When Jake sits in the therapy room with me it takes a long time before he will make eye contact. In fact, it takes a long time before he raises his eyes and really seems to see the room around him, or me, at all. When I ask him about any experiences of pleasure he had in the past week – a great smell, something beautiful he saw, a delicious treat, physical pleasure – he draws a blank. He looks down and says, "I can’t even imagine what would make me feel good anymore."
Loss of Pleasure: Depression, by clinical definition, causes a person to lose interest or enjoyment in things that once pleased them. It can seem like a gradual disconnection from the world, a drawing away from sensations, people, and activities. Depression impacts every area of a man's life and, of course, his sex drive can be affected profoundly.
When people are asked why they have sex, the most common answers, for both men and women, are for pleasure and to feel connected to the other person. What happens when a person's sense of pleasure is critically dampened? Not only may motivation and drive for sexual activity go down, but so do fantasies about sex, which can strengthen one's libido. It is no surprise that many people with depression report decreased sex drives. Add to this the general sense of being overwhelmed, exhaustion, and difficulty functioning through daily activities that may be a part of depression and having sex may become another example in their life of "going through the motions". This can be frustrating for partners who ask, "what can we do to make sex fun for you again?”, and find their depressed partner unable to answer because, like Jake, they have lost connection to their own pleasure.
Self Soothing: We all respond to life stressors, including depression, uniquely. Some men with depression report increased sex drives. They talk about having sex to receive the physical boost and also to feel loved and accepted by another. Indeed, if desired, sex can be a great way to increase feel good chemicals in our bodies such as dopamine, which facilitates pleasure seeking and can aid alertness and energy (Crenshaw, 1996). If it doesn’t feel aversive or overly stressful, having sex or masturbating can be a good choice for enhancing the mood of anyone!
It is a natural impulse to relieve ourselves of negative feelings or uncomfortable situations and we all develop skills for doing this by the time we are young children and add to them over the course of our life. We develop habits that we know make us feel better in the short term. Maybe we learn to distract ourselves with TV, by going for a run, or by eating something sugary. People struggling with depression feel badly most of the time and so their habits for self soothing may become more automatic and entrenched. Some of these habits are genuinely helpful and some end up making things worse. Turning to sex that makes you feel good emotionally and physically is helpful.
However, some men with depression report turning to sexual behaviors that don't make them feel good in the big picture. Increased porn use may cause unrealistic expectations or disconnection or isolation from partners. Seeking out new partners may complicate or betray current relationship agreements. Feeling forced to have sex with their partner to relieve their pain may create pressure or resentment in that relationship. These men may feel like their sexuality slips into a compulsive behavior, driven by a need to escape negative feelings rather than a positive drive. Conflicted feelings about sexual behaviors can create a feedback loop that increase feelings of depression, leading to more drive to escape those feelings, and on it goes.
Perfectionism/Pressure: When talking to people suffering from depression, what we often find is a very critical mind, a tendency to have high, often unrealistic, expectations and a pattern of focusing on the negative aspects of past experiences. Any sex therapist will tell you perfectionism is an enemy to sexual performance and satisfaction. Putting unrealistic expectations onto a sexual experience will led to pressure, stress, and difficulty being present for the fun of what is happening. This can lead to performance anxiety, erectile dysfunction, early ejaculation, and a lower libido. All of which can also lead to an increase in depression symptoms.
Meds for Depression: It’s pretty commonly known by now that one of the ironic side effects of popular anti-depression medications can be reduced sex drive. They can also create problems achieving erection and difficulty with ejaculation and orgasm (Komisaruk, Beyer-Flores, and Whipple, 2006). These side effects may be contributing to ongoing depression in some men on their own. However, these effects will not occur for everyone and some more recent antidepressants are reducing sexual side effects. If you are taking medications for depression, talk to your prescribing doctor about your sexual goals and symptoms. Medication may still be the best choice for you but there are options to limit impact on your sex life.
Seeking Help: If you are suffering from depression it is important to seek help. Find a therapist you like and don’t give up. Sadly, many doctors and therapists may not address sexuality with you. It is important for you to bring it up and talk about what is concerning you related to your sexuality. If your therapist seems hesitant or uncomfortable talking about sex with you, seek out a Sex Therapist, one who is trained in general therapeutic issues and also sexual issues. If you are part of a couple, know that your partner is impacted by your depression too. Couples therapy may be very helpful for you both, especially in talking about sexual concerns.
When Jake came in last week he told me how he noticed how wonderful it felt to let the hot water run over his body in the shower. He said his body felt alive, and he smiled as he remembered this moment of pleasure. We start talking about what it is like for something to feel good. It’s a good place to start.
Komisaruk, B, Beyer-Flores, C, & Whipple, B. (2006) The Science of orgasm. Baltimore, MD : John Hopkins University Press.
Originally published on YourTango.