Sexual problems and depression are the most common problems in general practice and psychiatry. Studies showed that 20% of women indicate difficulties in achieving sexual arousal and 7% do not experience orgasm. About 7% of men have temporary erectile problems, and 20% report premature ejaculation. Sexual problems are found in 36% of patients with affective disorders. This is hardly surprising since dopamine enhances sexual activity, the central effect of norepinephrine is associated with an increase in arousal, and aperipheral effects negatively affect sex life. Serotonin suppresses sexual function through 5HT2.
Reduced potency and depression: what is the link?
Sexual problems and depression can occur simultaneously or sequentially, one after another. Thus, depression and its treatment can lead to sexual dysfunction, and recurrent sexual problems, in turn, cause depression. It is important to know the anamnesis to understand and determine what is primary. Sexual problems are usually divided into the following categories:
- Disorder of desire – a decrease or loss of libido, which sometimes leads to the avoidance of sex in general.
- Arousal disorder – in which the normal sexual response of the genitals in the form of vaginal lubrication in women and the erection of the penis in men does not occur at all or is unsatisfactory.
- Disorder of the orgasmic function – in which men have impaired ejaculation, and women do not reach a peak and do not experience orgasm.
There are also painful sexual dysfunctions (vaginismus or dyspareunia) and other unspecified sexual disorders, although they are usually not associated with depression and its treatment. Depression has a negative effect on sexual activity and getting satisfaction. Depression affects the onset of sexual desire and gaining sexual satisfaction, which is one of the earliest and most subtle symptoms in this area. Relationships become strained. Patients are strained from their partners, communication becomes difficult. Reduced mood affects the ability to get satisfaction from sex. It is ironic that some people find solace in sexual activity, using it as a means to cope with depression, demonstrating their love to a partner.
Low sex drive and depression: FAQ
Is it possible to distinguish previous sexual problems from those caused by depression and its treatment?
A thorough anamnesis is important. If the topic of sex has already been touched upon, often patients are willing to talk about these problems quite frankly. The survey can focus on three aspects:
- whether the patient had sexual problems before the depression;
- what problems arose during the depression;
- what problems are associated with the treatment.
A doctor can assess the level of patient concern and decide whether to conduct a further more in-depth study.
Psycho-sexual counselling is acceptable, but it should be postponed it at the time of treatment. Patients are often happy to discuss their sexual problems and understand that they are not alone. Two out of three patients with depression have a loss of interest in sex. This may be the result of biochemical changes in depression or the action of psychological factors. Sexual problems during depression may not be the most important thing that requires attention when working with a patient. However, with long-term treatment, the topic of sexual life becomes more urgent.
What type of medication causes sexual problems?
Sexual problems can be caused by many medications, including thiazides, beta-blockers, carbamazepine, cimetidine, digoxin, disulfram, clofibrate, some antipsychotics and antidepressants. Antipsychotics cause sexual dysfunction mainly due to increased levels of prolactin, as well as alpha-blocking effects and dopamine blockade. Antidepressants affect sexual function primarily by stimulating serotonin (5HT2) neuromediation. Concomitant physical illnesses such as diabetes, multiple sclerosis, and alcoholic neuropathy can also lead to sexual dysfunction.
Which antidepressants have a greater effect on libido?
Antidepressants, as a rule, do not affect the libido. Perhaps this is the result of a decrease in mood and motivation. Typical effects of antidepressants are associated with problems of excitement, erection and anorgasmia. This is mainly due to the effect of neuropharmacology. Most antidepressants affect the quality of sex life. Mirtazapine exerts this effect to a minimum due to its pharmacological characteristics that affect the increase in 5HT2. Nefazodone was a good antidepressant that does not cause sexual dysfunction, but now it is not used.
Which antidepressants affect the body and ejaculation worst of all?
This is a fairly common effect of antidepressants, most of them can lead to a violation of these functions. Mirtazapine is a drug with the least effect on orgasm and ejaculation due to its special pharmacological action – it does not affect the level of 5 NT2. Bear in mind that SSRIs are quite effective for treating premature ejaculation in men. Even a single or double dose of the drug can help to prevent premature ejaculation. This is the result of a direct pharmacological action of the antidepressant, and therefore it does not take much time to achieve the effect.
Which antidepressants have the least adverse effects on sexual function?
Mirtazapine has special pharmacological characteristics that enhance 5HT2. As established, it is less affected by sexual function. Moclobemide also has minor side effects in terms of sexual dysfunction.
If you begin to notice a decrease in sexual desire when you start using antidepressants, in any case, do not stop using the drugs without consulting a specialist! If you experience these symptoms, contact your doctor to correct this problem.