Sex and Depression: A Tricky Combination

Even if you’ve been an emotional Rock of Gibraltar throughout your life, menopause can brew up a perfect storm for jittery moods, anxiety, and depression. And in addition to its psychological punch, depression and anxiety can put a definite crimp in your sex life. 

According to the North American Menopause Society, “Women suffering from depression (which is associated with a chemical imbalance in the brain) report symptoms of prolonged tiredness, loss of interest in normal activities [like sex], weight loss, sadness, or irritability.”

Who feels like sex when the rest of you feels like this?

Menopause and depression make such cozy bedfellows because:

1. hormonal and endocrine-related turmoil are the very hallmarks of menopause, and they are intimately related to our moods. And
2. certain predictable but challenging life events tend to coalesce during this period.

Ever since puberty, you’ve made a sometimes uneasy peace with the normal hormonal fluctuation of your monthly cycle. But now your hormones are all over the map. And in this case, a hormone like estrogen affects the functioning of a whole lot of other stuff.

For example, estrogen affects serotonin levels in your brain, and serotonin is the happy juice that regulates sleep, mood, energy, and libido. “It’s central to our well-being,” writes Colette Dowling, psychotherapist and author of The Cinderella Complex in an article on her website.

Dowling is no stranger to the emotional and physical punch of those hormonal changes. “It was only when I was a year past menopause that I began to address the sleep problems I was having, as well as the loss of energy and libido.… It took far longer than it should have for me to learn that menopausal depression, related to a drop in estrogen, was causing my symptoms, and to get the treatment that put me back on track.… I was stuck in this pattern for many many months, and it became hard not to think: Is this it, the end of my vitality and productivity?”

Research also suggests that women with depressive bouts in the past or who suffer from more severe or prolonged hot flashes are also more susceptible to depression during menopause.

And don’t count on life giving you a break during this stormy period. You may have to adjust to your children leaving, maybe to the death or disability of a parent, maybe to health issues of your own or of your partner. You may struggle with the emotional transition of a changing self-image or the inevitable and final loss of youth. Cultural stereotypes being what they are, you have to make peace (or not) with different social roles and perceptions.

Given these hormonal and psychological transitions, is it any wonder that depression often dogs the menopausal years? Is it any surprise that our sex life is an early casualty?

To get a handle on this dance between depression and loss of libido, begin by understanding how common and treatable it is. Give yourself a break and don’t be embarrassed to ask for help. Dowling writes, “Women at mid-life often feel guilty about their mood changes and avoid seeking treatment. ‘This will pass,’ they think, and while that may be true, depression can seriously affect the quality of life, including one's ability to make a living.”

Loss of libido is another of those quality-of-life issues. It can strain a relationship and affect your sense of well-being. You don’t have to compromise either your happiness or your sex life. And you shouldn’t suffer in silence.

A few additional issues with regard to depression and libido:

• Antidepressants that affect serotonin levels (SSRIs and norepinephrine reuptake inhibitors) also affect libido, and not in a good way. If you’re on an antidepressant and have lost any interest in sex, talk to your doctor about a change in medication.
• Low thyroid function (hypothyroidism) looks a lot like depression. It might be beneficial to have your thyroid levels checked. Also check your iron levels for anemia.
• Consider whether unresolved relationship issues might be involved with your lack of interest in sex. Many doctors think a multi-pronged approach to depression and loss of libido is a more effective treatment. This may involve antidepressants as well as psychological counseling and perhaps lifestyle changes.
• Ask your doctor about trying testosterone therapy to boost your sex drive. The jury’s still out, but there’s some indication that it can be effective.
• Don’t overlook the basics. Your salad years of hopping in the sack for a quickie in the afternoon may be over, but you can still enjoy long, slow evenings of sweet intimacy. Just don’t forget the lube—and maybe a few pillows to keep things comfy.