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Does Depression Cause ED? Here’s What the Research Says

Fact Checked

Depression can take a toll on your mood and impact your sex life. Likewise, erectile dysfunction can cause depression. Here’s how these two conditions are connected and what you can do about it.

Last Updated: 02/18/2025

Written by

Kimberly Wilkes

If you’re depressed, your mood and motivation can take a hit. It can cause you to lose pleasure in activities that once gave you joy, like sex. Scientists call this loss of pleasure anhedonia. As your sexual desire fades, it can impact your sex life and lead to erectile dysfunction.

The catch is that it works both ways—depression can lead to erectile dysfunction and ED also can lead to depression and affect your physical and mental health.

Here’s what the research has to say about depression and erectile dysfunction and what you can do to lift your mood and improve both your sexual function and your mental health.

Is It Depression or Something Else?

We all get sad or down from time to time. It doesn’t always mean you have full-blown depression.

You might suspect you’re depressed if you have:

Persistent feelings of hopelessness or pessimism
Sad feelings or feelings of emptiness that won’t go away
Irritability, frustration, or feelings of restlessness
Loss of interest in activities or hobbies that once gave you pleasure
Fatigue
Inability to concentrate
Insomnia or oversleeping
Poor appetite
Suicidal thoughts
Low self-esteem
Increased use of alcohol or drugs

There are also different types of depression. The two most common types are:

Major Depressive Disorder – In this form of severe depression, a person must be suffering from depressive symptoms for at least two weeks or longer and their symptoms interfere with the activities of daily living.(1)
Mild or Moderate Depression (Persistent Depressive Disorder) – This is a long-term type of depression that lasts for at least two years or longer. Depression symptoms are milder than with major depressive disorder but can at times be severe. You may feel hopeless and empty, lose interest in activities you once enjoyed, and have problems with relationships, work, and daily responsibilities.(2)

Depression and other mental disorders like anxiety are not something to take lightly. If you have any of the symptoms, it’s important to see your healthcare provider in order to get help.

What the Research Says About Depression and Erectile Dysfunction

Research shows that there’s definitely a link between depression and ED. In one review of the medical literature published in 2018, men with depression were 39% more likely to have erectile dysfunction.(3) The opposite was also true—having erectile dysfunction was a risk factor for developing depression.

According to the researchers, “Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED.”

The Results of Other Studies

Other research supports the connection between depression and erectile dysfunction. For example:

Whether ED causes depression or depression causes ED is difficult to pinpoint in a given patient. In most patients who have major depression, getting rid of the depression results in a return of erectile function.(4) In other people who suffer from minor depression, improving sexual function can lead to an improved mental outlook.(4)
Men with high depression scores are nearly twice as likely to have erectile dysfunction compared with non-depressed men.(5)
Erections in the middle of the night didn’t last as long and they weren’t as rigid in depressed men.(6) Nocturnal erections are a sign of sexual health.

How Does Depression Cause Erectile Dysfunction?

A depressive mood can lead to ED in several ways:

Negative Thoughts

The pessimism, hopelessness, irritability, and sad mood of clinical depression aren’t exactly going to do a lot for your sex life and sexual desire and can lead to male sexual dysfunction. People with depression also can suffer from a condition called anhedonia, where activities that once gave them joy are no longer pleasurable, such as sex.

Low Testosterone

Men who are depressed often have low levels of testosterone, a hormone linked to sexual health, which puts them at increased risk for sexual problems. This spells trouble for sex drive, libido, and erectile function. Treating depressed men with testosterone leads to a reduction in depressive symptoms, according to a review of 27 randomized placebo-controlled clinical trials involving a total of 1,890 men.(7)

Likewise, low testosterone levels are linked to erectile dysfunction, while testosterone replacement therapy can reduce ED in many men.(8)

A Genetic Connection

Men who have both depression and erectile dysfunction may have their genes to blame. Scientists have found 85 common genes between ED and depression. A lot of these genes have to do with free radical damage, which plays a role in both ED and severe depression.(9)

Free radical damage stops the body from producing nitric oxide, a molecule involved in erections. The brain also is especially vulnerable to free radical damage, and scientists believe free radical injury is the main cause of major depressive disorder.

Brain Chemicals

Sexual desire starts in your brain. Once aroused, your brain uses chemicals known as neurotransmitters to send signals to the sex organs, which leads to increased blood flow. In a person with depression, these brain chemicals involved in sexual desire are out of whack.

Brain chemicals linked to both mood and erectile function include:

Dopamine – This neurotransmitter is involved in mood and erectile function. It’s the main neurotransmitter in the central nervous system and it promotes sexual motivation, the act of having sex, and genital reflexes. Dopamine is involved in feelings of pleasure and satisfaction.
Serotonin – Optimal levels of this brain chemical/hormone keep you feeling happy and calm. It’s also involved in libido and sex drive, so if levels are imbalanced it may lead to sexual dysfunction and your sex life may suffer.

Antidepressant Drugs Side Effects

Drugs used to treat depression often have sexual side effects. These side effects are especially common in people taking a type of antidepressants known as selective serotonin reuptake inhibitors or SSRIs for short. An analysis of published studies found that between 30% to 60% of people taking SSRIs experience sexual side effects.(10)

Selective serotonin reuptake inhibitors include:

Celexa® (Citalopram)
Cymbalta® (Duloxetine)
Lexapro® (Escitalopram)
Prozac® (Fluoxetine)
Zoloft® (Sertraline)

Treatments for Depression and Sexual Dysfunction

Visit Your Healthcare Provider

The first step is visiting your healthcare provider, who can help you determine if your antidepressant medication is the culprit behind your erectile dysfunction. You should never stop taking your antidepressant medications all at once, since this can cause withdrawal symptoms or make your depression worse.

Your healthcare provider can help you switch medication, reduce your dose, or temporarily stop taking the antidepressant when you plan to have sex. Again, this should all be done under a doctor’s care, since depression is a serious mental health illness.

Lifestyle Factors

Exercising more can all improve your mental outlook and male sexual function. Research has found that exercise is as effective as antidepressants in mild to moderate depression.(11)

There’s a lot of good research showing exercise can benefit guys with ED. For example, in one study, a randomized controlled trial, 110 obese men between 35 to 55 years old who did not have diabetes, hypertension, or high cholesterol were told to exercise more over two years.(12) When the men increased their aerobic exercise from 48 to 195 minutes per week, their erectile score increased from 13.9 to 17.

Changing your diet also is good for your mood and your sexual function. Diet can directly affect your mood and weight, but depression also can lead you to make poor food choices.(13)

A Mediterranean-style diet is a good choice, since research has shown it improves mental health and erectile function.(14,15)

Counseling

Talk therapy is an effective way to get at the root cause of mental health problems that are affecting your mood and your sexual function. A therapist can discuss psychological factors that are causing your depression and suggest coping strategies.

What If ED Is Actually Causing Your Depression?

Although depression can cause erectile dysfunction, ED also can cause depression. The frustration of sexual dysfunction can affect your sex life and send you down in the dumps.

If erectile dysfunction is to blame for your mental health issues, the best approach is to work with your healthcare provider. Dr. Paul Thompson, a urologist and surgeon for over 30 years, finds that the following options are the most effective:

ED Medications

“These can work for some men, but for a lot of guys the meds stop working over time,” says Dr. Thompson. “ED pills also have side effects and they have to be taken right before sex, which is inconvenient for a lot of men.”

Penis Pumps

Dr. Thompson finds this method to work especially well when combined with other therapies. A penis pump creates a vacuum, which pulls blood into the penis to help it become erect. It’s usually used with a constriction band to hold the blood in the penis while you’re having sex.

In a study of middle-aged and older male veterans published in 2021, more than 96% of patients felt the device helped them maintain an erection and all of the men said they would recommend the device to others. Female partners felt that sex was better with the device.

Some of the men (23%) felt the device was uncomfortable, especially due to the constriction band. “So this solution isn’t for everybody,” Dr. Thompson says, “and there is a bit of a learning curve.”(16)

Acoustic Soundwave Therapy

One of Dr. Thompson’s top picks for supporting healthy erections is acoustic soundwave therapy, also known as low-intensity extracorporeal shock wave therapy or Li-ESWT for short. He’s used this therapy in his office for over a decade. A new device that men can use at home is more affordable and just as effective, Dr. Thompson says.

“It’s easy to use thanks to a protocol I created,” he explains. “You only use it twice a week for 17 minutes each time for a month and then you rest for another month. You resume using it for another month and then take another month off. Some of the best results occur in the off months while the tissue heals.”

Penis Ring

This is a good method to combine with other therapies. A cock ring is often used with a penis pump to hold the blood flow into the penis, but it can be used by itself to maintain an erection. Penis rings are worn around the base of the penis to keep the blood from flowing out.

“You’ll need to be either partially or completely erect to wear the ring,” Dr. Thompson explains, “ but if you’re having trouble getting there, try using the penis ring together with a penis pump.”

Exercise and Diet

“Getting more exercise and improving your diet are two of the best ways to enhance other forms of therapy,” Dr. Thompson says. “Both research and my experience in clinical practice indicate that eating a Mediterranean diet and engaging in more aerobic exercise can lead to satisfactory sexual performance, especially if you’re doing these two things together with other therapies such as acoustic soundwave therapy. So get ready to tackle the treadmill at the gym then come home and cook yourself a fish dinner with lots of vegetables.”

Frequently Asked Questions About Depression and ED

Can depression stop morning wood?

Morning wood are those erections that occur either in the middle of the night or during the early morning when you’re sleeping. Scientists call this nocturnal penile tumescence. It’s a sign that everything is working normally and you’re not experiencing any sexual dysfunction.

When you’re depressed, it can affect your risk of ED, and research has shown that men with depression have morning wood episodes that don’t last as long as they do in men who are not depressed.(17)

How does depression cause erectile dysfunction?

Many men who have depression also have ED. Depression can have sexual health implications because it::

Creates negative thoughts
Lowers levels of testosterone
Affects genetics
Impacts brain chemicals that are also linked to sexual health
Leads to taking antidepressants, which are known to cause erectile dysfunction as a side effect.

Working with your healthcare provider to improve your depressive symptoms can also improve your ED.

Can erectile dysfunction cause depression?

Yes, if you have ED, it can lead to feelings of anxiety and depression. ED is a psychological burden that can weigh you down and take away your happiness. Struggling to get or maintain an erection can lead to frustration, anxiety symptoms, low self-esteem, and unhappiness. It can lead to relationship problems, which can contribute to depression. Treating erectile dysfunction, on the other hand, can improve mental health.