When men achieve a successful erection this involves a number of complex bodily mechanisms. However, this process isn’t merely physiological. Many times but not always — as is the case with morning erections — a degree of psychological involvement is also necessary.
As such, when the psychological life of a man is suffering due to the presence of depressive symptoms, their sex life can also deteriorate. Depressive men often report a lowered sex drive, but the issue can become even more extensive, manifesting itself as an inability to achieve and/or maintain an erection, a condition known as erectile dysfunction (ED).
In this article, we’ll explore the links between depression and erectile dysfunction, discuss some of the more pertinent research findings, and consider what can be done about it.
Simply stated, depression-induced ED is just what is sounds like: ED whose primary cause is the presence of depressive symptoms.
In real life, though, there are significant problems with this definition, as the primary cause of ED can be surprisingly difficult to determine. Untangling the mental and physical factors is not a simple task, and there’s also a what-came-first dilemma: did the ED trigger the onset of depressive symptoms or vice-versa?
Sidestepping these pesky questions, what does seem undeniable is the connection between mental health and ED.
When it comes to defining and explicating the causal relationship between depression and ED, this debate is still ongoing in the medical community. The evidence displays a very high degree of comorbidity between ED and depression, and although theories abound, researchers are still at pains to prove how one relates to the other.
One of the prevailing theories around depression and erectile dysfunction emphasizes the role of testosterone, often called the “male sex hormone”.
First off, it’s important to understand that while a systematic review of the literature does not support a consistent relationship between testosterone levels and depressive symptoms, most studies do suggest that lower testosterone levels are associated with depressive symptoms .
It’s thought this association depends in large part on the abnormal stress levels the brain experiences while suffering from depression. Chronic stress lead to elevated levels of cortisol, otherwise known as the stress hormone, while increased cortisol decreases the amount of testosterone.
This hormonal imbalance is then responsible for a lowered sex drive and, to a lesser degree, erectile dysfunction. But what are the physiological mechanisms behind this theory?
Testosterone has a role in promoting libido and helps relax blood vessels in your penis so blood may flow into it, a crucial physiological step in achieving an erection. Cortisol, on the other hand, can constrict blood vessels and make it hard for blood to reach the penis, thus causing ED.
A decrease in libido, or “sex drive,” seems to be the other major theory when it comes to depression and ED.
Libido is linked to physiological factors like testosterone, but it manifests itself as a psychological phenomenon, which makes it inherently more difficult to quantify and explicate. However, you don’t need a Ph.D. to understand how a lowered sex drive could manifest as ED.
As explained before, erections have a psychological component to them, and if there is no arousal, this can impede the ability to achieve successful erections.
However, it is important to differentiate lowered libido stemming from depression from other psychological factors that could lead to ED.
A lot of research has gone into classifying different instances of psychogenic ED to improve treatment. One meaningful category is known as “situational ED”. This type of ED is not related to structural, psychological issues like childhood trauma, PTSD, or depression but to cognitive issues that arise during a sexual encounter.
For instance, research has identified performance anxiety as one of the main drivers of situational ED. This phenomenon has been described as the “adoption of a ‘spectator role’ in which the individual’s attention is focused predominantly on sexual performance and away from erotic stimulation” .
The good news regarding ED is that it’s treatable in nearly all cases. However, in order to properly treat ED, doctors have to isolate all the contributing factors accurately.
In this sense, doctors will first attempt to look at contributing factors related to the physical health of the patients. They will ask about your eating and exercise habits, as well as how much you drink and smoke. Poor overall health measures, such as being overweight and having high blood pressure, are known contributors to ED, and physical and mental factors will often coexist.
Doctors might also use a battery of different tests, which could potentially include:
- Blood tests – These tests can help identify underlying causes that might contribute to ED like heart problems, anemia, or hormonal abnormalities.
- Nocturnal penile tumescence (NPT) test – This test measures erectile function during sleep.
- Urine tests – Urine measures can alert doctors to the presence of diabetes.
- Thyroid tests – The thyroid gland is instrumental in the regulation of sex hormones. As such, thyroid deficiencies can be the cause of ED.
If the physical results are concerning, doctors will first attempt to address these before moving on to psychologically-related issues. As stated before, it’s quite difficult to identify the primary cause of ED. Just because a patient has depressive symptoms doesn’t mean that their ED is necessarily related to it.
When doctors fail to fix ED symptoms through physical solutions, they will then address the more nebulous psychological factors, often by recommending therapy.
The problem with this approach is there is no easy fix for depressive symptoms. And to make things worse, if a patient is prescribed antidepressants to deal with their depression, there’s a significant chance they could experience the associated sexual dysfunction side effects.
Whether a patient has ED or not, we would definitely recommend anyone suffering from depression to seek professional help. However, when it comes to ED, a pharmacological solution, like PDE-5 inhibitors, is a more rapid and effective solution. These drugs do require a doctor’s prescription, though, so make sure to speak with your doctor in order to avoid potentially dangerous drug combinations and determine which specific compound is right for you.
Erectile dysfunction is a multifactorial condition. Precipitating factors include cardiovascular disease, diabetes, smoking and other lifestyle factors, relationship concerns, anxiety, and depression. It is a common disorder that becomes more prevalent with age, but it is not an inevitable consequence of aging.
Solutions to ED and depression should be multidisciplinary. Also, while depression might very well be associated with ED, the treatment of depressive symptoms can present an unsatisfactory solution to ED, especially when antidepressants are involved.
We recommend those suffering from depression and ED improve their basic physical health measures – especially through exercise, as it’s been shown that working out has a positive effect on depression – while also utilizing a PED5 inhibitor as a more immediate solution.
- Rosen, R. C. (2001). Psychogenic erectile dysfunction: classification and management. Urologic Clinics of North America, 28(2), 269-278.