Sex and depression in men

Heather Little-White, PhD, Contributor

'Not tonight dear," is what women often hear when their men are not in the mood for sex, even when sexual overtures are made. Your man may become irritable, isolated or withdrawn or he may be working for extra long hours and he may resort to drinking. Depression among men is on the increase but some men may not admit that they are suffering depression once considered 'woman's disease'. Very often though, men do not know they are suffering from depression nor do they want to know as depression has been stigmatised as 'going crazy', a factor which will keep men who are clinically depressed from recognising the symptoms of depression and seeking treatment.

Signs and symptoms

Depression actually affects men and women. It disrupts relationships and stymies the sex lives of couples as well as interferes with work and daily activities. The symptoms of depression in men and women are similar but men will express them differently. According to the National Institute of Mental Health, symptoms of depression in men include:

• Persistent sad, anxious, or 'empty' mood.
• Feelings of hopelessness, pessimism.
• Feelings of guilt, worthlessness, helplessness.
• Loss of interest in usually pleasurable activities, including sex.
• Slowed pace in carrying out activities.
• Difficulty concentrating, remembering, making decisions.
• Difficulty sleeping, early-morning awakening or oversleeping.
• Appetite and/or weight changes.
• A casual 'don't care' attitude to most things.
• Thoughts of death or suicide; suicide attempts.
• Restlessness, irritability.
• Escapist behaviour, such as spending a lot of time at work or on sports.
• Infidelity or unhealthy sexual relationships.
• Alcohol or substance abuse.

Cultural expectations

Depression in men may more likely cause them to be irritable, aggressive, or hostile as they are expected to be the 'tough guy'. However, depression in men is not commonly recognised. Men are taught 'be strong' during their socialisation and expressing emotion is seen largely as a feminine trait. Culturally, men are supposed to be successful, be in control and not show emotions. Men who are depressed are more likely to talk about the physical symptoms of their depression instead of those symptoms related to the emotions.

Sex and performance

Men's sexual desire and performance are affected by depression. Men often are unwilling to admit to problems with their sexuality. Many mistakenly feel that the problems are related to their manhood when, in fact, they are caused by a medical problem such as clinical depression. Unfortunately, some antidepressants and other medications can do the same.

We know that chemical changes take place in the brain during sex but since little research has been done, it is not very clear the kind of changes that take place during depression. From the symptoms identified above, it is definitive that depression can affect all the bodily systems, dislocating them and often slowing them down. Sexual activities that require verve, spontaneity and good co-ordination will be affected.

Although some depressed people will manage to maintain normal sex lives using sex for comfort and reassurance, for many other depressed persons, they may lose interest in sex. In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems. When there is renewed interest in sex, it is a sign of recovery from depression.

Suicide

Men generally have a hard time dealing with the stigma of depression. As such, they will resort to drinking alcohol or abusing drugs, and/or pursue other risky sexual behaviour. Many men may avoid talking about depressed feelings to friends or family. Ultimately, depression in men can have devastating consequences. The Centers for Disease Control and Prevention reports that men in the United States are about four times more likely than women to commit suicide. Though more women attempt suicide, more men are successful at actually ending their lives. This may be due to the fact that men tend to use more lethal methods of committing suicide, for example using a gun rather than taking an overdose of pills as women would do. (Web MD).

Elderly men

Ageing does not mean that elderly men have to be depressed but they may have medical conditions such as heart disease, stroke, cancer, or other stressors that may contribute to depression. If there is reduced income and lack of meaningful work, retirement may be difficult from day to day. Stress is increased and elderly men feel a loss of self-esteem may contribute to depression. In addition, the death of family and friends, the onset of other health problems, and some medications can contribute to depression in men.

Treatment

Treatment can be successful through antidepressant medication, psychotherapy, or a combination of both. For help with depression, men should check out the family doctor who will refer them to specialists as needed. Even if men suspect that they are depressed, they may avoid diagnosis or refuse treatment because of the fear of the stigma of depression could damage their careers or cause family and friends to lose respect for them.

For improving sexual performance, men may resort to antidepressant medicines such as Prozac which can interfere with sexual function. For example, a common side effect is delayed orgasm or none at all. Of course, all medications for depression and its side effects should be taken under a doctor's supervision so that the medication can be changed if there are side effects.

Help your depressed partner

Your partner may lose interest in sex but do not make a personal attack on your man. Remember it is due to the depression and improvement may not be rapid. You should not say you understand what he is going through because you do not know the nature of depression, especially if you have not experienced it before. Supporting your depressed partner means going for the long haul giving constant love and support in persuading him that he is special and his life has value. You should encourage your partner to get all the professional help available. Try to act as though your partner were recovering from a serious physical illness or from surgery by giving plenty of tender loving care.

Care yourself!

During the period of helping your partner out of the depression, you will be under extreme pressure so you have to treat yourself periodically. Being around a depressed person is emotionally draining, so make time for you by having some time alone way from home like going to the movies our hanging out with friends. It is difficult to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. However, take comfort in the fact that this is natural and this period in your lives will pass. You will come to recognise that your partner is the same person underneath the depression that he was before.

Cuddle up!

While intimacy may never be the same during the depression, make every effort to cuddle to show him that you still care. Touch and closeness can keep a relationship intact. Very often, after orgasm, some men even go into post-orgasm depression, feeling a little let down after sex. They may experience difficulty getting hard again because their bodies secrete a hormone that makes most men sleepy. This is where cuddling helps to reassure them and make you feel better.

As the partner of a depressed man, you may be so frustrated that your lover has lost the ability to do the things you fell in love with him for in the first place. However, try to appreciate the good moments in life and accept that all these things are a part of the illness.

Send questions/feedback/comments to: heatherl@cwjamaica.com.