Depression Screening and Erectile Dysfunction Treatment

Researchers and investigators believe that erectile dysfunction has a cause-effect relationship with depression. Based on the extensive analysis, it can be safely assumed that long standing depression may cause erectile dysfunction in males or vice versa. Obviously in all such cases, it becomes extremely important to identify the association and manage the symptoms to prevent relapse or recurrence of either condition in patients.

Depression and Erectile Dysfunction

Scientists explain that depression and erectile dysfunction may present as an inter-linked entities in these scenarios:

• Depression due to erectile dysfunction: Certain drugs (such as 5-alpha reductase inhibitors) can lead to erectile dysfunction due to alteration in the vascular or circulatory pressure (1). Consequently feeling of being angry, sad, frustrated and insecure is not uncommon among men with erectile dysfunction. Such feelings, if not dealt correctly may lead to anxiety and depression.
• Erectile dysfunction due to depression: It has been observed that mild to moderate depression usually presents with changes in the libido that may eventually lead to depression if left poorly managed. In addition, patients undergoing therapy for depression are also likely to experience erectile dysfunction as a therapy related side effect. A few examples include serotonin norepinephrine re-uptake inhibitors, selective serotonin reuptake inhibitors (SSRIs), escitalopram etc. According to a new study, erectile dysfunction is reported in 60% patients who consume SSRI for the management of depression (2)
• Erectile dysfunction and depression due to a medical condition: Likewise, drug abuse, alcohol abuse, advancing age, psychological issues, disabilities, injuries, surgeries, uncontrolled diabetes are some examples where erectile dysfunction often co-exist with depression.

In a study reported in the Journal of Sexual Medicine (3), scientists concluded that depression and erectile dysfunction are associated “in both univariate and multivariate analysis”Depression mediated erectile dysfunction is treatable if proper diagnostic protocol is followed and core association is identified. Research and clinical data suggests that self-awareness and psychological counseling can significantly help the subjects in achieving early control of symptoms thus requiring minimal pharmacological support for either condition.

Screening for Depression

Although not always the first priority; yet most clinicians suggest that every patient who report to sex clinic should be screened for depression (4). Report compiled by Evan Atlantis concluded that all depressed patients should be screened for sexual dysfunction or erectile disorders. The most distinguishing symptoms of depression include:

• Feeling of hopelessness, sadness, despair
• Loss of interest in day to day activities or hobbies
• Psychological fatigue (manifested by physical symptoms such as headache, stomach ache, muscle pain etc.)
• Drastic changes in the appetite or food intake
• Changes in the rhythm or quality of sleep
• Low self esteem
• Apathy
• Inclination to abuse drug or alcohol
• Suicidal thoughts

If you are experiencing sign and symptoms of depression, it is highly recommended to speak to a healthcare professional in order to identify the cause, pathogenesis and management options. An open discussion with your doctor regarding what you feel is usually the first step to the treatment/ management of depression and ED.

Treatment of Depression and Erectile Dysfunction

• Management of medical/ health issues: Management of erectile dysfunction due to depression is decided after the identification of cause and pathogenesis of depression. For example if depression is caused by hormonal aberration (hypothyroidism) the treatment protocol is largely focused on the management of thyroid dysfunction that eventually helps in resolving both the complaints. Treatment of psychological or organic depression can be achieved via medications, counseling therapy or a combination of both.
• Antidepressant pharmacological therapy: In situations where erectile dysfunction coexists with depression, the choice of antidepressant should be made after thorough consideration. Many commonly available anti-depressants are known to cause or worsen erectile dysfunction.
• Talk Therapy (also known as psychological counseling): This treatment is done by a licensed and trained mental healthcare professional. Psychological counseling is helpful in cases, where the cause of depression and/ or erectile dysfunction is stress, psychological conflicts and other related issues.

Counseling can be done as couple therapy, individual therapy and group therapy.Identification of depression as the cause of erectile dysfunction not only helps in managing the two conditions but also helps in minimizing the risk of recurrence. It is highly recommended to screen the risk population for depression symptoms via psychological tests and scales.References:

1. Traish, A. M., Hassani, J., Guay, A. T., Zitzmann, M., & Hansen, M. L. (2011). Adverse Side Effects of 5α‐Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients. The journal of sexual medicine, 8(3), 872-884.
2. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23:176-194Nelson, C. J., Mulhall, J. P., & Roth, A. J. (2011). The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. The journal of sexual medicine, 8(2), 560-566.
3. Atlantis, E., & Sullivan, T. (2012). Bidirectional association between depression and sexual dysfunction: A systematic review and meta‐analysis. The journal of sexual medicine, 9(6), 1497-1507.=