How Depression and Anxiety Can Affect Your Sex Life
Depression and anxiety can change how you experience sexual intimacy. The low mood, loss of pleasure, and fatigue that come with depression in your daily life can also affect your sex drive, and end up bleeding into the bedroom. This is not uncommon among people with depression or anxiety: a 2022 systematic review and meta-analysis of people with Major Depressive Disorder not on medication found sexual dysfunction in 83% of women and 63% of men.
Sexual difficulties don’t mean you’re broken; it just means that your body and your mind are at capacity, and that is something your therapist can help you with.
How do depression and anxiety affect sexual drive?
Depression and anxiety can both get in the way of intimacy, but they do it differently.
In depression, you might feel like things you used to enjoy don’t feel as good anymore. This is a core symptom of depression that can extend to your sexual life. That’s because depression also comes with changes to your brain and the way it’s connected. The signals between the parts of your brain that handle desire, pleasure, and arousal can get disrupted. What’s more, depression can involve fatigue, changes in your sleep and appetite and sometimes a negative view of yourself, which can also affect intimacy.
Anxiety on the other hand activates your nervous system, your fight or flight mode, and gets your adrenaline pumping to face threats. A little activation can be neutral or even helpful during sex (Bradford & Meston, 2006), but elevated or chronic anxiety keeps your body locked in that state, which is the opposite of the relaxed state needed for arousal.
You might also feel like you can’t focus during sex, like your brain is everywhere. That’s because anxiety comes with worries, and a worried mind can’t stay present with sensations. Your attention might be pulled in many directions, such as self-monitoring, performance, thoughts about body image, or even finances and health. Your brain is too busy to stop and focus on intimacy, and everyday anxiety often morphs into anxiety about how things are going during sex itself.
Finally, antidepressant medication such as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Selective Norepinephrine Reuptake Inhibitors) can cause sexual side effects in 58-73% of people taking them. This further complicates the situation: is it the depression, anxiety, the medication or all of it? That would be the kind of question to bring up with your prescriber or therapist.
Should sexual health be part of my therapy?
Mental health difficulties and sexual difficulties affect each other. If you’re depressed, you may be more likely to develop sexual difficulties. And if you have sexual difficulties, you may be more likely to develop depression.
Even so, not all therapists routinely ask about sexual functioning. Many wait to be sure the client wants to talk about it, while clients often wait for the therapist to bring it up, creating an accidental mutual avoidance. But sexual well-being genuinely matters. The research shows that sexual quality of life is linked to overall quality of life and relationship satisfaction. And when it isn’t addressed, it can worsen the very thing you came to therapy for.
How do I bring it up in therapy?
Bringing this up can be hard, especially if it isn’t something you’ve talked about before. But a few things can make it easier:
- Naming the awkwardness is allowed. You can name how you feel about bringing up a topic, be it awkwardness, stress, shame, or guilt. Something as simple as “I’m not sure how to talk about this” is a good way in.
- Naming it once is the hard part. Once you’ve said it out loud once, the topic is in the room, and it gets easier from there.
- Being specific helps. Telling your therapist that something’s off with your sex drive is a good start but they may need more information. The better your therapist knows your problem, the better they can help. That might mean naming what’s changed, when it started, or whether it lined up with starting medication.
- Referral isn’t a rejection. If your therapist thinks this topic would be better handled by someone with specific training in sexual health, that’s not a rejection but a commitment to getting you the right care.
Therapy is your space to bring up anything you feel you need to work on. Talking about sexual difficulties may not be common in your day-to-day life, but it is an important part of your life and is completely normal to bring up in a therapeutic setting.
Not sure where to start? Connect with us today, we’re here for you.