The Complex Link Between Depression and Sex

It is well known that depression—and certain drug treatments for depression, such as selective serotonin reuptake inhibitors (SSRIs)—can lower sexual interest, desire, and activity levels. However, it turns out that the story of how depression and sex are connected is more complicated than this. Depression is one of those things that can affect different people in very different ways.

In addition to being linked to a lack of sexual activity, research has found that depression is also linked to increased sexual risk-taking. Most notably, this includes having more unprotected or condomless sex. In other words, depression can potentially increase and decrease sexual activity. So how do we explain this pattern of results?

It was once thought that these opposing effects might be due to differences in depression severity. Specifically, some researchers argued that lower levels of depression were probably linked to more risk-taking, while higher levels were probably linked to less sexual activity overall. However, recent research has found that this is not the case. In fact, what the data reveal is that higher levels of depression are linked to more risk-taking than lower levels of depression.

Psychologists and scientists now think that what is going on is that different people are using different coping strategies when it comes to depression. Specifically, some people seem to be externalizers, meaning they cope by looking outward. This can potentially increase sexual risk-taking, or engaging in other risky behaviors, such as substance use. These behaviors may be pursued for multiple reasons, such as seeking distraction or temporary relief from emotional pain. For some, however, these behaviors may also be a way of punishing one’s self (to learn more about sex as self-injury, see this article).

By contract, other people are internalizers, meaning they cope by looking inward and socially withdrawing. This is likely to reduce sexual activity, in part, because it reduces opportunities for sex.

Of course, beyond differences in coping strategy, medication treatment can also play a role in how depression affects people’s sex lives. For example, if someone is on an SSRI treatment and experiences sexual side effects such as decreased libido or erectile difficulties, that’s likely going to reduce sexual activity.

Also, genetic factors may play a role in how people cope with depression and whether they become internalizers or externalizers. Some researchers have argued that genes affecting certain dopamine receptors—which make people less sensitive to the effects of this neurotransmitter—may increase the co-occurrence of depression and risky behavior. In this case, risky behavior may become a form of self-medication in the sense that engaging in more thrilling or sensation-seeking activities is a way of enhancing dopamine release and regulating mood.

In short, what the research shows is that there isn’t a simple, straightforward link between depression and sexual behavior. Rather, it appears to be a complicated association. The impact of depression on people’s intimate lives can be quite variable.

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To learn more about this research, see: Miltz, A. R., Rodger, A. J., Phillips, A. N., Sewell, J., Edwards, S., Allan, S., … & Lampe, F. C. (2021). Opposing associations of depression with sexual behaviour: implications for epidemiological investigation among gay, bisexual and other men who have sex with men. Sexually Transmitted Infections.

Image Source: Photo by Yuris Alhumaydy on Unsplash