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.