Sexuality and mood disorders: Implications for Quality of Life

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By Heather Armstrong & Erin Michalak …

By Heather Armstrong & Erin Michalak

Poster presented at the annual meeting of the International Academy of Sex Research
Estoril, Portugal, July 2012

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  • 1. Sexuality and Mood Disorders Implications for Quality of Life Heather Armstrong & Erin Michalak Poster presented at the annual meeting of the International Academy of Sex Research Estoril, Portugal, July 2012
  • 2. Introduction The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV- TR) 1 identifies two categories of mood disorders: • the depressive disorders and, • the bipolar disorders. Each of these disorders, and the medications often used to treat them, can have a significant impact on a person’s sexual well-being2
  • 3. Depressive Disorders Depressive Symptoms Depressed mood Loss of interest or pleasure Weight gain/loss Difficulty sleeping Restlessness/sluggishness Fatigue Feelings of worthlessness/guilt Difficulty Concentrating Suicidality
  • 4. Major Depressive Disorder Diagnosis is made when at least five symptoms are present for a minimum of two weeks, cause significant distress or impairment, and are not better explained by medication/drug use, a medical condition, or a recent bereavement. At least one of depressed mood and/or loss of interest or please much be present. Lifetime prevalence has bee reported at 16.6%3. Typical treatment includes anti-depressant medication and/or psychotherapy.
  • 5. Dysthymic Disorder Depressed mood for the majority of days for a minimum of two years.  Other depressive symptoms may also be present. More chronic than MDD but symptoms are less severe. Lifetime prevalence has been reported at 3-6%4. Typical treatment includes anti-depressant medication and/or psychotherapy.
  • 6. Bipolar Disorders Manic Symptoms Inflated self-esteem/grandiosity Decreased need for sleep Increased talking/need to talk Racing thoughts Easily distracted Increased goal-directed activity/agitation Excessive involvement in pleasurable activities that may have negative outcomes
  • 7. Bipolar I Disorder Periods of depression coupled with periods of mania Diagnosis is made when at least three symptoms of mania are experienced for at least one week (or less if hospitalization is required), cause marked impairment, and are not better explained by drug use or a medical condition.  Psychotic symptoms may be present.
  • 8. Bipolar II Disorder Periods of depression coupled with periods of hypomania (i.e., sub-clinical manic symptoms).  Hypomanic symptoms can be associated with feelings of creativity, elation, and well-being; however impairment from depressive symptoms can be severe.
  • 9. Cyclothymic Disorder Both depressive and hypomanic symptoms are experienced, however criteria for full episodes are not met. Symptoms must be present for at least two years and must not be better explained by another medical condition.  Symptoms are less severe than BD I and BD II but there may still be significant distress and impairment.
  • 10. Bipolar Disorders: Prevalence and Treatment  Lifetime prevalence of BD is between 1.4 – 3.9%19,3. Typical treatment includes mood stabilizing medication (e.g., anti- depressants, neuroleptics, anti-psychotics) and psychological interventions.
  • 11. Mood Disorders: Impact on Sexuality  Women with psychiatric disorders (i.e., BD, depression, schizophrenia) are more likely to5:  Contract a sexually transmitted infection  Have had an abortion or given up their children for adoption  Have multiple sexual partners over the course of one year  Have been pressured into unwanted sexual intercourse Reproduction rates are 17% lower in people with mood disorders6.  As many as 87% of people with MDD experience decreased levels of sexual desire and interest7,8,9.
  • 12. Mood Disorders: Impact on Sexuality  Depressive symptoms are also related to decreased frequency of sexual contact, decreased sexual pleasure and satisfaction10,11,12, and increased sexual dysfunction13. Effects of depression can be direct (e.g., loss of interest/pleasure; fatigue) or indirect (e.g., weight gain and self-defeating beliefs lead to decreased self- esteem).
  • 13. Mood Disorders: Impact on Sexuality People with manic symptoms may be less inhibited and more impulsive which could lead to unplanned and unprepared sexual encounters, increasing the risk of STI and unplanned pregnancy. Distorted thoughts may also impair a person’s ability to consent which may increase the risk of sexual abuse and exploitation.
  • 14. Mood Disorders: Impact on Sexuality  Medication used to treat mood symptoms can have sexual side effects13. Prevalence of sexual dysfunction with anti-depressant use is 22-73%14,15.  Medications may pose risks for pregnancy and child birth16.
  • 15. Sexual Quality of Life  Defined as a “dynamic, interactive model affected by several factors, including desire, situations and sexual ability”17. Can be affected by depression, partner relationships, performance anxiety, and sexual function disorders. Some health related QoL studies have included components of sexual QoL18. Still a new and developing research area which has not yet expanded to include the study of mood disorders.
  • 16. References 1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author. 2. Armstrong, H. L., & Michalak, E. E. Sexuality and mood disorders. In A. C. Michalos (Ed.). Encyclopedia of quality of life research. Berlin: Springer-Verlag. 3. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602. 4. Sansone, R. A., & Sansone, L. A. (2009). Dysthymic disorder: Forlorn and overlooked? Psychiatry, 6, 46-51. 5. Coverdale, J. H., Turbott, S. H., & Roberts, H. (1997). Family planning needs and STD risk behaviours of female psychiatric out-patients. The British Journal of Psychiatry, 171, 69-72. 6. Tondo, L., Lepri, B., & Baldessarini, R. J. (2011). Reproduction among 1975 Sardinian women and men diagnosed with major mood disorders. Acta Psychiatrica Scandinavica, 123, 283-289. 7. Bossini, L., Fagiolini, A., Valdagno, M., Polizzotto, N. R., & Castrogiovanni, P. (2007). Sexual disorders in subjects treated for mood and anxiety diseases. Journal of Clinical Psychopharmacology, 27, 310-312. 8. Casper, R. C., Redmond, E., Jr., Katz, M. M., Schaffer, C. B., Davis, J. M., & Koslow, S. H. (1985). Somatic symptoms in primary affective disorder. Archives of General Psychiatry, 42, 1098-1104. 9. Kennedy, S. H., Dickens, S. E., Eisfeld, B. S., & Bagby, R. M. (1999). Sexual dysfunction before antidepressant therapy in major depression. Journal of Affective Disorders, 56, 201-208. 10. Clayton, A. H., Maserejian, N. N., Conner, M. K., Huang, L., Heiman, J. R., & Rosen, R. C. (2012). Depression in premenopausal women with HSDD: Baseline findings from the HSDD Registry for Women. Psychosomatic Medicine, 74, 305-311.
  • 17. References 11. Kashdan, T. B., Adams, L., Savostyanova, A., Ferssizidis, P., McKnight, P. E., & Nezlek, J. B. (2011). Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: A daily process approach. Behaviour Research and Therapy, 49, 352- 360. 12. Mosack, V., Steinke, E. E., Wright, D. W., Walker, C., Medina, M., Moser, D. K., & Chung, M. L. (2011). Effects of depression on sexual activity and sexual satisfaction in heart failure. Dimensions of Critical Care Nursing, 30, 218-225. 13. Perlman, C. M., Martin, L., Hirdes, J. P., Curtin-Telegdi, N., Pérez, E., & Rabinowitz, T. (2007). Prevalence and predictors of sexual dysfunction in psychiatric inpatients. Psychosomatics, 48, 309-318. 14. Clayton, A. H., Pradko, J. F., Croft, H. A., Montano, B., Leadbetter, R. A., Bolden-Watson, C., ... Metz, A. (2002). Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychiatry, 63, 357-366. 15. Montejo, A. L., Llorca, G., Izquierdo, J. A., & Rico-Villademoros, F. (2001). Incidence of sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. Journal of Clinical Psychiatry, 62, 10-21. 16. McCandless, F., & Sladen, C. (2003). Sexual health and women with bipolar disorder. Journal of Advanced Nursing, 44, 42-48. 17. Schober, J. M. (2004). Sexual quality of life in an intersexual population: A needs assessment. British Journal of Urology International, 93, 54-56. 18. Lai, Y.-H., Hsieh, S.-R., Ho, W.-C., & Chiou, A.-F. (2011). Factors associated with sexual quality of life in patients before and after coronary artery bypass grafting surgery. Journal of Cardiovascular Nursing, 26, 487-496. 19. Ferrari, A. J., Baxter, A. J., & Whiteford, H. A. (2011). A systematic review of the global distribution and availability of prevalence data for bipolar disorder. Journal of Affective Disorders, 134, 1-13.