You’re busy, you’re tired, you’re stressed, and you’re definitely not in the mood. 

We all have days like this. And everyone finds themselves in a rut from time to time. These things pass. But for many women, a noticeably decreased sex drive that differs from their typical pattern can point to something more serious: major depressive disorder, says Jennifer Payne, M.D., director of the Women’s Mood Disorders Center at Johns Hopkins. In fact, major depression is nearly twice as common in women as it is in men — as many as 21 percent of women will experience major depression at some point. And lack of libido can be a tipoff.

“Change in sex drive is a key symptom we look at when deciding if someone fits the diagnosis for major depressive episodes,” Payne says. “A primary symptom of depression is the inability to enjoy things you normally enjoy, like sex. People with depression also have decreased energy, feel badly about themselves and might view their partners through a negative filter, all of which impacts sex drive.”

Other symptoms of depression include feelings of sadness, appetite or weight changes, decreased energy and trouble concentrating. Talk to a doctor if you have been experiencing these symptoms. Treatment can help you manage depression. 

A depression-related sexual slump is usually temporary. So if you’re dealing with depression, you don’t have to resign yourself to a sexless existence. 

How to Maintain Your Sex Drive, Even If You Have Depression

Even if you’ve been diagnosed with major depressive disorder, it’s possible to maintain a healthy sex life. Payne offers several tips:

• Get help for the depression. Payne recommends a combination of antidepressants and cognitive behavioral therapy (CBT). CBT helps treat depression by teaching people to recognize and reframe unhealthy thought patterns. Though this combination is very effective, it can take time to find the right balance, since some antidepressants can cause a reduced sex drive. “Your doctor might need to fiddle with finding the right medication for you. And they can take up to two months to work,” she says. Common antidepressant medications include selective serotonin reuptake inhibitors (serotonin is a neurotransmitter that affects mood) and bupropion, which affects neurotransmitters dopamine and norepinephrine in addition to serotonin.
• Keep doing it. Even if sex is the last thing on your mind, it’s important to keep those flames burning. “Sometimes I write prescriptions for my patients that tell them to go home and have sex with their partner,” Payne says. “If you don’t do it, it becomes a self-fulfilling prophecy: You’ll do it less and less. Having sex increases the chances that you’ll return to a regular sex life once you feel better.” Plus, she says, intimacy might give you a mental break from the depression.
• Don’t compare yourself to others. There’s no “right” amount of sex. “Some 80-year-olds have sex multiple times per week. Some 20-somethings might have sex once a month,” she says. Do what feels right for you and your relationship.
• Get buy-in from your partner. It can be difficult to recognize depression as a valid reason for decreased sex drive, Payne says, because mental illness is still stigmatized. It’s also invisible, unlike, say, a broken leg. “People don’t see depression as a serious illness,” she says. “I try to educate about how serious it is. I compare it to a medical illness, like diabetes. If your partner was having trouble sexually due to diabetes, you’d be understanding. Think about it from that perspective.”
• Redefine intimacy. You don’t need a hot and steamy tangle in the sheets to reap the benefits of a close physical relationship. If you’re not up for going all the way — or even part of the way — simply holding hands, snuggling or laughing together is helpful. 

Sometimes the most important thing you can do is remember that there’s a light at the end of the tunnel.

“Depression affects every aspect of a person’s life, including sex,” says Payne. “But once a doctor figures out the right medication, most people get completely better.” 

#TomorrowsDiscoveries: A Different Approach to Treating Psychiatric Disorders | Atsushi Kamiya, M.D.