Depression and erectile dysfunction: what’s the connection?

It’s Movember. And even though ‘support men’s mental and physical health’ is scribbled in bold across every month of the Mojo calendar, we wanted to take this moment to tackle two very common problems that don’t get enough air time: depression and erectile dysfunction (ED).

With help from medical expert, Dr Matthew Chan, and psychosexual therapist, Amanda Barge, we’ll be lifting the lid on men’s mental health to discover:

• why and how erectile dysfunction and depression are linked

• how depression can make it hard to get hard

• how ED can also lead to depression

• the connection between ED and antidepressants (exploring your options when it comes to depression medication and erections)

• complementary treatment options and lifestyle choices for depression and ED

• ED and depression in relationships and with sexual partners (with some tips from Amanda to support you both)

Depression and erectile dysfunction: it can be chicken/egg

If you’re wondering whether ED and depression are tightly linked, the answer is 100% ‘yes’, according to research:

• Men with depressive symptoms in middle age (40 to 70 years) are nearly twice as likely to report ED compared to men who don’t

• Experts think the relationship between depression and erectile dysfunction is bidirectional. That means it flows both ways, and can lead to a negative spiral where each condition makes the other worse over time

To break the cycle, another analysis even concluded that every guy with depression should be routinely screened for ED – and vice versa – all guys with ED should also be routinely screened for depression.

We don’t include this to make you worry, and of course, having ED and depression don’t always go hand in hand. However, we do want to highlight how looking after your mental health is a vital part of looking after your erections.

How can depression cause erectile dysfunction?

If you’ve never experienced depression, you might think it boils down to feeling blue. The truth is much more complicated.

Depression is associated with lots of different symptoms, from fatigue and brain fog, to feelings of numbness, persistent sadness, and (as we now know) erectile dysfunction. These can all lower your sex drive (libido) and make it harder for some men (and women) to reach orgasm.

There are many different types of depression that can impact your erections.

Here are just a few:

• low mood (feeling down for over two weeks)
• depression (that’s often linked to anxiety)
• major depression (long-term feelings of sadness, and loss of interest in things you used to enjoy)
• bipolar disorder, previously known as manic depression (which causes periods of extreme highs and lows)
• postnatal depression (yes, men can develop depression after having a baby too)
• seasonal affective disorder or SAD (which occurs during the dark, winter months)

There’s a few key reasons why depression can impact your erections, which Dr Matt breaks down for us:

Reduced libido

“Everyone’s sex drive is different, and there’s no such thing as a ‘normal’ libido, or a ‘normal’ amount of times you should be having sex.

However, depression can reduce your sex drive. This can be a result of feelings of low self-esteem, loss of interest in activities that you’d usually find pleasurable, fatigue, and low energy. These can all make it harder for you to get an erection.”

 Dr Matthew Chan, Medical Doctor

Brain chemistry

For some people, depression is caused by unbalanced brain chemistry.

Our brains release lots of chemicals that control a huge range of different functions all over our bodies. Some of them are responsible for sparking arousal and telling the body it’s time to get hard.

When our chemical messages aren’t working properly, it can become a whole lot harder to get in the mood for sex and maintain an erection. Enter ED.

While this brief explanation is relevant to a lot of people, it has been overused and  doesn’t explain the link between ED and depression for everyone.  

As Dr Matt points out:

“Depression is complicated, and can be caused by other things besides unbalanced brain chemicals. For instance, some people’s depression is due to the way their brain is actually wired. That’s why any treatment for depression and ED should be tailored to you and your individual needs.”

‍Dr Matthew Chan, Medical Doctor

Antidepressants

“Some of the medications we use to treat depression work by tweaking your brain chemistry – making it harder to get it up. Not only that, but antidepressants can also reduce libido which we know can impact your erections too. So, if you’re worried, go and speak to your doctor.”

Dr Matthew Chan, Medical Doctor

We’ll talk more about depression medications and ED later, to give you a better picture of what could be going on and talk through your options.  

How can erectile dysfunction cause depression?

As we mentioned, ED has lots of causes, both physical and psychological. But regardless of where your erection troubles came from, many guys find even temporary ED makes them feel:

• isolated and alone
• broken
• worried
• frustrated and angry
• guilty and with lower self-esteem
• preoccupied and unable to concentrate
• unsettled in their relationships

As you can imagine, these feelings don’t just stay in a box. If left unchecked, they can negatively impact your mind enough to (you guessed it) cause depression.

This is something Amanda sees all the time.

“I’ve never worked with a client whose mental health wasn’t negatively impacted in some way by ED, and often the two get so intertwined it can be hard to untangle what’s going on.”

Amanda Barge, psychosexual and relationship therapist

Amanda tells us when this happens, asking yourself the following questions can help you unravel things:

• Have you always struggled with ED, or was there a time where it felt less difficult?

• Were there other aspects of life that seemed easier at that time?
  
• Do you often find it difficult to feel ‘good’ about yourself?

• Can you see a link between erection worries and your general mood?

Anti depression drugs and erectile dysfunction

When it comes to ED and depression, we know antidepressants can be part of the story. Now it’s time to find out why.

But before we begin, we want to reiterate that your mental health comes first. Antidepressants are useful and effective tools for treating depression, and if your doctor has prescribed them, don’t shy away from them for the sake of your erections.

As Dr Matt touched on earlier, if you’re taking antidepressants, it’s important to be aware of some potential sexual side effects, which for lots of men do include erectile dysfunction.

The most common culprits for causing ED belong to a group of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs).

SSRIs and erectile dysfunction: what’s the link?

Taken in pill form, SSRIs are good at treating depression because they boost your brain’s serotonin levels, which can then improve your mood.

However, this chemical tweak can also interrupt the normal signals that that pass between the brain and your sex organs (which can lead to ED).

Are there any antidepressants that don’t cause ED, and how can your doctor help you make the best choices?

If you’re worried about the impact antidepressants are having on your erections, the best thing to do is talk to your doctor.

They may discuss options like adjusting your dosage or changing to another type of drug with different side effects.

This may mean changing to a different type of SSRI, or changing to an antidepressant that doesn’t target serotonin at all.

Some antidepressants focus on different brain chemicals like dopamine or norepinephrine, which may be less likely to cause sexual side effects.

However, you should never start, stop or make changes to your medication without professional help. Dr Matt tells us that sudden or unsupervised changes can lead to unexpected and undesirable effects, but you’ll be in safe hands in the doctor’s office.  

Considering complementary treatment options and lifestyle choices for depression and ED

Dr Matt explains that for most medical conditions, doctors often aim to start with lifestyle interventions, and then slowly add in other treatments (such as medications and surgeries) later on if needed.

So, although we know that antidepressants are a very effective way to treat depression, there are many complementary options and lifestyle choices which have fewer (or no) side effects.

These may include:

• talk therapies (like psychosexual therapy, CBT or couples counselling)
• exercising
• healthy eating (read our foods for erectile dysfunction piece here)
• prioritizing sleep
• limiting screen time or taking a break from social media
• avoiding recreational drugs, alcohol, and tobacco
• practicing mindfulness to help you to control negative thoughts
• getting support from a loved one
• speaking to others who are going through a similar situation. You can do this anonymously on Mojo’s Community forum

Starting with some of these, or incorporating them alongside your medications, could not only help improve your mental health and boost your overall wellbeing, but also help to reduce any erectile dysfunction symptoms that you may experience from your antidepressants.

Tips to navigate depression and ED in a relationship or with a sexual partner

Whether you’re in a long-term relationship, or you’re having more casual sex, both of you may be impacted by the changes ED and depression can bring.

Sex and mental health are both tough topics to tackle, but when it’s a double whammy, things get even trickier. So, Amanda has shared some initial tips for anyone working through ED and depression:

Get creative in the bedroom

When you’re feeling depressed, the brain chemicals that spark the sexual urge might not spring into action as quickly, but that doesn’t mean they can’t be coaxed out at all.

To give these urges the best chance of emerging, try slowing sex down and managing your expectations.

Good ideas include showering or taking a bath together. You could also kiss for longer than usual or enjoy a sensual massage.

Try these experiments without too much expectation, as it’s easier to stay relaxed (and get an erection) when any chance of failure is off the table (or more specifically the bed).

Make the distinction between love and sex

Some of us express our love through sex or rely on sex to feel loved. So if you’re going through a period of depression and ED, it can help to separate the two.

If your partner wants more sex than you’re able to give right now, let them know they aren’t being rejected.

Reassuring them that your love (or attraction towards them) hasn’t changed, and that you’re just not feeling yourself right now, will help them feel secure and more able to support you.

Likewise, hearing your partner reaffirm their love for you (or just hearing how much they fancy you), might help squash some of those fears and make sex easier to embrace.

Make space to talk properly

It’s cliché, but communication really is key. If you feel comfortable, the best thing you can do is let your partner know what you’re going through.

This requires proper time and space away from distractions. So, rather than drop how you’re feeling into conversation, set your partner’s expectations and ask them for the time you need.

This could sound like:

“I think you might have noticed that I haven’t been feeling myself lately? Would it be okay to have a chat sometime this week when we are not too busy? I would really like to talk to you about what’s been going on for me.”

If you’re having more casual sex and don’t feel ready to talk to your partner, it can help to speak to another person you trust outside of your relationship and the bedroom.

Other depression and ED resources to check out

Resources for depression

If you’re struggling with depression and need some support, there are lots of great people out there who are ready to take your call. These include the skilled and friendly folk at:

• Mind (a UK based mental health charity)
• Depression UK (a national self-help organization, helping people cope with depression)
• Samaritans (a UK based charity providing emotional support to anyone in emotional distress)
• Mental Health America (a US based non-profit organization with education and screening tools for mental health)

Resources for erectile dysfunction  

If you’re struggling with psychological ED or lowered libido (as a result of depression), Mojo can help. We have the resources to understand more about what’s going on with your erections, and the tools to help you communicate and work through them with your partner. You can explore more here.

And if you want to talk anonymously to guys who really get it, we know just the place. The Mojo Community is humming with questions about erectile dysfunction and mental health, and you’re more than welcome to tap into the conversation.

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