When bipolar depression or medications lower your libido, these expert-backed strategies can help restore intimacy.
Key Takeaways
- Hyposexuality — a noticeable drop in sexual desire — is common with bipolar disorder but often goes unmentioned, especially during depressive episodes.
- Some psychiatric medications (including certain mood stabilizers and antipsychotics) can lower libido, so talk with your prescriber before changing anything.
- Honest, nonjudgmental conversations with your partner, and support from a therapist if needed, can ease the emotional and relationship strain.
- Basics matter: Steady sleep and stress reduction can help restore energy and, for some people, sexual interest.
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Hypersexuality during manic or hypomanic episodes can put relationships, health, and safety at risk. Because it can lead to impulsive choices, it tends to get a lot of attention.
But there’s a quieter counterpart that can feel just as painful: hyposexuality — a significant drop in sexual desire. It doesn’t always look “dramatic” from the outside, so it’s talked about less, even though it can fuel loneliness, stress, and disconnection in long-term partnerships.
Hyposexuality is most common during depressive episodes, but it can also be linked to other factors that come with living with bipolar disorder. Like hypersexuality, this drop in libido can deeply affect your intimate relationships and overall quality of life. The good news is that if low libido is bothering you, there are practical ways to address it.
What Is Hyposexuality?
Hyposexuality is marked by a lower sex drive and challenges with sexual satisfaction. For people with bipolar disorder, the decrease in sexual desire or activity is most often seen during depressive episodes, explains Sanam Hafeez, PsyD, a licensed neuropsychologist in New York City.
Recognizing Symptoms of Hyposexuality
The telltale sign of hyposexuality for people with bipolar disorder is a significant drop in sexual desire compared with their typical experience. According to Alex Dimitriu, MD, a board-certified psychiatrist and sleep medicine doctor, hyposexuality comprises these aspects:
- Reduced overall libido (sexual desire)
- Reduced ability to achieve arousal or erection
- Reduced ability, or inability, to orgasm
- Symptoms severe enough to cause personal or relationship distress
Activities that you once found enjoyable, including sex, may no longer hold any appeal, says Dr. Hafeez. “[This] can put a strain on intimate relationships and lead to broader emotional distress.”
How Prevalent Is Bipolar Hyposexuality?
Some research suggests that about 28 percent of people with bipolar may experience some form of sexual dysfunction that can contribute to hyposexuality.
Hyposexuality can affect people of all genders. Rates can vary, but researchers from the previous study found that among their participants:
- Low sexual desire affected up to 35 percent of men and 46 percent of women
- Low arousal affected up to 31 percent of men and 26 percent of women
Another small survey of 61 women with bipolar disorder found that 54 percent reported sexual distress, especially women with greater depression scores. This rate was significantly higher than the rate in women who didn’t have bipolar disorder. Higher sexual distress was also associated with lower quality of life.
Causes of Hyposexuality in Bipolar Disorder
Several factors can contribute to reduced sexual desire or gratification.
1. Depression Symptoms
Depression affects you mentally and physically, and both kinds of effects can lead to hyposexuality.
“Depression can disrupt the balance of neurotransmitters like serotonin and dopamine, which are important for mood and sexual function,” Hafeez explains. “When these chemical levels are off, it can lead to decreased libido.”
Other symptoms of depressive episodes can contribute to hyposexuality, too, says Hafeez. These include:
- Physical symptoms such as extreme fatigue and low energy
- Psychological aspects such as anhedonia (lack of interest in activities you once enjoyed) and pervasive feelings of sadness or worthlessness
2. Bipolar Medications and Their Impact on Libido
For some people, the medications they take for their bipolar symptoms may come with sexual side effects, notes Hafeez. Generally, different classes of drugs affect the body in various ways:
- Mood Stabilizers Medications like lithium (Lithobid) are foundational for stability but are frequently linked to reduced desire or erectile challenges.
- Anticonvulsants Used as mood stabilizers in bipolar disorder, medications such as lamotrigine (Lamictal) are generally associated with fewer or milder sexual side effects compared with lithium, according to several studies. However, valproate (Depakote) can still affect sexual and reproductive function in some people.
- Antipsychotics Drugs such as quetiapine (Seroquel) or olanzapine (Zyprexa) can increase levels of prolactin, a hormone that, when elevated, can significantly dampen sex drive.
- Antidepressants While sometimes used for depressive episodes, SSRIs like fluoxetine (Prozac) or sertraline (Zoloft) are well-known for delaying orgasm or reducing interest in sex altogether.
Despite any associated sexual side effects, Dimitriu emphasizes the importance of treating your underlying bipolar condition. Many factors contribute to sexual functioning and how someone responds to medication. Talk to your doctor if you think your medication is negatively affecting your sex life. They may be able to alter your medication, or they can work with you to find other solutions.
3. Lowered Self-Esteem
Psychological and physical symptoms, such as weight gain caused by medication, can impact your self-image, Dimitriu says. So, that can affect your sexual desire. Feelings of guilt or frustration about this decline in sexual interest can further affect your self-esteem, compounding the problem, Hafeez adds.
4. Fatigue
“Even with good control over bipolar symptoms, people can continue to experience some residual anxiety, stress, fatigue, or diminished energy, all of which can lead to reduced sexual interest,” Dimitriu says. And a lack of energy and motivation can make sexual activity feel both physically and emotionally burdensome.
5. Trauma History
For someone with bipolar disorder, trauma, including experiences of sexual abuse, can significantly impact their sexuality, contributing to hyposexuality in several ways. During depressive episodes, unresolved trauma may resurface, intensifying feelings of worthlessness or fear, which can reduce sexual desire.
Even outside these episodes, trauma can create lasting feelings of shame, fear, or distrust, making it hard to feel safe or comfortable in intimate relationships. The emotional pain from past experiences can make physical intimacy feel overwhelming or frightening.
The Impact on Intimate Relationships
Sexual distress, dissatisfaction, and low sexual interest can all take a toll on relationships.
Hyposexuality can mean someone with bipolar disorder stops initiating sex or starts avoiding any sexual contact, according to Johns Hopkins Medicine. For sexual partners, this change can be confusing and feel like rejection, creating tension or conflict.
Hyposexuality can also lead to feelings of guilt, frustration, or inadequacy for both the person with bipolar and their partner, Hafeez notes.
A literature review suggested that relationship problems can lead to a return of symptoms. Other bipolar symptoms can further relationship difficulties, which can amplify hyposexuality.
How to Deal With Bipolar Hyposexuality
If your decreased sexual interest or satisfaction is bothersome to you, you have options for coping.
Hafeez notes that addressing hyposexuality typically involves:
- Managing the bipolar disorder
- Adjusting medications if needed
- Exploring therapy to improve sexual function and relationship dynamics
Research suggests that learning about the impact of bipolar disorder on sexual desire and functioning is important for understanding how low sex drive can impact relationships. You can do this work with a therapist.
Besides these approaches, medications that may help improve sexual interest and performance are also available, Dimitriu notes. Your doctor can give you more information to help you both decide if one of these medications may be right for you.
The importance of self-care cannot be emphasized enough. “For anyone, living with bipolar or not, getting good sleep, exercise, time in nature, time with friends, and time to relax, can all boost sexual performance,” Dimitriu says.
When to Talk to Your Doctor About Sexual Health
Sexual health is an important part of your overall well-being, and you don’t have to manage these changes alone. Consider talking with your healthcare team if low libido is causing you distress or creating tension in your relationship. Possible next steps your clinician might explore include:
- Medication Adjustments Sometimes a small dose change or a switch to a more “sex-friendly” option can make a noticeable difference.
- Hormone Checks Medications, stress, and mood episodes can affect your hormones. A simple blood test can help rule out other physical factors.
- Therapy Working with a sex therapist or a counselor specializing in chronic conditions can help you (and your partner, if you have one) work through the emotional side of desire and connection.
How Can Partners Help?
It can be hard for partners to know how to support each other through hyposexuality and the feelings of rejection, hurt, and inadequacy it may bring. But it’s important to find ways to be supportive. Research has established that having support from loved ones has a positive and protective effect on mental health.
Dimitriu says that with partners, it helps to have nonjudgmental, supportive dialogues about sex and each other’s sexual needs.
How? “The key to all effective communication is nonviolent communication, or gently stating the facts without judgment or criticism,” he says. Discuss the facts, and try to focus on positive outcomes for both partners.
And if you’re in a sexual relationship with someone with bipolar disorder, be sure to make time for your own mental and physical health.
Editorial Sources and Fact-Checking
- Grover S et al. Sexual Dysfunction in Clinically Stable Patients With Bipolar Disorder Receiving Valproate. Indian Journal of Psychiatry. July–August 2021.
- Sørensen T et al. Sexual Distress and Quality of Life Among Women With Bipolar Disorder. International Journal of Bipolar Disorders. June 6, 2017.
- Suppes T et al. A Single Blind Comparison of Lithium and Lamotrigine for the Treatment of Bipolar 2 Depression. Journal of Affective Disorders. March 20, 2008.
- García-Blanco A et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. Journal of Sex Medicine. May 2020.
- Bipolar Relationships: What to Expect. John Hopkins Medicine.
- Azorin JM et al. The Impact of Bipolar Disorder on Couple Functioning: Implications for Care and Treatment. A Systematic Review. Medicina (Kaunas). July 29, 2021
- Montejo AL et al. Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach. Journal of Clinical Medicine. October 7, 2019.
- Acoba EF. Social Support and Mental Health: The Mediating Role of Perceived Stress. Frontiers in Psychology. February 2024.
UPDATED: Originally posted September 23, 2024
