People with bipolar disorder often experience changes in their sex lives alongside their mood shifts, but exactly how these symptoms connect over time has rarely been measured. A recent six-month study of newly diagnosed patients found that depressive symptoms correspond with lower sexual desire and increased distress about sex, while daily mood swings are linked specifically to higher sexual distress. The research was published in the Journal of Psychiatric Research.
Bipolar disorder is a mental health condition characterized by extreme shifts in a person’s mood and energy levels. These shifts manifest as distinct clinical episodes. During depressive episodes, individuals may feel intense sadness, lethargy, and a loss of interest in daily activities. During manic or hypomanic episodes, individuals experience elevated energy, impulsivity, and sometimes a decreased need for sleep.
Clinical observations frequently note that energy fluctuations influence a patient’s sexual life. The risk of sexual dysfunction is often elevated in psychiatric populations. Sexual function generally involves multiple phases, including an initial desire phase followed by arousal and physical climax. In clinical settings, the desire phase is particularly relevant for people with bipolar disorder because a sudden increase or decrease in sexual interest is a known symptom of the condition.
Another component of sexual health is sexual distress. This concept is distinct from physical sexual dysfunction. Sexual distress encompasses feelings of inadequacy, grief, frustration, and worry that arise from a person’s sexual problems. To formally diagnose a clinical sexual dysfunction, a medical provider must confirm that the patient is experiencing distress about their symptoms.
Researchers Helle B. Krogh, Caroline Fussing Bruun, Jeff Zarp, Maria Faurholt-Jepsen, Lars Vedel Kessing, Annamaria Giraldi, and Maj Vinberg conducted the study. The team is affiliated with the Sexology Clinic at Copenhagen University Hospital and the University of Copenhagen in Denmark.
The researchers noted a lack of longitudinal data tracking sexual health in this patient population. Most previous studies relied on cross-sectional designs, which capture a single snapshot in time. A snapshot approach can obscure how symptoms evolve. The team wanted to track patients over several months to see how formal psychiatric episodes, as well as minor daily mood changes, impact sexual desire and distress.
The researchers recruited 236 adults between the ages of 18 and 68. All participants had received a diagnosis of bipolar disorder within the previous two years. The study spanned six months, with participants attending in-person clinical visits at the start of the study, at three months, and at six months.
During the clinical visits, medical professionals evaluated the participants using standardized rating scales. They used the Hamilton Depression Rating Scale to measure the severity of depressive symptoms. They used the Young Mania Rating Scale to measure the intensity of manic symptoms. These tools assign numerical scores to a patient’s psychological state based on a clinical interview.
Participants also filled out several questionnaires. They used the Changes in Sexual Functioning Questionnaire to report their levels of sexual desire. They used a separate tool called the Sexual Distress Scale to quantify their feelings of frustration or worry regarding sex. Participants also completed a general assessment of their physical, psychological, and social quality of life.
To capture the nuances of bipolar disorder between formal clinical visits, the study utilized a smartphone application. Participants logged their mood every day using a nine-point scale on their phones.
The daily check-ins allowed the researchers to measure mood instability. Mood instability refers to the day-to-day emotional turbulence that patients experience even when they are not in a full depressive or manic episode. The researchers used a statistical formula to calculate how much a participant’s mood jumped around from one day to the next based on the smartphone data.
The data showed a distinct relationship between depressive symptoms and sexual desire. Participants with higher depression scores consistently reported lower levels of sexual desire. This finding aligns with trends seen in people who have unipolar depression without manic episodes.
In contrast, higher scores on the mania scale were initially associated with increased sexual desire. To test the strength of these relationships, the researchers conducted a secondary analysis. They removed the specific questions about sexual interest from both the depression and mania rating scales, aiming to see if the overall mood state still predicted sexual desire.
When the sexual interest questions were removed, the association between depressive symptoms and reduced desire remained intact. The link between manic symptoms and increased desire was no longer statistically significant. The researchers suggest that the initial finding regarding mania might have been an artifact of overlapping questionnaire design rather than a distinct effect of the manic mood state itself.
The team found a different pattern when analyzing sexual distress. Higher depressive symptoms were strongly associated with an increase in sexual distress. Participants who were more depressed felt more frustration and worry about their sex lives. Better overall quality of life was associated with decreased sexual distress.
Higher levels of manic symptoms did not correspond with increased sexual distress. This suggests that the heightened sexual desire or activity that often accompanies manic states is not necessarily perceived as bothersome or worrying by the patient at the time it occurs.
The smartphone data revealed that mood instability is also linked to sexual health. Participants who logged more erratic daily mood changes on the app experienced higher levels of sexual distress. This suggests that day-to-day emotional fluctuations are associated with a person’s sexual well-being, even outside of severe mood episodes.
The researchers observed a massive amount of variety across the participant pool. Statistical modeling indicated that roughly two-thirds of the variation in sexual desire and distress scores was due to differences between individuals. The researchers noted that personal, societal, and relationship factors likely exert a large influence on sexual outcomes, highlighting the clinical diversity of people with bipolar disorder.
Only about 16 percent of the participants met the criteria for overall sexual dysfunction. This prevalence is remarkably low compared to previous studies, which have reported dysfunction rates nearing 50 percent in similar populations.
Several factors likely contributed to the lower rates of sexual dysfunction, creating some limitations for the study. The researchers specifically excluded individuals who were taking selective serotonin reuptake inhibitors. These medications are a common class of antidepressants known to cause high rates of sexual side effects. Excluding these patients likely removed many individuals who were experiencing medication-induced sexual dysfunction.
The participants in this study were also concurrently enrolled in a separate clinical trial testing a daily aspirin regimen. Participating in a clinical trial requires a high level of organization and compliance. This requirement may have attracted a subset of patients who were generally functioning better and experiencing less severe symptoms than the average person living with bipolar disorder.
The study only examined newly diagnosed individuals. The findings might not be generalizable to patients who have managed bipolar disorder for decades. The compounding effects of multiple hospitalizations or years of psychiatric medication could alter how mood impacts sexual health later in the course of the illness. Future research could investigate whether these patterns hold true for chronic patients or utilize qualitative interviews to explore the personal factors driving individual differences.
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.