The Impact of Bipolar Disorder on Sex

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 be 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 date 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 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.

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

Not only might these behaviors hurt otherwise stable relationships, but they can also 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.

Impact of Depression on 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 feelings 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:

• Lack of sleep: Exhaustion can make even the pursuit of sex emotionally and physically draining.
• Medications: 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.
• Negative cycle: The less sex a person has, the more he or she may feel guilt and self-doubt.
• Self-care: Lack of hygiene and grooming will often accompany these feelings.
• Self-esteem: The bipolar person will often feel physically unattractive and undesirable. Feelings of inadequacy, vulnerability, and worthlessness can also interfere with intimacy.

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.