Erectile dysfunction and depression

New treatments for erectile dysfunction have renewed attention to this age-old medical condition. Estimates are that 30 million American men suffer from erectile dysfunction or impotence, and the likelihood of erectile dysfunction occurring is significantly increased for those suffering from depression, according to a new study.

Reporting in the journal Psychosomatic Medicine, researchers from the Massachusetts Male Aging Study found that erectile dysfunction is nearly twice as likely in men who have symptoms of depression compared with those who don't. In this HopkinsHealth interview, Sylvia Simpson, M.D., associate professor of psychiatry at Johns Hopkins, discusses the role depression plays in erectile dysfunction and the variety of treatments. She cautions that certain antidepressant medications also can cause decreased sexual libido and erectile dysfunction.

Q: What are the symptoms of depression?

Answer: The symptoms of clinical depression include a depressed mood, which people may describe as feeling sad, blue, or low, or not being able to feel anything. There is often a pervasive loss of interest in things, as well as changes, usually decreases, in appetite and sleep. Also, there may be difficulty with thinking and concentration, low self-esteem, feelings of hopelessness and thoughts of death or suicide. To be considered a significant depression, the symptoms have to be present most of the time for at least a couple of weeks and impair the individual's performance at work, school or home. If you have any of these symptoms, contact your doctor or other healthcare professional.

Q: What kind of sexual dysfunctions occur with depression?

Answer: Just as depressed people lose interest in most other things, they also lose interest in sex. So there is a decreased sexual desire or libido. In men, there may be difficulty getting an erection or maintaining an erection for sexual intercourse.

Q: What role does depression play in erectile dysfunction?

Answer: That's still a topic of research. In this study, researchers were looking at the association of depressive symptoms and erectile dysfunction; however, there may be many other contributing factors, including cardiovascular and other medical illnesses, cardiac and blood pressure medications, and drug and alcohol use.

Q: How does the treatment of depression affect the sexual dysfunction associated with the depression?

Answer: A number of antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs) such as Zoloft’and Paxil® may decrease sexual desire and sexual functioning. If a man is both depressed and having erectile problems, these are probably not the best medications to start with. One would expect that if a depression is treated, the person would regain his or her sexual desire; however, the situation could be complicated if the medication being used to treat the depression could also have a negative effect on the patient's sexual desire and functioning.