This is the fourth installment to our discussion on sex and bipolar. The conventional wisdom is that (hypo)mania increases our sexual drive - often to the point of excess - while depression has the opposite effect. Indeed, Goodwin and Jamison in their 2007 "Manic-Depressive Illness" note that Aretaeus of Cappadocia in the second century AD observed "a period of lewdness and shamelessness exists in the highest type of [manic] delirium."
The authors cite a number of studies showing increased sexual interest and behavior during mania or hypomania, and the DSM makes it official by including "sexual indiscretions" in manic and hypomanic episodes. It also notes "decrease in sexual interests or drive" during depression.
Okay, time to challenge that notion. In our first installment, I alluded to a 2006 NIH-funded study of a large teen population which found that those who were depressed were far more likely to engage in risky behaviors such as drug use and sex. The study corroborates earlier findings. What gives?
My guess is that most psychiatrists would not even be able to make a reasonable attempt at defining depression. One reason is the term is exceptionally misleading, implying that all depressions are the same. The reality is a number of different things may be going on inside our heads at once.
One mind state is that we tend to feel clinically dead. This is the very opposite of the "feeling alive" states of mind we experience in pure mania and hypomania. Our dopamine is not firing (see my most recent post in this series on the sex and dopamine connection). We lack energy and motivation and are indifferent to all that life has to offer. Among many other things, we lose interest in sex. No doubt, you have observed this in yourself or in your partner.
But something else tends to be going on in depression - intense psychic pain. If the clinically dead aspect of depression is about feeling too little, our psychic pain is about feeling too much. In this tortured state of mind we have all contemplated the unthinkable. Indeed, in our extremity, it is the logical choice, which is why it is a miracle most of us are still here.
But suicide is not our only option, particularly if our psychic pain is less intense. Many of us find ourselves turning to alcohol or street drugs or both, so much so that “dual diagnosis” is all too common. We also may indulge in over-eating, which (with under-eating) is listed as a symptom of depression. Moreover, eating disorders have been linked to depression. Likewise, those with depression are known to self-medicate with "retail therapy." Many of us tend to buy stuff - often things we don’t need or can’t afford - for the instant feel-good sensation.
I would add to this an overwhelming need to sleep. Sometimes, I simply need to reboot my brain. Other times, I need to hibernate as a way of dealing with a brain that is way too much to handle awake. Unfortunately, employers do not understand the concept of hibernation, which means we can also classify sleep as a risky behavior.
So - when psychic pain hits: We may want to kill ourselves, we may turn to alcohol and drugs, we may over-eat, we may spend too much money, we may burrow under the covers when we’re supposed to be keeping our promises. What other type of risky behavior are we likely to engage in? You guessed it. A warm embrace, the flood of feel-good hormones. The feeling may quickly wear off, but so what? People who have never experienced depression cannot possibly understand. The pain - the pain - the promise of release, even for one precious second. What is that worth to you? What are you willing to risk?
Thus the studies finding links between teen depression and risky behavior, including sex. Fortunately with sex, there are convenient alternatives to practicing it on a live partner. But doing it yourself raises its own complications, particularly if this mindset sabotages one’s ability to forge a healthy sexual relationship with another human being.
So both sides of the bipolar equation find us at risk, up as well as down. Yes, it is true that we are more likely to lose interest in sex when we are depressed, but this should not mask the fact that in certain instances the very opposite may occur, replete with the full menu of life-altering consequences. Psychic pain has that kind of effect on us.