ED is a common problem among men and its cause can be attributed to a large number of factors both mental and physical, often combinations of associated conditions. It is defined as the inability to get or keep an erection and according to WebMD, “Psychological factors are responsible for about 10%-20% of all cases of erectile dysfunction. It is often a secondary reaction to an underlying physical cause.” *

If you’re one of the 30 million men in the United States with this problem then proper diagnosis is essential to finding a solution. Physical causes are easier to diagnose and should be your first step toward treatment. A doctor trained in treating sexual dysfunctions would review your medical history and perform a number of non-invasive tests to determine the causes and severity. In some cases blood analysis could help determine the causes. It’s important to keep in mind that ED can sometimes be a symptom or precursor of a much more serious physical ailment like cardiovascular disease or diabetes so it’s very important to consult with a doctor to find out early what is causing the condition. In other cases it may be lifestyle choices like excessive alcohol or smoking that can lead to ED.

If physical issues are ruled out as the prime cause then psychological issues should be considered, although they aren’t as easy to detect, diagnose or treat. The most common psychological causes include:

Anxiety – higher blood pressure and/or heart rates and fatigue are by-products of anxiety and can affect sexual performance.
Depression – caused by chemical imbalances in the brain, it can affect both desire and function. Not easy to diagnose but once treated most men can return to normal function (but note: some of the very drugs that alleviate depression can also lead to ED themselves).
Stress – as they say ‘stress kills’ and it can also kill your desire or sexual ability. One should look to decrease the conditions and environment that is causing this condition.
Fear – the fear itself of not performing or putting your relationship in jeopardy can become a self-fulfilling issue.

In many psychological cases, and especially when the person has deep rooted mental issues (often derived from early sexual abuse), consultation with a professional therapist is recommended.

So is ED psychological? It can be, but in the majority of cases it comes from physical causes that can be diagnosed and treated safely and effectively. All of us are unique and like us the variables around the condition of ED can be nuanced, benign or quite complex.

*Source: WebMD, 2017.

There is a large body of evidence supporting the correlation between ED and depression.

A recent systematic review and meta-analysis* published in the Journal of Sexual Medicine, concludes “an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED.”

Some oral ED medications aren’t working for patients with depressive disorders. Is this normal?

This can be certainly normal. Although oral ED medications are generally effective, they may not work for everyone. However, there are other safer treatments available for men with ED and depression.

Do side effects of antidepressants affect men’s health?

There are some harmful side effects of antidepressants that often affect men’s sexual function. Although antidepressants work to relieve depression, they can potentially decrease libido and contribute to sexual dysfunction.

There are available treatments for depression and impotence that do not generally conflict with other medications taken. Thus, it’s best to consult a physician concerning the right treatment for sexual dysfunction.

Are there antidepressants that have fewer sexual side effects?

According to an article by the American Academy of Family Physicians, evidence shows that bupropion (Wellbutrin), trazodone (Desyrel) and nefazodone (Serzone) have a lower risk a causing or exasperating sexual dysfunction than other antidepressants.

However, you must seek medical advice from an expert before undergoing treatment for depression and erectile dysfunction.

Is it possible for depressive patients to manifest no signs of ED?

There is no clear evidence that will support if depression will affect every man’s sexual function.  However, a study from the University Of New Mexico School Of Medicine shows that depressive patients are twice as likely to develop erectile dysfunction.

In some cases, depressive men without symptoms of sexual dysfunction should talk with an expert for preventive measures.

Can depression lead to impotence?

Having depression does not mean that you’ll become impotent. Although, there are recent studies that will support a strong link between depression and impotence.

Taking preventative actions such as proper exercise, keeping low cholesterol levels and refraining from smoking can also help improve erectile function.  Nowadays, lifestyle modification is important to lessen the risk for depression and erectile dysfunction.

Why does depression cause erectile dysfunction?

ED and depression are interrelated. Also, psychological and physiological symptoms of depression can lead to sexual dysfunction. Depression can affect neurotransmitters in the brain, potentially resulting in poor sexual stimulation and erection problems.

Some antidepressants can diminish libido and often result to impotence. On the other hand, emotional stress as a result of erectile dysfunction can eventually lead to crisis in men with ED and depression.

* Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018