Bipolar disorder is a brain disorder that causes unusual shifts in mood, energy, and activity levels, as well as the inability to perform everyday tasks. Bipolar disorder, which affects about 6 million people in the US alone, is marked by periods of unusually intense emotions, including alternating episodes of mania and depression.1 During a manic episode, the person feels restless, energized, and agitated. They often talk abnormally fast, have racing thoughts, and engage in reckless behaviors. During a depressive episode, the person feels very sad, hopeless, empty, and tired. They have abnormal sleep and eating patterns, have low energy, and sometimes contemplate suicide. Clearly these two episodes are vastly different, and with each lasting for days, weeks, or even months, the person may feel like they are on an emotional rollercoaster. Additionally, a person might experience symptoms of both mania and depression simultaneously in a period referred to as a mixed state (see picture). With the help of medication and therapy, many people are able to decrease the intensity of their manic and/or depressive episodes and 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 often feel indestructible and not concerned with 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 manic people to experience a significant increase in sex drive that they feel cannot be satisfied, leading them to engage in impulsive and risky sexual behaviors.
Such behaviors include:
- Unprotected sex
- Sex with multiple partners or strangers
- Having one night stands
- Extramarital affairs
These behaviors can lead to unwanted pregnancy, contraction of a STI, and can destroy relationships. Bipolar people in 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 hypersexuality and finds that it is causing problems in their life, they should talk to a doctor. Medication and therapy, which help manage the underlying bipolar disorder, can help mediate hypersexuality. Because bipolar 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 are experiencing.3
Sex During a Depressive Phase
During a depressive phase, some people lose interest in sex completely, or they feel like they do not have enough energy to become aroused and engage in sexual activities. This lowered sex drive during a depressive episode, especially if it occurs right after a period of mania marked by hypersexuality, can confuse partners and leave them feeling frustrated, confused, and rejected. Depression can also lead to sexual difficulties, including erectile dysfunction and delayed ejaculation in men.5 On the other hand, some people may turn towards sexual activities as a way to help dull the pain, just as many others 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), Latuda (lurasidone), Risperdal (risperidone), Saphris (asenapine), Seroquel (quetiapine), Zyprexa (olanzapine) .7 These are used if the person is experiencing episodes of psychosis, 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 drugs mentioned above.8
- 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 better if they are also in some sort of therapy.8
- Electroconvulsive therapy (ECT): This procedure involves attaching electrodes to the person’s scalp and sending small electrical currents through their brain. This is supposed to change the electrical activity in the brain, causing a brief seizure and altering chemicals in the brain. This procedure 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 bipolar disorder 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.8
Many medications used to treat bipolar disorder can have negative side effects, including decreasing sex drive. The most common class of medications that can have sexual dysfunction side effects (especially erectile dysfunction) are the antipsychotics. However, for the most part, medication that treats bipolar disorder and helps stabilize the alternating episodes of mania and depression can help 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 the proper combination of medication and therapy, people with bipolar disorder can live a much more stable life.
It is important to talk with a doctor about your specific medication and ask them about changing your dosage or switching medication until you arrive at a place where your sex drive is what you want it to be, while still keeping your bipolar disorder under control. We do not advise you to adjust your own dosage or stop taking your medication without consulting a doctor, as this can send you into a more severe episode of mania or depression.
1. Duckworth, Ken, M.D. “Mental Illness Facts and Numbers.” National Alliance on Mental Illness (n.d.): n. pag. Mar. 2013. Web. 18 Apr. 2016. <http://www2.nami.org/factsheets/mentalillness_factsheet.pdf>.
2. “Bipolar Disorder.” National Institues of Health. National Institute of Mental Health, Apr. 2016. Web. 18 Apr. 2016. <https://www.nimh.nih.gov/health/topics/bipolar- disorder/index.shtml>.
3. “Bipolar Hypersexuality.” SexHealthMatters. Sexual Medicine Society of North America, Inc., Apr. 2013. Web. 18 Apr. 2016. <http://www.sexhealthmatters.org/did-you- know/bipolar-hypersexuality>.
4. Solovitch, Sara. “Opening the Door on Hypersexuality.” BpHope. N.p., 1 May 2009. Web. 18 Apr. 2016. <http://www.bphope.com/opening-the-door-on-hypersexuality/>.
5. Connell, Kelly, PhD. “Bipolar Disorder & Sexual Health.” Healthline. N.p., 13 May 2015. Web. 18 Apr. 2016. <http://www.healthline.com/health/bipolar-disorder/sexual- health#SexualityandDepression3>.
6. Healthwise Staff. “Mood-stabilizers for Bipolar.” WebMD. WebMD, 14 Nov. 2014. Web. 19 Apr. 2016. <http://www.webmd.com/bipolar-disorder/mood-stabilizing-medications-for- bipolar-disorder>.
7. Goldberg, Joseph, M.D. “Antipsychotic Medication for Bipolar Disorder.” WebMD. WebMD, 17 Sept. 2014. Web. 19 Apr. 2016. <http://www.webmd.com/bipolar- disorder/antipsychotic-medication>.
8. Smith, Melinda, M.A., Lawrence Robinson, and Jeanne Segal, PhD. “Bipolar Medication Guide.” HelpGuide. N.p., Apr. 2016. Web. 19 Apr. 2016. <http://www.helpguide.org/articles/bipolar-disorder/bipolar-medication-guide.htm>.
Last Updated 20 May 2016.