Jacob and Ashley* sat on opposite ends of the couch but shared identical expressions: apprehension mixed with sadness and a hint of resignation. It was one week after their 10th wedding anniversary and they were in couples’ therapy. The reason for the visit: Over the last seven months the two had basically stopped having sex.

“My libido just totally disappeared. I used to love sex and now I basically have no interest—at all,” Ashley explained.

Jacob seemed at a loss. “You know, it’s hard not to think of her disinterest as some kind of rejection. It feels like rejection.”

During our session the reason became clear: Ashley’s libido dip coincided with the beginning of a major depressive episode. You often hear about the symptoms associated with depression—things like changes in appetite and sleep habits, low self-esteem, and inability to enjoy things that previously brought pleasure, but you forget that sex is one of those things you used to enjoy.

Link Between Depressive Disorders And Low Libido

There are two main ways depression messes with your sex drive: the depression itself and the meds you may take to treat it. (More on the meds, later.) Let’s start with a ridiculously oversimplified but accurate neurochemistry lesson. In normal, everyday life, chemicals called neurotransmitters fire inside our brain increasing communication between brain cells and triggering blood flow to sexual organs. If you have depression (or some other mood disorders), this delicate communication changes. It’s almost like losing your libido is the innocent bystander in a neurotransmitter misfiring. And, temporary depression, like what you’d see with seasonal affective disorder can do this too.

Now let’s get to the other issue: prescriptions used to treat depression.

Are Anti-Depressants A Desire-Killer?

Unfortunately some of the most popular medications prescribed for depression cause side effects in both men and women. These meds known as selective serotonin reuptake inhibitors (SSRIs) include Lexapro, Paxil, Celexa and Zoloft.  While raising the level of serotonin leads to feelings of calm, it also gets in the way of the hormones that transmit libido-lifting messages to our brain.

According to Dr. Gail Saltz, MD, Clinical Associate Professor of Psychiatry at the New York Presbyterian Hospital and bestselling author of numerous books including The Ripple Effect: How Better Sex Can Lead to a Better Life there are some things you can do. First, “people with mild to moderate depression may not require medication,” she says. Things like 30 minutes of intense exercise, sleeping well, eating well have all been shown to improve mild to moderate depression.

If you do need to be on medication, once you find an effective regimen you want to stay on them 9 to 12 months to help you maintain a better mood.” Dr. Saltz says. But, “sometimes reducing the dosage–with your doctor’s guidance—can help lessen the side effects.”

Another option is trying different meds. Viibryd and Wellbutrin are often cited for having fewer sexual side effects. The silver lining is that even if you are on an anti-depressant that impacts sexual desire, that can lessen with time. Again, work with your doctor; don’t figure it out alone.

Is Gender A Factor?

Women are at twice the risk of developing depression than men. One reason for this, according to Jill Goldstein, PhD, Director of Research at the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, is the hormones and genes that are disrupted as brain regions develop in the fetus. So, genetics do play a role, but women may also be more in tune to their feelings and be more willing to be diagnosed.

Mental health practitioners notice they hear more from women about depression and low sex drive and that they are more likely to initiate treatment. The other difference is that “women in a relationship can continue to have sex passively without desire,” says Dr. Saltz, “But for men loss of libido means erectile difficulties.”  This might make the issue seem more like only a physical problem, not a psychological one since it presents in a physical way.

But, with men, just like women, a decreased sex drive can be a tip-off to depression and it is important to seek medical help to ensure a proper diagnosis.

Re-Sparking Your Libido

Jacob and Ashley took an important first step by coming to therapy. In a safe space the two were able to honestly and openly discuss their feelings and fears. Ashley had been harboring guilt over ‘being a crappy wife’ and Jacob had felt like a sexual dud.

Once they felt comfortable discussing the elephant in the room, we were able to move to a few options, which by the way, can be beneficial no matter which partner is the one with a low sex drive.

The two began scheduling sex dates (which actually didn’t have to be sex, they could just be cuddling, taking a shower together, kissing).  Once that pressure of sex was gone, Ashley could enjoy the feel of skin-to-skin contact and even experience some arousal.

They also tried sex toys (there are some on the market that are helpful for men who cannot get erect), masturbation, and watching soft porn together. The goal was to help the couple reconnect whether or not intercourse was on the menu.

There is no one right cure. But as Ashley said after we’d been working together for a few months, “The brain is the biggest erogenous zone!”

*not their real names

Last Updated: Jan 23, 2020