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Depression and ED: Why They Go Together

May 5, 2022

The link between depression and erectile dysfunction has been firmly established by clinical research, follow-ups, and systematic reviews.

For many, the focus is on figuring out which is the root cause. For some, it can be a “chicken and egg” issue: is depression the result of erectile dysfunction, or is erectile dysfunction the result of depression?

While that varies case-by-case, studies have shown that treating erectile dysfunction can lead to improvements in overall wellbeing and may help to improve feelings of depression. Here's the story.

What Are the Signs of Depression?

A common misconception about depression is that those affected are simply "sad" all the time. This condition is much more complex than that.

Sadness is a poor descriptor for the feelings of hopelessness that can accompany depression, but this darkness is absolutely a part of depression. Still, those facing depression are often able to experience times of joy and pleasure — in fact, one aspect of depression for many people is working to disguise it under apparent happiness or by distracting themselves with things that can bring some level of temporary relief.

Two common forms of depression are:

Major depressive disorder or clinical depression includes symptoms of depression most of the time for at least two weeks that interferes with one’s ability to work, sleep, study, and eat.
Persistent depressive disorder often includes less severe symptoms of depression that last longer, typically for two years or more.

As a result, someone might think they aren’t depressed since they had "a good day" or are currently "not feeling sad." However, depression involves more symptoms than just feelings of sadness.

Depression symptoms include:

Low self-esteem
Irritability and irrational anger
Poor confidence
Loss of interest in hobbies and activities
Fatigue or loss of energy
Feelings of guilt and worthlessness
Sense of hopelessness
Physical aches and pains
Dramatic changes in appetite
Issues with concentration and focus
Insomnia or oversleeping
Digestive problems
High risk-taking behavior
General apathy
Pessimism
Moving or talking more slowly
Increased drug or alcohol use
Recurrent thoughts of suicide or death

How Does Depression Cause Erectile Dysfunction?

Depression can cause disruptions to your sex life in a few ways.

The first and most obvious is that depression can significantly alter your mood.

The things that you used to enjoy may not bring you the same amount of pleasure as they once did. This loss of interest and pleasure can happen with sex, too.

The early stages of an erection require experiencing stimulation and arousal. If depression makes the effort for sex or stimulation feel out of reach, those with depression may not attempt to initiate sex, or may dismiss attempts from their partner.

Another way that depression can impact sexual function is from a chemical standpoint. When you consistently experience the range of emotions that accompany depression, stress can remain elevated and your levels of the stress hormone cortisol, among others.

Cortisol is the primary stress hormone in the human body, and elevated cortisol can have a variety of suppressive effects on your physiology. For sexual function, it’s harmful in two ways.

First, cortisol is a vasoconstrictor, which means that it contributes to the constriction of your blood vessels and increases blood pressure. When blood flow is disrupted to a meaningful degree, it can make achieving an erection much more difficult.

The second side effect of elevated cortisol is that it has a see-saw-like relationship with the primary male sex hormone testosterone. The more cortisol in your system, the less testosterone your body will produce. Low levels of testosterone can result in a reduced sex drive and contribute to erectile dysfunction.

Another way that depression can impact your sexual capabilities is through prescription medications.

If you've decided to improve your mental health and treat depression with the help of a psychiatrist, they may have prescribed antidepressants to help. Some of the most common medications to treat depression are selective serotonin reuptake inhibitors (SSRIs). These drugs can have a significant impact on sexual function. In fact, they're so impactful that they're often prescribed off-label to treat premature ejaculation. It’s entirely possible that your erectile dysfunction isn’t caused by depression alone, but a medication you're using for treatment.

Does Erectile Dysfunction Cause Depression?

Erectile dysfunction can also cause depression when severe or impacting your relationships meaningfully. Guys with ED can feel insecure, incapable, embarrassed, and otherwise. This can lead to depression.

(The reality is that ED is common, affecting over 50% of men over the age of 40 and an estimated 20% of guys in their 20s.)

If you're dealing with ED and worried about depression, treating this underlying cause can help men rebound from feelings of depression or self-confidence issues. Resolving this physical issue may help to stem depression before it gets worse.

This ED-vs-depression issue can be challenging to unravel, and a professional psychologist or psychiatrist can help you untangle these two issues. Your primary care doctor may be able to help as well. In some cases, a prescription ED medication may be a good option to help men regain their confidence.

How Do You Treat Depression Induced Erectile Dysfunction?

It can be a little discouraging if you're experiencing feelings of depression or hopelessness and symptoms of erectile dysfunction. However, it’s not an uncommon combination, and many men go through the same thing.

Here are some ways to address depression and ED at the same time:

Start with a physical checkup. Erectile dysfunction is often caused by physical conditions that affect your blood flow, such as high blood pressure, diabetes, heart disease, and cardiovascular conditions. It’s possible that your erectile dysfunction is due to one of these conditions. It could also be a key factor contributing to your depression.
Speak with a therapist. If you think that depression is at the core of your erectile dysfunction, you should set up a meeting with a trained counselor, psychiatrist, or medical professional. They can help you to identify the thought patterns, challenging goings-on in your life, and other potential contributing factors to your depression. They can also suggest ways to manage depression. If they recommend medication, be sure to ask them about potential side effects, as SSRIs might make erectile dysfunction worse.
Treat your erectile dysfunction directly. Getting more exercise and eating a healthier diet can improve blood flow, cardiovascular health, and strengthen your erections. Of course, depression can make new routines like exercise hard to start. If you're unable to make some lifestyle changes, it may be worth consulting a doctor about prescription ED medications that can help treat erectile dysfunction. For some men, the research suggests that putting your ED issue to bed can help alleviate one trigger of depression and make the next phase of treatment that much easier or more effective.

The Takeaway

Depression can be a persistent issue that impacts just about every aspect of your daily life. For many men, it can be difficult to acknowledge or recognize depression until there are undeniable symptoms.

Due to its potential for significant impacts to sexual physiology, it’s common for men with depression to also experience erectile dysfunction.

In many cases, treating one condition can help resolve the other. Your doctor may recommend prescription medications for erectile dysfunction such as Viagra® or Cialis® as a way to tackle this potentially contributing element. They may also recommend prescription medications for depression –– it's worth knowing that these medications can contribute to the symptoms of ED. Talk to your prescriber if this is a concern for you.

Either way, working with a professional is a great way to get on the road to recovery. Depression and ED are both treatable, and your future is absolutely worth some effort.

If you or anyone you know needs help with mental health problems or depression, the following organizations can help:

National Suicide Prevention Lifeline: 800-273-8255 (TALK)
Substance Abuse and Mental Health Services Administration (SAMHSA): 800-662-4357 (HELP)
Samaritans: 877-870-4673 (HOPE) (call or text)
Crisis Text Line: Text “HOME” to 741741