As if Having Depression Isn't Enough, It Can Also Ruin Your Sex Life. Here's How to Deal.

It's a troubling side effect, whether you're the one with depression or your partner has it.

A decade ago, Karen C.'s sex drive disappeared. The 39-year-old had recently started medication to deal with mood imbalances, but while her emotions stabilized, her libido bottomed out—and never returned.

"I have no interest in sex whatsoever; I literally just bend or roll over and silently endure whatever my partner needs in order to keep him satisfied," she tells Health. "I don't think he understands. I know he doesn't understand. How do you communicate to someone how you're feeling when they don't experience it themselves? And sometimes you don't even know how you're feeling so you can't communicate it correctly."

All the ways depression sinks desire

Dealing with depression can be tough in so many ways. The devastating effect it can have on sex makes the condition even worse. Researchers have definitively linked this mental health diagnosis to a number of intimacy challenges: difficulties with sexual self-esteem, feeling sexually distant from a partner, trouble communicating about sex, being unsure how to initiate sex, and a flatlining interest in sex in general, according to a new study in the Journal of Social and Personal Relationships.

"Issues with self-esteem are the hallmark of depression," Christine Manley, PhD, a clinical psychologist based in Nashville, explains to Health. "The core diagnostic criteria of depression is chronic and pervasive feelings of worthlessness. So if that's the foundation you're coming from with a depressive episode, your self-esteem is going to be in the toilet—and that's going to affect every major area of your life, including your sex life," she says.

Depression itself can have ramifications in the bedroom, and it also brings on a number of side effects that also influence libido, adds Michael Salas, a sex therapist based in Dallas, tells Health. "Depression can make people lose interest in pleasurable things in their lives; it can increase irritability and pessimism. It's also highly correlated with low energy and fatigue," he explains. "All of this can lead to a loss of interest or even avoidance." Who wants to get naked if they feel angry, defeated, or detached? Exactly.

While not everyone with depression experiences a sad mood, the number one symptom that corresponds to almost every single case is fatigue, says Manley. "Like no matter how long you sleep or how many naps you take, you're never enough," she says. "Depressed people are exhausted all the time; they certainly don't want to have sex at the end of the day." Think about it like this: On the most basic level, depression diminishes your ability to experience pleasure; and what is sex about if not pleasure?

Antidepressants play a role, too

Major depressive disorder affects more than 16.1 million American adults, or about 6.7% of the U.S. population age 18 and older in a given year. To treat all those people, the most obvious solution to depression is antidepressants; one in nine Americans of all ages reported taking at least one antidepressant medication in a given month, according to national survey data released by the Centers for Disease Control and Prevention (CDC).

But "the gold standard antidepressants—like Zoloft, Prozac, Paxil, and Celexa—are called selective serotonin reuptake inhibitors, and a ton of research shows that they completely demolish your sex drive," says Manley. That's because they increase the amount of the neurotransmitter serotonin in your brain, but too much of a spike can inhibit libido and make it harder to have an orgasm.

"I do wish things were different," says Karen. "I wish I didn't have to rely on medication to stabilize my moods, but I've tried repeatedly to get off of them and it literally makes me feel crazy. I long to feel like my old self so badly, I think it almost makes the depression worse."

There are other types of antidepressants, like Wellbutrin, but those can sometimes increase anxiety or irritability, Manley says. "It's crucial to talk to your doctor about the side effects of these meds: How will it affect your sex drive? Will you experience lubrication or have difficulty with arousal or desire? You may have to try a couple before you find the one that's worth it," she says.

It also may end up being a cost/benefit analysis: The medications that work best may be ones that do have some kind of effect on your sex life, so you and your partner should work with your doctor to determine what's right for you.

How to beat the sexual side effects

It's very hard to get over the inertia of depression—not just in the bedroom, but in all aspects of your life. But there are things you can do even without medication that can make a difference when it comes to intimacy.

First, get moving. "I really encourage people to experiment with new types of exercise," says Manley. "It's so important that they start to feel connected to their bodies again, and that can really get the ball rolling." If you wince at the idea of hauling yourself to the gym, go with activities that make you work up something of a sweat without any special gear or a gym membership: dancing, walking, chasing your kids around a playground.

Initiating non-sexual contact in and out of the bedroom can also help. "You can re-engage with your partner by touching, kissing, cuddling, fondling, etc.," says Salas. "This can make people feel less pressured to follow the traditional sexual response cycle and practice enjoying the experience for what it is. When people do this, I encourage them to pay attention to what is most enjoyable and pleasurable and let the body and emotions respond to these sensations." Often, that contact will become sexual, but you've taken away the performance pressure.

And talk. Talk, talk, talk about your feelings. "A lot of times, the problem isn't sex, it's intimacy. Partners aren't sure how to connect or the connection they had before has been strongly influenced by depression," explains Manley. "Actively attempt reconnection: Remind them how you felt when you first met, talk about a time you felt super connected. If someone has trouble with that level of basic vulnerability in a relationship, of course sexual intimacy is going to suffer."

What if your partner is the one who's depressed?

Even if you're not the one suffering from depression, it can still wreak havoc on your sex life—and it can almost feel worse, because it's hard to know how to bring the issue up. Whatever you do, tread gently. "People can have a lot of shame around feeling depressed, so if you just show curiosity, it will plant some seeds for the other person to consider depression as a problem," says Salas.

Make sure they know that their quality of life is more important than your sexual gratification. But if you're at your last straw with a partner who won't talk about their depression or how it's left your sex life circling the drain, you may want to find a couples therapist. "You're going to need to be open that you need things to change to remain in the relationship," says Salas. Sometimes, people can be too gentle and avoid these topics, adds Salas. But it's best to be clear about your needs how your bond as a couple has taken a hit.

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