Bipolar disorder is a mental illness that causes severe shifts in mood, energy, and activity levels and can affect one’s ability to perform everyday tasks. Bipolar disorder affects about 6 million people in the US alone, and is marked by periods of extreme, intense emotions in the form of alternating episodes of mania and depression.¹ During a manic episode, a person can feel restless, energized, and agitated. They might also talk unusually fast, have racing thoughts, and engage in reckless behaviors during one of these episodes. During a depressive episode, a person can feel very sad, hopeless, empty, and tired. It is common for people in this state to experience abnormal sleep and eating patterns, have low energy, and sometimes even contemplate suicide. Because these two kinds of episodes are vastly different and can each vary in duration from hours to even months, the person experiencing them may feel like they are on an emotional rollercoaster. Additionally, a person with bipolar disorder might experience symptoms of both mania and depression simultaneously. With the help of medication and therapy, many people are able to decrease the intensity of their manic and depressive episodes, as well as minimize their mood swings. Bipolar disorder is a life-long mental illness that can affect many aspects of a person’s life, including their sex life.²

Sex During a Manic Phase

During a manic phase, people can feel indestructible and may be particularly unaware of the consequences of their actions. Because mania is often marked by impulsive behavior, it is important to understand sexual behavior during a manic phase and the implications that such impulsive behavior can have. Although hypersexuality may not initially sound like something to be concerned about, it is often one of the most destructive and challenging aspects of bipolar disorder.⁴ It is not uncommon for people going through a manic episode to experience a significant increase in sex drive which they do not feel can be be satisfied, leading them to engage in impulsive and risky sexual behaviors.

Such behaviors include (but are not limited to) having unprotected sex with multiple partners or strangers, one night stands, and extramarital affairs, or cheating. These behaviors can lead to unwanted pregnancy or contraction of an STI, and they can destroy relationships as well. People with bipolar disorder who are experiencing a manic episode may also masturbate or use pornography more frequently than they do in non-manic phases.³ These markers of hypersexuality are more common in women than men and affect about 57% of people in manic episodes, according to a meta-analysis of the few studies that have been conducted on the topic.⁴

If a person experiences bipolar disorder-induced hypersexuality and finds that it is causing problems in their life, they could benefit from talking to a doctor. Medication and therapy, which help manage the underlying bipolar disorder, can help mediate hypersexuality that is brought on by manic episodes. Because this kind of hypersexuality can put a significant strain on relationships, partners are encouraged to seek counseling and speak with a therapist about any problems or difficulties they may be experiencing.³

Sex During a Depressive Phase

During a depressive phase, some people lose interest in sex completely or feel like they do not have enough energy to become aroused and engage in sexual activities. This lowered sex drive during a depressive episode can confuse partners and leave them feeling frustrated, confused, and rejected, especially if the lower sex drive occurs right after a period of mania-induced hypersexuality. This depression can also lead to physiological sexual difficulties, such as erectile dysfunction and delayed ejaculation in men.⁵ Conversely, some people experiencing a depressive episode may turn towards sexual activities as a way to help dull the pain, just as many others might turn to drugs or alcohol.

Treatments for Bipolar and their Effects on Sex Life

Today, the most common treatments for bipolar disorder include:

• Mood-stabilizing medications: Lithibid (lithium), Depakene or Depakote (valproic acid), Lamictal (lamotrigine), and Equetro or Tegretol (carbamazepine).⁶ This is the most common type of medication prescribed to treat bipolar disorder, as it helps with both mania and depression.
• Antipsychotic medications: Abilify (aripiprazole), Clozaril (clozapine), Geodon (ziprasidone), Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine).⁶ These medications are prescribed if a person is experiencing episodes of psychosis, which are marked by hallucinations or delusions.
• Antidepressants: While antidepressants may help with the depressive phases of bipolar disorder, when taken as the sole form of medication, they can trigger mania and rapid mood cycling. If antidepressants are used at all, it is recommended to take them in conjunction with one of the mood-stabilizing medications mentioned above.⁶
• Cognitive-behavioral therapy: While medication is often the first step in trying to stabilize bipolar episodes, therapy is very important for maintaining effective treatment. In fact, research shows that people who take medication for bipolar disorder tend to recover much faster and control their moods with greater ease if they are also in some sort of therapy.⁶ [PHOTO 4]
• Electroconvulsive therapy (ECT): This procedure involves attaching electrodes to a person’s scalp and sending small electrical currents through their brain. This treatment is intended to change the electrical activity in the brain, causing a brief seizure and altering chemicals in the brain. ECT is used as a last resort if the patient is not responding to any other form of treatment.

Bipolar medication is most effective when used in combination with other treatments, including therapy, self-help coping strategies, and healthy lifestyle choices such as exercising regularly, getting enough sleep, eating a healthy diet, and building a strong social support network.⁶

Many medications used to treat bipolar disorder can have negative side effects, including a decrease in sex drive. The class of medications that are the most likely to have sexual dysfunction-related side effects (especially erectile dysfunction) are antipsychotics. However, for the most part, medication that treats bipolar disorder and helps stabilize the alternating episodes of mania and depression can help one’s sex drive return to its normal level. The highs and lows of mood cycles can be exhausting and can take a major toll on a person’s sex life and relationships, but with proper combination of medication and therapy, people with bipolar disorder can live a much more stable life.

If you have been diagnosed with bipolar disorder and find that it has negatively affected your sex life, consider talking with a doctor about any medications you may have been prescribed. You may also want to  discuss with them the possibility of changing your dosage or switching medication until you arrive at a place of balance in which your sex drive is at your desired level, while still keeping the effects of your bipolar disorder under control. It is strongly discouraged to adjust your own dosage or stop taking your medication without consulting a doctor, as these actions can send you into a more severe episode of mania or depression.

Concluding Remarks

Bipolar disorder can have detrimental effects on one’s sex life, whether in the form of a decreased sex drive during depressive episodes, a period of hypersexuality during manic episodes, or other manifestations of the instability a person may experience during these mood cycles. Though the impact of bipolar disorder on one’s sex life may vary, with a combination of medication and therapeutic treatment, an affected person has a stronger chance of living a life of greater stability, both inside and outside of the bedroom. If your life has been impacted by bipolar disorder, seeking medical help and social support can benefit you greatly.

References

1. Duckworth, Ken. (2013, March). Mental Illness Facts and Numbers. National Alliance on Mental Illness.

2. (2016, April). Bipolar Disorder. National Institutes of Health. National Institute of Mental Health.

3. (2013, April). Bipolar Hypersexuality. Sexual Medicine Society of North America, Inc.

4. Solovitch, Sara. (2009, May 1). Opening the Door on Hypersexuality. BpHope.

5. Connell, Kelly. (2015, May 13). Bipolar Disorder & Sexual Health. Healthline.

6. Smith, M., Robinson, L., & Segal, J. (2020, September). Bipolar Medication Guide. HelpGuide.

Last Updated 4 March 2021.