Bipolar disorder may cause big shifts in your sexuality. One moment you may be hypersexual, and the next, hyposexual. But you can maintain a balanced sex life with bipolar disorder.
People who live with bipolar disorder may experience both euphoric (manic) and depressive episodes.
During a manic episode, you may experience hypersexuality or an increase in sexual activity. During a depressive episode, you may lose interest in sex.
These sexual fluctuations and any medications you may take for bipolar disorder may influence your sex life.
Keep taking your medicationDon’t stop your bipolar medication because of sexual side effects. Stopping your bipolar medication may trigger a manic or depressive episode.
Talk with your doctor if you think your medication is lowering your sex drive. They may be able to adjust your dosage or help you choose a different medication.
During a manic episode, your sex drive (libido) and sexual impulses may lead to sexual behavior that’s atypical for you when you aren’t experiencing a manic episode.
Examples of hypersexuality during a manic episode may include:
- greatly increased sexual activity without a feeling of sexual satisfaction
- sex with multiple partners, including strangers
- excessive masturbation
- continuous sexual affairs, despite the potential risk to relationships
- sexual behavior or actions that may result in negative effects, such as having unprotected sex
- preoccupation with sexual thoughts
- increased use of pornography
A 2021 pilot study of five people with bipolar disorder found that they experienced a higher sexual drive during manic episodes. They engaged in some or more sexual interactions as a result.
You may also feel like your sexual urges are difficult or impossible to control during a manic episode.
Teens and younger children with bipolar disorder may display inappropriate sexual behavior toward adults as a symptom. This may include:
- inappropriate flirting
- inappropriate touching
- heavy use of sexual language
You may experience the opposite of hypersexuality during a depressive episode — a low sex drive or hyposexuality. A lower sex drive is also associated with depression.
Participants in the same 2021 pilot study as above also described their sexual desires during a depressive episode:
- Female participants experienced a low sex drive.
- Male participants described more negative sexual feelings associated with self-destructive behavior, such as asking their partner to inflict pain during sex.
These inconsistencies in lived experiences highlight how everyone may endure hyposexuality differently.
A depressive episode may also cause sexual dysfunction. This includes erectile dysfunction (ED) in men and high levels of sexual distress for women.
A 2023 observational study of 45 people with bipolar depression found that 41 (91%) reported sexual dysfunction.
A 2018 research review of older studies analyzed the effects of medications for mental health conditions, including bipolar disorder, and their impact on sexual health.
The researchers state sexual dysfunction to be one of the most common side effects of:
- mood stabilizers, such as lithium
- anticonvulsants, such as valproate (valproic acid) and carbamazepine
- antipsychotics
- antidepressants
- benzodiazepines
These medications are commonly prescribed in monotherapy or combination therapy treatment for bipolar disorder.
Remember: It’s important to continue taking your bipolar disorder medication unless your doctor tells you otherwise. Stopping without approval may have serious health consequences.
Lithium, anticonvulsants, and benzodiazepines and sexual dysfunction
A 2020 study tested the effects of treatment with lithium in people with bipolar disorder. They were split into four treatment groups:
- lithium alone
- anticonvulsants alone
- lithium and anticonvulsants
- lithium and benzodiazepines
After 6 months of treatment, participants self-reported their sexual desire, arousal, and orgasm. From the self-reports, the researchers concluded:
- Lithium alone or lithium with benzodiazepines may be related to worse total sexual functioning and desire than anticonvulsants alone.
- Lithium with benzodiazepines or anticonvulsants may negatively affect sexual orgasm and arousal.
- Lithium with benzodiazepines may also improve sexual arousal.
- Anticonvulsants alone may have the least negative effects on sexual functioning.
Antidepressants and sexual dysfunction
A 2020 research review lists specific classes of antidepressants that may have a high risk of sexual dysfunction,
- Selective serotonin reuptake inhibitors (SSRIs):
- Serotonin and norepinephrine reuptake inhibitors (SNRIs):
- Tricyclic antidepressants:
- clomipramine
- Other antidepressants:
- vortioxetine (medium to high risk)
Benzodiazepines and sexual dysfunction
A 2021 research review of older studies looked at sexual dysfunction from benzodiazepines, a type of sedative.
It found that some may decrease your sexual desire and desire to orgasm and may cause ED. These medications may include:
Recognize your symptoms and triggers
Determine which situations may trigger your shifts in mood and sexual desire. This may help you avoid them if necessary.
Learn the side effects of your medication
Ask your doctor about medications that are the least likely to have sexual side effects.
According to a 2020 research review, antidepressants with a low risk for sexual dysfunction
- moclobemide
- agomelatine
- bupropion
- mirtazapine (low to medium risk)
- reboxetine
Bupropion, in particular,
The research, however, is very limited. More research on the sexual effects of bipolar disorder medications is needed.
The Food and Drug Administration hasn’t approved bupropion for the treatment of low libido. Your doctor may prescribe it for off-label use.
Take medications to address sexual side effects
Some medications, in particular, may directly help with the sexual side effects of your bipolar disorder medication.
For example, ED pills, such as sildenafil and tadalafil, may help with maintaining an erection for people with a penis.
However, medications used to address the sexual side effects of bipolar disorder have their side effects, too.
Side effects of ED pills are mostly mild but may include:
Speak with your doctor if the benefits of taking additional medications, such as ED pills, will outweigh the risks for you.
Understand the consequences of sexual activities
This is especially important during periods of hypersexuality.
Understanding what can happen as a result of sexual activities is important, as it relates to events that may be unintended, such as an unplanned pregnancy.
Having clarity about your sexual actions can also help prevent STIs.
Consider behavioral or sex therapy
Behavioral therapy or sex therapy may help you manage sexual urges bipolar disorder may cause.
Individual and couples therapy are often effective in helping you and/or your partner maintain a balanced sex life. These may be available online or in person.
During a manic phase of bipolar disorder, you may take sexual risks and be less concerned with the consequences. During a depressive episode, you might feel apathetic about sex or upset by a loss of libido.
Managing your bipolar disorder is the first step toward improving your sex life. Many people living with bipolar disorder have healthy relationships and satisfying sex lives.
The key is working with your doctor to find the right treatment and talking with your partner about any sexual issues that you may experience.