The Impact of Bipolar Disorder on Sex

Behaviors can swing from excessive to non-existent

Sexual relationships can be impaired by bipolar
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Sex is an important part of most of our lives and no less so for people living with bipolar disorder. But maintaining a healthy sexual relationship when bipolar can as complex as the disease itself.

Depending on the individual, behaviors can swing from periods of excessive sexuality to ones where sexual libido and function are seriously diminished. This high level of variability can impact a person's ability to pursue or maintain a long-term relationship.

On the one hand, the impulsivity associated with ​bipolar mania can fuel unhealthy and even hurtful behaviors, while the rigors of depression can strain even the most committed of relationships.

Mania and Hypersexuality

Hypersexuality is one of the behaviors that may manifest as a symptom of mania. It is defined as the increased need for sexual gratification, characterized by lowered inhibitions and/or the desire for forbidden sex.

It is not unusual for people to experience a heightened sense of sexuality during a manic episode. In and of itself, this is not a problem. It is when it is paired with impulsivity, risk taking, poor judgment, and expansiveness—all features of bipolar mania—that hypersexuality can be destructive.

When the pursuit of sex becomes compulsive, it may even be classified as a sex addiction. While the classification is still considered controversial, a person is said to have an addiction when he or she spends inordinate amounts of time in sexual-related activity to the point where important social, occupational, or recreational activities are neglected.

Characteristics may include:

  • Compulsive masturbation
  • Compulsive sex with sex workers
  • Anonymous sex with multiple partners
  • Multiple affairs outside a committed relationship
  • Frequent patronizing of sexually-oriented establishments
  • Habitual exhibitionism
  • Habitual voyeurism
  • Inappropriate sexual touching

While hypersexuality and sex addiction are not inherent facets of bipolar mania, it is important to recognize the signs.

Not only might like these behaviors hurt otherwise stable relationships, they can place the individual at increased risk of sexually transmitted infections and other harms. As such, finding the right combination of medications to control mania is considered essential to keeping hypersexuality from becoming destructive.

Depression and Loss of Sexual Function

Depression can kill the sex drive. And it's not just the mood disorder itself that contributes to this; the very drugs used to treat depression can stifle libido and a person's ability to sexually function.

People with bipolar disorder will sometimes go for months or even years with little to no interest in sex. This makes either pursuing or sustaining a relationship all the more difficult. Depression, by its very nature, fuels feeling of inadequacy and self-blame that translates to how one feels about sex in general.

Bipolar disorder can challenge sexual relationships in a number of distinct ways:

  • The bipolar person will often feel physically unattractive and undesirable.
  • Lack of hygiene and grooming will often accompany with these feelings.
  • Feelings of inadequacy, vulnerability, and worthlessness interfere with intimacy.
  • Exhaustion can make even the pursuit of sex emotionally and physically draining.
  • The less sex a person has, the more he or she may feel guilt and self-doubt.
  • Certain medications used to treat bipolar disorder (particularly selective serotonin reuptake inhibitors, or SSRIs) can decrease a person's sexual desire and/or ability to achieve an orgasm or erection.

But a lack of sexual interest is only one of the possible consequences of bipolar depression. In some case, a person will behave in just the opposite manner, exhibit symptoms of hypersexuality as means to compensate for these negative feelings.

While treating bipolar depression must always remain the primary focus, it doesn't necessarily have to be the detriment of one's libido.

There are ways to manage the sexual side effects of bipolar drugs without compromising treatment. By and large, SSRIs have not been found to be particularly effective for bipolar disorder. Mood stabilizers like lithium, Depakote (valproic acid), and Lamictal (lamotrigine) are considered more effective and typically have fewer sexual side effects.

Sources:

Bella, A. and Shamioul, R. "Psychotropics and Sexual Desire." Cent European J Urol. 2013; 66(4): 466-471.

Kafka, M. "Hypersexual Disorder: A proposed diagnosis for DSM-V." Archives of Sexual Behavior. 2010; 39:377-400.

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