Sex and Depression: An interview with JoEllen Notte, author of The Monster Under the Bed: Sex, Depression, and the Conversations We Aren’t Having

As the veils of secrecy and shame of both depression and sex gradually lift, now is the time to talk about the two together. JoEllen Notte is a sex educator who has lived with depression for most of her adult life. Years ago, she was in a sexless marriage, worried that her low libido was a result of her depression. With a combination of medication and therapy, her mood improved, but still, her interest in sex didn’t. It turned out, this wasn’t to do with her depression, but was more of a “partner issue”. 

Notte has since surveyed and interviewed over 1,000 people to learn more about people’s different experiences with depression and sex. She compiled her research into a book called The Monster Under the Bed: Sex, Depression, and the Conversations We Aren’t Having. I spoke with her recently about how we can better navigate sex and depression together.

Prevalence and acceptance

Since Robin Williams’ suicide in 2014, depression has been in the public consciousness. As well, COVID-19 has magnified many previous challenges that people both with and without depression were facing. The pandemic has created for folks countless additional stresses like living with others 24/7 or being isolated from others, and all of these challenges can justifiably add up to feelings of stress, anxiety, or depression. These realities and the discussion of their impact in the media means that people are used to hearing about depression as a natural and understandable outcome of the current extraordinary circumstances, on top of pre-COVID-19 discussions about mental health. 

How can you tell if your partner might be anxious or depressed?

You may very well known someone, or many people in your life, who’ve suffered from anxiety or depression, but not everyone has the same symptoms and responses. Notte states that there are some classic indicators of depression. If your partner is constantly irritable, that might be a sign of depression. If something has shifted in their personality or outlook, or if they are physically or mentally exhausted, those can also be indicators. Other signs include a sudden loss of interest in things that used to be enjoyed, or if things that once seemed easier are now more challenging, especially something ordinary such as brushing their teeth. If your partner has developed new coping strategies, especially in harmful or unhelpful ways, depression may be part of the reason for their change in behaviour. 

Ways sex can change with depression

• Feelings about sex: Some people want more sex, the majority want less sex. It's not universal. 
• Lack of lubrication: Many people reported a lack of natural vaginal lubrication. Fortunately, personal lubricants can resolve most of this challenge
• Genital numbness and challenges getting or maintaining erections: Lots of people feel less sensation than others, or even less than what they used to feel. Notte stated that some describe it as having their genitals “wrapped in bubble wrap.” Wands and powerful toys can help with additional stimulation. Toys with ribs such as the Tantus Curve offer additional intensity for internal stimulation, too. While many toys for penises require erections for pleasure, the Hot Octopuss, and Miracle Massager attachment for Magic Wands can be enjoyed with or without an erection. 
• Body numbness: Notte’s interviewees described full-body touch sensations as though someone had turned down the volume on everything. For example, touch or sensations that used to feel like a “10” might now feel more like a “4” in terms of pleasure. Increasing the intensity of play such as using crops, paddles, and floggers can help someone experience more physical pleasure. 
• Changes in orgasm: Some described having delayed orgasms, others experience no orgasms at all, while still others called them “weird” or different. A few will also experience tears with or instead of orgasm. 

How to ask your partner about depression 

Notte recommends asking a partner how they are feeling. Reassure them that if they are not okay, that they can talk about their sadness or anger or any other emotion. It’s important to convey your acceptance of them and how they are feeling—that their depression does not define them. She advises reassuring them that they have your full support.

She also stated that there is a difference between being supportive and pushing a partner.  She recommends offering to do specific things for them to help them feel an ongoing sense of safety and security with you. When they are feeling low, ask if they want empathy, strategy, or distraction? Offering strategic “fixes” such as going for a walk or cuddling might not be what they are looking for at that time. They may prefer you to just listen to them and love them as they are. Or they may want a distraction such as watching a movie together. Narrowing down the options to those three categories of empathy, strategy, or distraction can help guide both of you to a more satisfying and successful connection at that moment. 

How can depression impact someone's sex life?

Depression plays out differently in folks’ sex lives, and doesn’t always look like the stereotypical avoidance of sexual connection, according to Notte. She, for example, experienced a steady dating life, while depressed. In fact, one-quarter of her interviewees in her research had more sex when depressed. This increase could be due to the boost in energy from taking medications, a desire to escape from their feelings, out of self- destructiveness, and/ or for looking for validation. In any case, there is an impact on sexual health, mental health, and/or relational health.

How do medications for depression affect sexuality and what medications might have different sexual side effects?

The sexual side effects of medications to treat depression (such as SSRIs) are mostly physical and 15-70%—depending on the study—can have sexual side effects. These medications tend to impact “sexual functioning”, especially desire, arousal, orgasms, and erections. Some varieties such as Wellbutrin tend to have less of an impact on orgasms and lubrication; however, Notte described that some of these options can produce an elevated interest in sex that sometimes leads to harmful behaviours. On the other hand, their impact on depression overall can be milder, which might lead to taking other medications—which can still have side effects, sexual or otherwise. For some, the boost in sexual wealth may not be worth the trade-off in sacrificing one’s overall mental health overall. 

How can you maintain a sexual relationship if suffering from depression/ anxiety?

Notte believes that one of the keys to maintaining a sexual relationship while experiencing depression is to remain open about it and to normalize it. When dating, it can feel intimidating, and overwhelming, to tell someone you suffer from depression, for fear of how they might react. However, once you trust someone, it’s best to normalize depression, and talk about it openly—it helps in demystifying it, and can help both partners immensely to better understand each other.

Many have described depression as the “destroyer of relationships”; Notte believes, however, that it is resentment that destroys relationships. To avoid resentment, it’s important for everyone to talk openly about their feelings—fears, dreams, desires, and pleasures. 

Any supression or shame about feelings will often cause them to resurface later disguised as something much more intense. And hiding feelings is never helpful when it comes to communicating openly, managing depression, or having sex. This withholding makes it hard for a partner to understand what’s happening in one’s life, and can breed distance rather than intimacy.

The other important key is to not see the person with depression as “broken.” The belief that there is something “wrong” with a person with depression can lead to someone feeling bad about themselves, like they need “fixing,” like they’re not good enough, like they’re a burden. Another fallacy is that the partner with depression feels “lucky” to have a partner who stays with them. This sense of unworthiness is a dangerous breeding ground for poor consent and unhappiness: unhealthy decisions are often made when one partner feels less worthy of love and acceptance, compromising one’s own needs or preferences in order to prevent the other from leaving them.  

Notte acknowledges that it can be very challenging to be in a relationship with a partner with depression. She states that living with someone with depression means that “you are living with depression too.” What she finds important to do, howeve,r is to “get on the same team”: both partners need to rally together. You’re much more effective working as a cooperative team.

Recommendations

Notte is adamant that, despite what many people believe, depression does not have to kill someone’s sex life. She recommends: 

• looking a little deeper at one’s medications and side effects and benefits;
• talking to one’s medical doctor about symptoms and options; 
• not assuming anything, since depression can look very different from person to person and from episode to episode: see what all partners’ interests are and how you can meet in the middle
• leading and not pushing: meeting a partner where they are at and supporting them forward rather than pushing them to where you think they might need to be;
• talking to a professional: trying to keep hard emotions and thoughts and experiences inside tends to worsen the symptoms; some say that repressed,  unexpressed rage makes one more prone to depression whereas support is generally beneficial;
• taking time to check in about sexual issues on a daily or regular basis: this keeps sex from being hot-button issue or taking sex off the table for discussion;
• recognizing and revealing to any partners about your “accelerators and brakes”, i.e. things that turn you on and things that turn you off (and putting those ideas into words for a partner can help your sex life, anyhow);
• identifying your “sexual skeleton key”, i.e. things that almost always turn you on, so that you can try them when sex is a possibility, and then if it still does not spark and interest in sex, you know that sex is just not for you right now;
• expanding your ideas and expectations around sex: believing that it must include or finish with intercourse or has to include an orgasm means that you might miss out on some great intimacy and pleasure that you might not have called “sex” before but still enjoy. 

JoEllen Notte, author of The Monster Under the Bed: Sex, Depression, and the Conversations We Aren’t Having, can be found at redheadbedhead.com