Dr. Mezhebovsky is Director of Psychiatry at Boston Clinical Trials. She has conducted over one hundred clinical research studies in the areas of mental health and sexual dysfunctions.

Most people are surprised to realize how many of us have difficulties having and enjoying sex. In our culture, enjoyment of sex is taken for granted; as a result, both men and women are hesitant to bring up their sexual dysfunction concerns even in conversations with their physicians, much less with their partners. But the reality is that sexual dysfunction is rather common. According to American Society of Reproductive Medicine about 40% of women and 30% of men experience at least one symptom.There are many possible causes for sexual dysfunction. Some are manifestations of serious physical problems, such as heart disease. It is not a coincidence that every Cialis or Viagra advertising is accompanied by “Consider if you are healthy enough for sex” disclaimer. But what I’d like to write about today is something different: the link between sexual dysfunction and depression – the link that many people either don’t recognize or dismiss offhand as “normal”.

In fact, one symptom of depression is a lack of pleasure in things that were once enjoyable. (In professional lingo, it is called anhedonia). And, unfortunately, sex is one of these. Add that to mood swings, fatigue, and desire to be “left alone”, and it is no wonder that romantic relationships suffer. In turn, this leads to low self-esteem, alienation, and resentment, further worsening the depression. This is a dangerous, self-destructing cycle. Even, worse, it is often contagious, destroying not only the person him/herself, but the person’s partner.

About a year ago I had a patient, Lauren (not a real name), a college-educated, 35-year old woman with worsening symptoms of depression. This is how she described her story. “For about 3 years, my husband, Michael, and I enjoyed strong relationships. We were really close, cherishing our time together as romantic partners. When Michael unexpectedly lost his job about a year ago, it was a terrible blow to his self-esteem. He became tense, moody, and distant; he lost interest in bicycling (his long-term hobby) and he lost interest in me. For a long time, I made an effort to get Michael interested in sex, but was constantly getting rejected. Was there something wrong with me? Have I become less attractive to him? Not only did my self-confidence take a hit, I also blamed myself for not being there for him at the time when he was so much in need of my support. So we both stopped trying. We never talked about sex – I thought it would be so insensitive on my part…”

But as Lauren’s needs in closeness, in healthy relationships were not met, she turned to snacking and began putting on pounds. Not able to control her weight, she started hating herself. Known to her friends and colleagues as a cheerful, happy person, she became irritable and glum. Eventually, she got diagnosed with depression herself.

Where did Lauren go wrong? What can she and Michael do to fight back, to bring back their lives they used to enjoy together? Here are a few pointers.

    • Recognize that loss of interest in sex is not normal. While it is normal, for most people, men and women alike, to have sex less frequently than in their 20s, lack of enjoyment of sex, particularly, for extended periods of time, is not. It is, quite possibly, a symptom of incipient depression.

    • Talk to each other, however difficult it might be at first. Yes, there are some times when a person going through difficult events in his/her life may need to be left alone for a while. But the key word here is “for a while”. Find the right moment and bring the issue up in a tactful, supporting way. Be positive. Focus on the future, not on the past.

    • Just do it. If both partners are otherwise physically healthy, they need to find a way to break from the daily routine and start anew. As one of my colleagues advised, “Go to Bed and Breakfast in a faraway place and make sure that bed is more important than breakfast”. It’s a good advice: sex gives a boost to brain’s so-called “happy chemicals”: serotonin and endorphins. The more you do it, the better you feel – and the more you will want to be together.

    • Find the right medication. Sometimes addressing underlying depression with medications is the necessary step. The challenge is that many commonly prescribed medications have side effects that can dull libido. Fortunately, there are newer medications both on the market and in clinical studies that hold a promise of fewer side effects.

Click here to learn more about Depression and Sexual Dysfunction studies being conducted at BCT.