Sex Drive, Sexual Performance, and Depression

Depression and sex are two topics that at one point were taboo for men to discuss. It was rare for men to share personal struggles relating to these topics (even with therapists). However, the tides are changing as stigma surrounding mental health continues to erode while discussions about both mental health and sexual health are becoming more open. Additionally, research has helped uncover how intimately connected these topics actually are, enabling us to have more informed conversations.

Experiencing a lower sex drive is quite common among men. Studies show that upwards of 25% of men under 60 years old experience low sexual desire.^{[1, 2]} (To note, it is very common amongst women as well).

We’ve divided this article up into the following sections:

How depression can lower your sex drive
How sexual difficulties can impact depression
When to seek support
How antidepressant medications may be involved
Tips on regaining your sex drive

In this article, we will explore the complex relationship between depression and sex, and examine how addressing either one can have a positive impact on the other.

How depression can lower your sex drive

The relationship between depression and sex requires a closer look at the impact of depression on the body and on the libido (i.e., your sex drive).

One major symptom of depression is anhedonia, meaning you don’t find pleasure in the activities that used to bring you joy, which can include lessening the level of interest in sex and the satisfaction you get from it.
Additionally, other symptoms of depression like depressed mood, irritability, and fatigue significantly interfere with our sexual mojo.
Over time, this can erode our sense of self-worth and confidence, and even contribute to a sense of body dissatisfaction.

It’s been found that roughly two-thirds of men who experience depression also experience sexual challenges, ranging from sexual desire, orgasmic problems, and overall dissatisfaction with sex.^[3]

How sexual difficulties can impact depression

Underperforming, embarrassment, and lack of confidence in your sexual ability can worsen symptoms of depression. It can be seen as a cycle, where depression and sexual difficulties impact one another as things get more difficult to manage.

This cycle can make guys less inclined to share what is going on with sexual partners, exacerbate any feelings of worthlessness, and increase the likelihood of experiencing erectile dysfunction, among many other symptoms. Many men often have an expectation that they need to be rockstars in bed because of what they see in movies/TV, which can make sex feel like a daunting task rather than an intimate interaction with another person.

Examples of sexual difficulties are:

Erectile dysfunction (ED)
Premature ejaculation
Difficulty reaching orgasm
Performance anxiety (nervousness and anxiety around sex)

It is important to point out that the onset of sexual difficulties is not a sign that you may have, or will have, depression. However, these difficulties may be signs of other health issues that should be addressed by a medical professional. Ultimately, it is always a good idea to speak with a doctor about your health concerns, regardless of how minor you may feel they are or possibly embarrassing they may seem.

When to seek support

It’s important to seek professional support if you’re experiencing symptoms of depression, sexual difficulties, or both. As mentioned above, depression and sexual difficulties are risk factors for each other, and if experiencing both, can create a negative feedback loop, causing each other to become worse.

If you’re experiencing difficulty sleeping, have lost your appetite, or feel hopelessness, you might be suffering from depression. A check-in with your family doctor is a good idea.
If you’re experiencing sexual difficulties such as ED, premature ejaculation, difficulty reaching orgasm, or find yourself avoiding situations where intimacy may occur, a check-in with your family doctor is a good place to start. Connecting with a therapist who specializes in sexual difficulties is also a good idea.

How antidepressant medication may be involved

There are a few different treatment options when it comes to depression. Medication may be recommended if depression seriously interferes with your ability to function. Unfortunately, side effects often associated with antidepressants are low libido and erectile dysfunction.

Therapeutic response to antidepressant medications and the side effects experienced will vary from person to person. Typically, the therapeutic effects of the medication are not observed until at least several weeks, but side effects tend to be experienced much sooner, which can affect a person’s decision about whether to continue with the medications.

If you are currently taking antidepressant medications and have noticed that they have impacted your sexual desire and/or performance, discuss this with your physician. A change in dosage or type of medication could be considered to reduce these side effects. You may also decide that the side effects that you experience are not tolerable and wish to stop using the medication. While the decision of whether you take medications or not is always in your hands, if you choose to discontinue, do so in consultation with your physician.

Antidepressants and sexual side effects

Here are some antidepressants that have been associated with more sexual side effects:^[4]

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

Here are some antidepressants less associated with sexual side effects:

Moclobemide
Phenelzine
Tranylcypromine
Agomelatine
Bupropion
Mirtazapine

When considering treatment involving medication, talk to your doctor about any concerns and past experiences you have had with antidepressants to ensure you are able to come up with a treatment plan that best suits you and your needs.

Tips on regaining your sex drive

Manage stress

Stress plays a large role in developing sexual difficulties, as it causes an increased production in cortisol – a stress hormone – and a lower level of testosterone, which plays a role in sex drive. Stress also has a way of consuming our minds and leaving little or no space for enjoyable/pleasurable life activities like sex. Check out our section on stress management if you’ve been feeling stressed and feel like it’s interfering with your sex life.

Manage negative thoughts about sex

Try not to judge yourself too harshly for having any sexual difficulties. These are actually common issues! Check out our page on negative thinking to get better at noticing when you are degrading yourself and what to do about it.

Communicate with your partner

Communication with your partner about the challenges you’re experiencing is one of the most important things that you can do. Understandably, this is not easy. However, left in the dark, our partners will feel alienated and often assume that they have done something wrong or that we are no longer attracted to/interested in them. Our relationship inevitably suffers more because of this.

Letting your partner in, so to speak, can actually help increase intimacy in a relationship.

If you are hesitant or not sure how to approach a conversation with your partner, consider sharing this in therapy to come up with ways to help you talk about it with your partner.

Change medications (if causing sexual side effects)

If you have been using antidepressants and are noticing side effects that are impacting your sex life, discuss this with your family doctor or psychiatrist to find options best suited for you and your needs.

Talk therapy

Therapy is perhaps the most important thing you can do for yourself when it comes to recovering from depression, providing you with new insights, skills, and strategies to aid your recovery and help you live well. Additionally, therapy helps us build better relationships, which includes working on issues relating to sex and intimacy. You and your partner might also consider working with a sex therapist or a couple’s therapist to help zone in on sex and intimacy issues together.

Use a holistic approach

Consider discussing lifestyle changes with your family doctor or therapist to consider how changes to sleep, diet, physical activity, and other areas in your life may help improve sexual desire and performance.

Physical activity, for example, is known to provide benefits to both sexual performance (including erectile dysfunction) and sexual desire. A variety of exercises have proven to help men when it comes to sexual health:

Cardio: Aerobics have been found to increase blood flow to the genitals, resulting in increased libido and improved erectile function, as well as reduced stress and anxiety, which helps with your libido.^[5]
Pelvic floor exercises (such as Kegel exercises) have led to improved blood flow and erectile functioning.

Considering the complex interplay between depression and sexual difficulties, it is very important to address either challenge if you’re experiencing them. Not doing so can lead to an increased risk for one or the other. However, working toward improvement in either can help with the other as well.

References:

Nimbi, F. M., Tripodi, F., Rossi, R., & Simonelli, C. (2017). Expanding the analysis of psychosocial factors of sexual desire in men. The Journal of Sexual Medicine, 15(2), 230–244. https://doi.org/10.1016/j.jsxm.2017.11.227
Brett-Renes, C. (2021). Low sex drive (low libido). Healthy Male. https://www.healthymale.org.au/mens-health/low-sex-drive-low-libido
Sawant, N., & Thakurdesai, A. (2018). A prospective study on sexual dysfunctions in depressed males and the response to treatment. Indian Journal of Psychiatry, 60(4), 472. https://doi.org/10.4103/psychiatry.indianjpsychiatry_386_17
Rothmore, J. (2020). Antidepressant‐induced sexual dysfunction. Medical Journal of Australia, 212(7), 329–334. https://doi.org/10.5694/mja2.50522
Exercise and sex: Does Working Out Increase Sex Drive?. Proactive Men’s Medical. (2022, May 2). https://proactivemensmedical.com/blog/exercise-and-sex-does-working-out-increase-sex-drive/