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Depression and erectile dysfunction: The link, causes, and treatment

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What to know about depression and erectile dysfunction

Medically reviewed by Nicole Washington, DO, MPH — By Mary West on November 14, 2022

This article is a repost which originally appeared on MEDICAL NEWS TODAY.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our takes:

‧ There are many potential causes of Erectile Dysfunction (ED).

‧ Anxiety and emotional stress appear to be common underlying factors.

‧ Medical professional assistance is available for treating ED.

Research has shown that there is a link between the two conditions. If a person has depression, they have a higher risk of developing erectile dysfunction (ED).

The above information comes from a 2018 review published in The Journal of Sexual Medicine.

Researchers do not fully understand the connection. However, theories suggest the underlying causes may include sexual performance anxiety or antidepressant side effects.

If a person with depression experiences ED, their doctor may prescribe a medication such as sildenafil (Viagra). Alternatively, they may recommend trying a different antidepressant.

Read on to learn about the symptoms of ED, how depression can cause it, treatment options, and more.

Signs and symptoms of erectile dysfunction

The signs of ED include‧:

‧ ability to get an erection only sometimes, despite a desire to have sex

‧ inability to get an erection at any time

‧ ability to get an erection, but being unable to sustain it throughout sex

Can depression cause erectile dysfunction?

Research from 2018 evaluates 49 studies to determine the relationship between depression and ED. It finds that a person with depression was 39% more likely to have ED than a person without depression.

Experts do not fully understand the factors that underlie how depression may cause ED. However, the current theories include:

‧ Behavioral: Depression involves negative thoughts and low mood. Either or both can lead to performance anxiety that hinders erectile function.

‧ Antidepressants: Many people with depression take antidepressant medications to manage their symptoms. However, these medications can cause low libido and inhibit the ability to have or maintain an erection.

‧ Low testosterone: The male hormone, testosterone, plays a key role in sexual performance. As such, low levels often correlate to ED. There is an association between depression and low testosterone levels in men.

The previously mentioned 2018 review also finds that people with ED are 192% more likely to have depression. This means that the link between depression likely goes both ways. For example, a person with depression may have ED for the reasons listed above. Similarly, a person with ED may also be more likely to experience depression.

Low self-esteem, self-consciousness about sexual performance, and other negative thoughts could contribute to depression in people with ED.
Other causes

There are a wide variety of factors besides depression that can cause ED. They include:

physical health conditions, such as:

‧ type 2 diabetes

‧ high blood pressure

‧ heart and blood vessel disease

‧ multiple sclerosis

‧ Peyronie’s disease (curvature of the penis)

‧ chronic kidney disease

‧ surgery for bladder cancer

‧ injury to the penis or pelvic area

certain medications, including:

‧ antidepressants, such as fluoxetine (Prozac)

‧ blood pressure drugs, such as atenolol (Tenormin)

‧ tranquilizers, such as diazepam (Valium)

‧ antiandrogens (medications that block the effects of testosterone), such as bicalutamide (Casodex)

‧ appetite suppressants, such as phentermine (Adipex-P)

Mental health factors can also increase a person’s likelihood of ED. In addition to depression, these include:

‧ anxiety

‧ low self-esteem

‧ fear of sexual failure

‧ stress

‧ guilt about certain sexual activities

Treatment options

Treatment for ED and depression includes medication, lifestyle changes, and psychotherapy. The treatment a healthcare professional recommends depends on the underlying cause of a person’s symptoms.

Medications for erectile dysfunction

Older research from 2001 explains when depression and ED occur simultaneously, treating one condition may improve the other. The findings indicate that treating ED with Viagra can alleviate the issue and lead to a notable reduction in depression.

Despite this, the research did not investigate how long the improvement lasts.

Doctors commonly prescribe Viagra for ED. It works by relaxing the muscle and increasing blood flow to the penis during sexual arousal. Other medications in the class include:

‧ vardenafil (Levitra)

‧ avanafil (Stendra)

‧ tadalafil (Cialis)

Additionally, if a person has low testosterone, a doctor may prescribe supplemental hormones.

Another treatment option that can trigger an erection is alprostadil. This comes in the form of an injection (Caverject) or a suppository (Muse).

Medication change for depression

A study from 2017 notes that sexual dysfunction is a common side effect of many antidepressants. For that reason, changing medication can help. Low libido and difficulty maintaining an erection are common side effects of antidepressants. However, some medications are less likely to have these effects.

The study’s authors recommend the following antidepressants for people who consider sexual functioning important:

‧ desvenlafaxine (Pristiq)

‧ trazodone

‧ vortioxetine (Trintellix)

‧ vilazodone

Lifestyle changes

Lifestyle changes may also reduce symptoms‧ of ED. These changes include:

‧ stopping smoking, if applicable

‧ eating a nutritious diet

‧ exercising regularly

‧ maintaining a moderate weight

‧ limiting or stopping recreational drug use, if applicable

Psychotherapy

The following psychotherapy interventions may help a person manage the emotional and psychological effects of depression and ED.

‧ Sex therapy: This involves counseling partners about their relationship or sex-related concerns.

‧ Cognitive behavioral therapy (CBT): This helps a person identify unhelpful thoughts and develop healthier ways of responding to challenges.

‧ Mindfulness therapy: This mental exercise consists of focusing on the present moment.

When to contact a doctor

If a person thinks they may have ED, it is a good idea to make an appointment with a doctor.

Additionally, people should seek medical attention if they have symptoms of depression. The sad feelings associated with depression last weeks and months, not days.

If they have suicidal thoughts, they should get immediate medical attention.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

Ask the tough question: “Are you considering suicide?”
Listen to the person without judgment.
Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
Stay with the person until professional help arrives.
Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Summary

People with depression are more likely to have ED, and ED is also associated with higher rates of depression. Symptoms of ED include being unable to attain and sustain an erection long enough to have sex.

If a person has both depression and ED, treating one condition is likely to improve the other. Medication and psychotherapy interventions, such as mindfulness, may help someone manage both conditions.

Sources:

Chokka, P. R., et al. (2017). Assessment and management of sexual dysfunction in the context of depression.
https://journals.sagepub.com/doi/10.1177/2045125317720642
Liu, Q., et al. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis.
https://www.jsm.jsexmed.org/article/S1743-6095(18)31007-5/fulltext
Lue, T. (n.d.). Erectile dysfunction (ED).
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
Overview – clinical depression. (2019).
https://www.nhs.uk/mental-health/conditions/clinical-depression/overview/
Seidman, S. N., et al. (2001). Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.10.1623
Walther, A., et al. (2019). Association of testosterone treatment with alleviation of depressive symptoms in men.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976

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