn, enhance sexual desire and function.

Moreover, lifestyle changes can also play a significant role in improving sexual health. Regular physical activity, a balanced diet, and adequate sleep can positively influence mood and energy levels, which may help rekindle sexual desire. Engaging in open communication with partners about your feelings and experiences can also foster intimacy and understanding, alleviating some of the pressure associated with sexual performance.

In conclusion, the interplay between depression and sexual desire is multifaceted, involving both physiological and psychological components. It is crucial to seek professional help, as a tailored treatment plan that includes medication, therapy, and lifestyle modifications can lead to significant improvements. Remember, you are not alone in this experience, and addressing these concerns with a healthcare provider can pave the way for recovery and a healthier relationship with your sexuality.

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