By Heather Armstrong & Erin Michalak Poster presented at the annual meeting of the International Academy of Sex Research Estoril, Portugal, July 2012

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.