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People newly diagnosed with bipolar disorder experience changes in their sexual desire and levels of sexual distress that closely track their shifting moods. A recent six-month study found that depressive symptoms were linked to lower desire and higher distress, while manic symptoms corresponded with increased desire. The findings were published in the Journal of Psychiatric Research.
Bipolar disorder is a psychiatric condition characterized by extreme swings in mood, energy, and activity levels. People with the condition typically experience episodes of depression, marked by deep sadness, hopelessness, and lethargy. They also experience periods of mania or hypomania, which involve elevated mood, impulsivity, and unusually high energy. Between these distinct episodes, individuals might also experience daily fluctuations in their emotional state, a phenomenon known to mental health professionals as mood instability.
Doctors and therapists have recognized that these emotional highs and lows often spill over into patients’ sex lives. Bipolar disorder can increase the risk of sexual dysfunction, which involves difficulties in the phases of sexual desire, arousal, or orgasm. However, most previous research on this topic has relied on single snapshot surveys of patients. Medical researchers wanted to better understand how specific mood symptoms interact with sexual desire and sexual distress across a longer period.
The research team was led by Helle B. Krogh, a researcher at the Sexology Clinic at Copenhagen University Hospital in Denmark. The team designed a longitudinal study to observe how symptoms of depression, symptoms of mania, and daily mood instability related to sexual function. They also wanted to look at sexual distress, which involves the grief, worry, and frustration people feel regarding their sex lives. Assessing distress is a necessary step for clinicians when diagnosing sexual dysfunction, making it a highly relevant factor for patient well-being.
The study enrolled 236 adults between the ages of 18 and 68 who had been diagnosed with bipolar disorder within the previous two years. The participants were evaluated at three specific points over a six-month period: at the beginning of the study, at three months, and at six months. During these visits, clinical researchers used standardized interviews to rate the severity of each participant’s depressive and manic symptoms.
To measure daily mood instability, participants used a smartphone application called Monsenso. The app prompted them to rate their mood every day on a scale ranging from negative to positive. This allowed researchers to track emotional turbulence outside of the formal clinical visits.
At each of the three in-person visits, participants also completed detailed questionnaires about their sexual functioning and overall quality of life. The sexual functioning surveys measured their current level of sexual desire and any distress they felt about their sexual experiences.
When analyzing the data, the researchers found a consistent pattern linking depression to sexual difficulties. Higher scores on the depression rating scale were associated with decreased sexual desire and an increase in sexual distress. This held true even after the researchers adjusted their statistical models to account for the age and sex of the participants. Women in the study generally reported lower sexual desire than men, and older age was linked to lower desire.
Symptoms of mania showed a different pattern. The data showed that higher scores on the mania rating scale were associated with increased sexual desire. The researchers did not find an association between manic symptoms and increased sexual distress. This suggests that the heightened sexual desire experienced during manic or hypomanic phases is not typically perceived as distressing by the individuals themselves at the time.
The researchers noted that heightened sexual interest is a central feature of manic episodes, which aligns with these observations. The daily smartphone ratings provided another layer of information about the patients’ experiences. The researchers found that greater day-to-day mood instability was associated with higher levels of sexual distress. This indicates that even outside of full-blown depressive or manic episodes, daily emotional turbulence correlates with worse sexual well-being.
The researchers also discovered that a large portion of the variation in sexual desire and distress was due to individual differences between people. The statistical models showed that over 60 percent of the variance in the sexual outcomes was attributable to factors unique to each person, rather than just their clinical mood symptoms. This highlights that sexuality is highly individualized and influenced by many personal, social, and situational factors beyond a psychiatric diagnosis.
Quality of life was also measured during the clinical visits using a standardized survey from the World Health Organization. The researchers found that a better overall quality of life was associated with lower levels of sexual distress. However, quality of life scores were not statistically linked to the level of sexual desire itself.
The study has several limitations that provide context for the results. Because the participants were observed in their natural clinical treatment rather than subjected to a controlled experiment, the findings can only show associations. The data cannot prove that mood symptoms directly cause the changes in sexual function.
The study also excluded patients who were taking certain common antidepressants known to cause sexual side effects. This exclusion, along with the fact that many participants were in partial or full remission from their mood episodes, may have resulted in a sample with better overall sexual functioning than the broader population of people with bipolar disorder. The researchers noted that participants with more severe symptoms might have dropped out of the study before the six-month mark.
This attrition means the findings might mostly reflect the experiences of individuals who have relatively stable disease progression and are functioning well in their daily lives. Future studies would benefit from including a wider range of participants, particularly those with higher scores for manic symptoms. This would help determine if the patterns hold true during severe manic episodes.
The research team suggested that healthcare providers should regularly ask patients about their sexual health. Initiating these conversations could help patients manage sexual distress both during active mood episodes and during periods of relative stability.
The study, “The impact of affective symptoms and mood instability on sexual desire and sexual distress in newly diagnosed bipolar disorder: a longitudinal study,” was authored by Helle B. Krogh, Caroline Fussing Bruun, Jeff Zarp, Maria Faurholt-Jepsen, Lars Vedel Kessing, Annamaria Giraldi, and Maj Vinberg.