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Sexual concerns

Erectile dysfunction and depression often occur together, possibly as a result of common risk factors, including age, diabetes, obesity, cardiovascular disease, and sedentary lifestyle. Without these or other physical problems, depression alone can be the cause of erectile dysfunction.

With three phosphodiesterase-5 inhibitor (PDE-5) oral agents for erectile dysfunction available and widely marketed in the media — sildenafil (Viagra), vardenafil (Levitra), and taldalafil (Cialis) — men are now seeking treatment for erectile dysfunction in record numbers. A reciprocal relationship is emerging in which treatment for erectile dysfunction improves underlying depression scores.¹⁵

Yet the reverse must not be overlooked. Thorough screening by clinicians before prescribing PDE-5 medications may reveal underlying depressive disorders that need to be addressed.

Treatment for depression, however, doesn’t always result in improved erectile function. Some medications used for depression actually interfere with sexual function and may ultimately lead men to refuse or discontinue treatment.¹⁴ Impotence and abnormal ejaculation have been reported with mirtazipine (Remeron) or venlafaxine (Effexor), and men who take trazodone (Desyrel) or nefazodone (Serzone) have experienced priapism. Men who take any of the SSRIs may experience decreased libido.¹⁶ Wellbutrin and other atypical antidepressants can affect libido less than Prozac, Paxil, and Zoloft, the commonly prescribed SSRIs. For anyone taking an antidepressant, careful monitoring with an eye toward the need for medication adjustment is the rule.

Desperately seeking ...

Instead of turning to a health care professional, some men who feel depressed will self-medicate with alcohol or illicit drugs. Excessive marijuana use is closely associated with a high incidence of depression.¹⁷ In others, impulsivity, violence, and problems with anger may signal depression, especially in youth: Angry young men may be seriously depressed young men — just undiagnosed.

Some men turn to alternative or complementary therapy to relieve their depression, and these choices have become increasingly more acceptable. Many fitness gyms and personal trainers also sport a variety of fitness-related supplements and services.

Some biological agents commonly used for depressed mood include hypericum perforatum (Saint-John’s-wort), s-adenosyl-l-methionine (SAMe), and 5-hydroxytryptophan (5-HTP).¹⁸ (See sidebar for precautions related to each of these biological agents.)

Other methods men may use to combat depression include exercise, relaxation therapy, yoga, tai chi, and biofeedback.¹⁸ Exercise promotes the release of natural mood-elevating endorphins. The benefits of yoga in reducing depressed mood and fatigue have been associated in one clinical study of 28 mildly depressed individuals with the development of higher morning cortisol levels.¹⁹

Nurses can help

Suicidal ideation presents a higher risk for men than for women. When men talk about suicide, pay close attention and seek immediate assistance, particularly if they have previously attempted suicide.

While women may talk about suicidal ideation more often, men use more violent methods and are more likely to complete suicide than women.²⁰