Depression

Sexpert · #1 (**permalink**) 03-20-2008, 10:59 PM

It's not exactly clear which comes first - the psychologicaljeeling of depression or the sexually dispiriting physiological changes that go along with it. Not that it really matters. All that really matters is that depression can alter the body's sexual functioning so profoundly that physical changes (at least in men) can be measured even during sleep.

This was discovered fairly recently during studies of the nocturnal penile tumescence test. The test is a way of measuring whether a man is having normal erections while he's asleep (a healthy man will have a series of them during the dream or REM-rapid eye movement-phase of sleep). The test is used by therapists as a screening device to determine whether an impotent man's erectile problems are caused by some underlying physical impairment or by psychological difficulties. Until recently it was believed that no psychological condition could interfere with nighttime erections. If the guy was having poor erections while he was asleep, so the reasoning went, there must be something physically wrong with him. If not, the problem was probably "all in his head."

But now it's known that depression is perhaps the only exception to that rule. Studies have shown that depressed men who are physically healthy in every other way tend to have fewer nighttime erections, or erections that are softer or more short-lived, than men who aren't depressed. And once the clouds of depression clear, their erections usually return to normal.

What do you do if you have sexual problems due to depression?
Unfortunately, there's no completely satisfYing answer. "Sexual problems like retarded ejacula¬tion are the easy stuff to treat-it's the desire phase disorders (like depression) that are tough," says Robert Birch, Ph.D., director of the Arlington Center for Marital and Sexual Concerns in Columbus, Ohio.

If you go to see a psychiatrist, it's very likely that he or she will prescribe an antidepressant medication, typically something from one oftwo classes of drugs¬the tricyclics (such as Elavil or Tofranil) or the monoamine oxidase inhibitors (such as ardil or Pamate). The trouble is, many ofthese drugs have sexual side effects-including, ironically, loss of sexual desire. Even the alleged wonder drug for depression, Prozac, can have sexual side effects in some people.

A good sex therapist or psychologist (who, not being an M.D., can't prescribe drugs) may be just as capable of helping you as a psychiatrist. Recent studies comparing the effectiveness of drug therapies for depression with drug-free "talking therapies" have shown that they're both about equally effective, observes psychologist and sex therapist Jude Cotter, Ph.D., who has a private practice in Farmington Hills, Michigan.
"The only time I'd refer a patient to a psychiatrist for medication is if there was really extreme depression-somebody who almost needed a jump-start to get out of the hole they're in," says Dr. Cotter. "These drugs are very expen¬sive and have so many side effects that I think they should be used only with extreme caution."

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