New treatments for erectile dysfunction have renewed attention to this age-old medical condition. Estimates are that 30 million American men suffer from erectile dysfunction or impotence, and the likelihood of erectile dysfunction occurring is significantly increased for those suffering from depression, according to a new study.

Reporting in the journal Psychosomatic Medicine, researchers from the Massachusetts Male Aging Study found that erectile dysfunction is nearly twice as likely in men who have symptoms of depression compared with those who don’t. In this HopkinsHealth interview, Sylvia Simpson, M.D., associate professor of psychiatry at Johns Hopkins, discusses the role depression plays in erectile dysfunction and the variety of treatments. She cautions that certain antidepressant medications also can cause decreased sexual libido and erectile dysfunction.

Q: What are the symptoms of depression?

Answer: The symptoms of clinical depression include a depressed mood, which people may describe as feeling sad, blue, or low, or not being able to feel anything. There is often a pervasive loss of interest in things, as well as changes, usually decreases, in appetite and sleep. Also, there may be difficulty with thinking and concentration, low self-esteem, feelings of hopelessness and thoughts of death or suicide. To be considered a significant depression, the symptoms have to be present most of the time for at least a couple of weeks and impair the individual’s performance at work, school or home. If you have any of these symptoms, contact your doctor or other healthcare professional.

Q: What kind of sexual dysfunctions occur with depression?

Answer: Just as depressed people lose interest in most other things, they also lose interest in sex. So there is a decreased sexual desire or libido. In men, there may be difficulty getting an erection or maintaining an erection for sexual intercourse.

Q: What role does depression play in erectile dysfunction?

Answer: That’s still a topic of research. In this study, researchers were looking at the association of depressive symptoms and erectile dysfunction; however, there may be many other contributing factors, including cardiovascular and other medical illnesses, cardiac and blood pressure medications, and drug and alcohol use.

Q: How does the treatment of depression affect the sexual dysfunction associated with the depression?

Answer: A number of antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs) such as Zoloft�and Paxil� may decrease sexual desire and sexual functioning. If a man is both depressed and having erectile problems, these are probably not the best medications to start with. One would expect that if a depression is treated, the person would regain his or her sexual desire; however, the situation could be complicated if the medication being used to treat the depression could also have a negative effect on the patient’s sexual desire and functioning.

Q: Faced with this problem, what are the alternatives to medication?

Answer: If a person is experiencing mild to moderate depression, psychotherapy might be helpful. They may respond to interpersonal psychotherapy, which deals mainly with problems a person may be having in relationships or cognitive behavioral therapy. If it is a moderate to severe depression, medication probably will be a necessary part of the treatment. The erectile problems due to the depression are probably more significant than what might be due to the medication. For this and other reasons, it is important to treat the depression.

Q: What do you do if sexual dysfunction doesn’t get better after the depression is treated?

Answer: There is usually a multidisciplinary workup for erectile dysfunction; for example, an evaluation by a urologist who specializes in erectile problems. One also would look at other medications that the person is taking to see if they might be contributing to the problem. A doctor would not want to wait until the depression is treated to do these things. A thorough evaluation should be done up front so one could intervene in whichever ways are indicated.

Q: Do the various prescription pills have any role in the treatment of sexual dysfunction due to antidepressant medications?

Answer: Yes, they do. They are indicated in any kind of erectile dysfunction, though sexual stimulation will be needed as well. They should not be taken by anyone who is taking a medication containing nitrates.

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SOURCE: The Journal of Urology