When a Man’s Sex Drive Is Too Low

The male libido is always in overdrive, right? Wrong — one out of five men actually have a low sex drive.

Men. High sex drive. Panting sexual animals. We know what they want. And we know when they want it: right now.

Even doctors tend to see men as “sexual automatons,” hardwired always to want sex, says pioneering sex researcher Irwin Goldstein, MD, director of sexual medicine at San Diego’s Alvarado Hospital and editor in chief of The Journal of Sexual Medicine. “But that is not the case at all,” Goldstein tells WebMD Magazine. “Many, many men — about one in five –have such low sexual desire they’d rather do almost anything else than have sex.”

One in five men doesn’t want sex? How can that be true? And why haven’t we heard about it? Actually, many women have — the ones hearing the phrase “Not tonight, dear.” Goldstein says most people think that is a rare occurrence. “But in fact, almost 30% of women say they have more interest in sex than their partner has.”

The causes of low sex drive

So what’s behind low sexual desire? Aging plays a role, though many older men have a robust interest in sex, Goldstein points out. Like most other human traits, the sex drive varies. Most men are in the normal range; some are extraordinarily driven toward addiction-like sexual behavior. At the other end of the scale are men with very low sexual interest. These are men who suffer from hypoactive sexual desire disorder (HSDD).

“There are always men on both sides of the normal curve,” Goldstein says. “And a certain percentage — perhaps up to a quarter — will be considered to have HSDD for a whole host of reasons.” These include:

Psychological issues. Stress and anxiety from the strain of daily life, relationship or family problems, depression, and mental disorders are among the many factors that can affect sexual desire.

Medical problems. Diseases such as diabetes; conditions such as obesity, high blood pressure, and high cholesterol; and HIV drugs, some hair-loss remedies, and other medications can negatively affect sexual desire.

Hormonal causes. “Testosterone is the hormone of desire, arguably for women as well as for men,” Goldstein says. Low testosterone levels usually mean low sexual desire. Levels dip as men age; other causes include chronic disease, medications, and other drug use. Other hormones can play a role, too, such as low levels of thyroid hormone or, rarely, high levels of prolactin, a hormone produced in a gland at the base of the brain.

Low dopamine levels. Sexual desire obviously involves the brain — and the brain’s chemical messaging system is intimately linked to sexual desire. One of those messengers is dopamine. Doctors have noted that Parkinson’s disease patients treated with dopamine-stimulating drugs had increased sexual desire. Goldstein says these drugs help some men with HSDD.

Each cause of low sexual desire has its own treatment. When the root cause is psychological, sex therapy can offer men specific techniques and strategies for regaining their enjoyment of sex. “It is not psychotherapy; it is psychology counseling focused on sexual issues,” Goldstein explains.

In cases where the problem is low testosterone, men can take testosterone supplements if they have measurably low levels. About 25% of men go for weekly testosterone shots, Goldstein says, but most opt for skin patches or gel formulations applied directly to the skin of the chest, shoulders, or abdomen.

When Goldstein suspects low dopamine levels are at the heart of a man’s low sexual desire, he might prescribe dopamine-increasing drugs, though this treatment is not currently approved by the FDA and has risks.

However, a new drug now in clinical trials — for women — does increase dopamine levels while decreasing a specific kind of serotonin in the brain. Early clinical studies suggest the drug could help women with low sexual desire. Goldstein thinks this new treatment has promise. And if it’s approved for women, he says, it will likely be tested in men.

In the end, the choice for men who’ve lost their desire for sex is not between being a panting sexual animal and being a eunuch. Instead, the real choice is whether these men are ready to regain a vital source of intimacy with their partners — and a key part of a healthy life for themselves.

Non-starchy Vegetables

Eat more! You don’t often hear that when you have diabetes, but non-starchy vegetables are one food group where you can satisfy your appetite. Vegetables are full of vitamins, minerals, fiber, and phytochemicals – and with so few calories and carbohydrate, everyone can enjoy more!

There are two main types of vegetables – Starchy and non-starchy. For this section, we are going to focus only on the non-starchy vegetables. Starchy vegetables like potatoes, corn, and peas are included in the Grains and Starches section because they contain more carbohydrate.

What are the best choices?

The best choices are fresh, frozen and canned vegetables and vegetable juices without added sodium, fat or sugar.

General tips:

• If using canned or frozen vegetables, look for ones that say low sodium or no salt added on the label.
• As a general rule, frozen or canned vegetables in sauces are higher in both fat and sodium.
• If using canned vegetables with sodium, drain the vegetables and rinse with water then warm in fresh water. This will cut back on how much sodium is left on the vegetables.

For good health, try to eat at least 3-5 servings of vegetables a day. This is a minimum and more is better! A serving of vegetables is:

• ½ cup of cooked vegetables or vegetable juice
• 1 cup of raw vegetables

Tips for Carb Counters
Generally, non-starchy vegetables have about 5 grams of carbohydrate in ½ cup cooked or 1 cup raw. Most of the carbohydrate is fiber so unless you eat more than 1 cup of cooked or 2 cups of raw at a time, you may not need to count the carbohydrates from the non-starchy vegetables.

Tips for the Plate Method
Enjoy the colorful variety of vegetables to brighten your plate. With half of your plate filled with vegetables, your options are endless for delicious combinations. If you are still hungry after the plate on your food is gone, try having a salad with a low-calorie dressing to satisfy your appetite and get an extra serving or two of vegetables in at the same time.

Grains and Starchy Vegetables

There is no end in sight to the debate as to whether grains help you lose weight, or if they promote weight gain. Even more importantly, do they help or hinder blood glucose management? One thing is for sure. If you are going to eat grain foods, pick the ones that are the most nutritious. Choose whole grains. Whole grains are rich in vitamins, minerals, phytochemicals and fiber. Reading labels is essential for this food group to make sure you are making the best choices.

Every time you choose to eat a starchy food, make it count! Leave the processed white flour-based products, especially the ones with added sugar, on the shelves or use them only for special occasion treats.

What is a whole grain?

A whole grain is the entire grain — which includes the bran, germ and endosperm (starchy part). The most popular grain in the US is wheat so that will be our example. To make 100% whole wheat flour, the entire wheat grain is ground up. “Refined” flours like white and enriched wheat flour include only part of the grain – the starchy part, and are not whole grain. They are missing many of the nutrients found in whole wheat flour. Examples of whole grain wheat products include 100% whole wheat bread, pasta, tortilla, and crackers. But don’t stop there! There are many whole grains to choose from.

Best Choices
Finding whole grain foods can be a challenge. Some foods only contain a small amount of whole grain but will say it contains whole grain on the front of the package. For all cereals and grains, read the ingredient list and look for the following sources of whole grains as the first ingredient:

• Bulgur (cracked wheat)
• Whole wheat flour
• Whole oats/oatmeal
• Whole grain corn/corn meal
• Popcorn
• Brown rice
• Whole rye
• Whole grain barley
• Wild rice
• Buckwheat
• buckwheat flour
• Triticale
• Millet
• Quinoa
• Sorghum

Most rolls, breads, cereals, and crackers labeled as “made with” or “containing” whole grain do not have whole grain as the first ingredient. Read labels carefully to find the most nutritious grain products.

For cereals, pick ones with at least 3 grams of fiber per serving and less than 6 grams of sugar.

Best Choices of Starchy Vegetables
Starchy vegetables are great sources of vitamins, minerals and fiber . The best choices do not have added fats, sugar or sodium. Try a variety such as:

• Parsnip
• Plantain
• Potato
• Pumpkin
• Acorn squash
• Butternut squash
• Green Peas
• Corn

Best Choices of Dried Beans, Peas and Lentils
Try to include dried beans into several meals per week. They are a great source of protein and are loaded with fiber, vitamins and minerals.

• Dried beans such as black, lima, and pinto
• Lentils
• Dried peas such as black-eyed and split
• Fat-free refried beans
• Vegetarian baked beans

Tips for Carb Counters
Starchy foods are one of the main sources of carbohydrate in our diet — along with milk, fruits, and sweets. For most grains and starches, 1/2 cup or 1 oz contains 15 g of carbohydrate. A few exceptions are 1 cup of winter squash and pumpkin and 1/3 cup of rice has about 15 grams.

For the Plate Method
About 1/4 of your plate should come from starchy foods. Remember, only the depth of a deck of cards! This is usually about 3/4 to 1 cup of a starchy food.

For using the Glycemic Index
The general rule of thumb when using the GI to select foods is that the closer to nature, or less processed a food, the lower the GI. For example, whole rolled oats have a lower GI than instant oatmeal. Dried beans, lentils and starchy vegetables all have lower GI values. Potatoes are an exception but a small serving can still fit into your meal plan.

Diabetes Food Pyramid

The Diabetes Food Pyramid is another meal planning option that some people use. It is less popular compared to both carbohydrate counting and the plate method for diabetes management.

The Diabetes Food Pyramid divides food into six groups. These groups or sections on the pyramid vary in size. The largest group – grains, beans, and starchy vegetables – is on the bottom. This means that you should eat more servings of grains, beans, and starchy vegetables than of any of the other foods. The smallest group – fats, sweets, and alcohol – is at the top of the pyramid. This tells you to eat very few servings from these food groups.

The Diabetes Pyramid gives a range of servings. If you follow the minimum number of servings in each group, you would eat about 1600 calories and if you eat at the upper end of the range, it would be about 2800 calories. Most women, would eat at the lower end of the range and many men would eat in the middle to high end of the range if they are very active. The exact number of servings you need depends on your diabetes goals, calorie and nutrition needs, your lifestyle, and the foods you like to eat. Divide the number of servings you should eat among the meals and snacks you eat each day.

The Diabetes Food Pyramid is a little different than the USDA Food Guide Pyramid because it groups foods based on their carbohydrate and protein content instead of their classification as a food. To have about the same carbohydrate content in each serving, the portion sizes are a little different too. For example: you will find potatoes and other starchy vegetables in the grains, beans and starchy vegetables group instead of the vegetables group. Cheese is in the meat group instead of the milk group. A serving of pasta or rice is 1/3 cup in the Diabetes Food Pyramid and ½ cup in the USDA pyramid. Fruit juice is ½ cup in the Diabetes Food Pyramid and ¾ cup in the USDA pyramid. This difference is to make the carbohydrate about the same in all the servings listed.

Following is a description of each group and the recommended range of servings of each group.

Health by Chocolate – How enjoying a little chocolate might actually help your health.

“Take two squares of dark chocolate and call me in the morning.” I’d be all over those doctor’s orders! Can eating chocolate really be good for your health?

Well, if it is, I’m certainly in great shape. I rarely let a day go by in which I don’t enjoy a little bite of chocolate. I crave a little bit a day, much like those people who MUST have two cups of coffee in the morning.

The craving usually hits me mid-morning or right after lunch. A couple of squares or a small handful of chocolate-covered nuts, and I’m good to go. I just love the smoothness and the flavor of chocolate. No other food quite compares to it.

Chocolate and Your Health

The possible health benefits of chocolate stem from the antioxidant flavonoids. Chocolate comes from the cacao plant, and cacao is extraordinarily rich in flavanols, a type of flavonoid phytochemical. (Other plants rich in flavanols include tea, grapes, grapefruit, and wine.) That sounds simple enough, but some forms of chocolate have a lot more flavonoids than others.

So here’s Health by Chocolate Rule of Thumb #1: The more nonfat cocoa solids a chocolate product contains, the more antioxidants it tends to contribute.

And what about the fat found in the cacao bean? It’s true that cacao contains some saturated fat. But most of it is stearic acid — which studies have suggested doesn’t elevate blood cholesterol levels as much as other saturated fatty acids. The other fatty acids in cocoa butter are monounsaturated fat (considered a desirable fat) plus another saturated fat called palmitic fatty acid. But here’s where it gets confusing: chocolate products can have other types of fat added, like “milk fat” or “partially hydrogenated vegetable oil” or even coconut or palm oil (both naturally saturated oils), in addition to “cocoa butter.”

So here’s Health by Chocolate Rule of Thumb #2: If the chocolate contains fat ingredients other than cocoa butter, it might contain the more harmful saturated fats and trans fats, rather than stearic acid.

One tablespoon of cocoa butter oil contains:

• 8 grams of saturated fat (4.5 grams of which are from stearic acid and 3.5 grams of which are from another saturated fatty acid).
• 4.5 grams of monounsaturated fat.
• 0.4 grams of polyunsaturated fat (most of which is omega-6 fatty acids).

The Possible Health Benefits of Chocolate

More research needs to be done, but recent studies suggest four possible health benefits of dark chocolate and cocoa.

1. They May Reduce the Risk of Heart Attack.

A few squares of dark chocolate a day can reduce the risk of death from heart attack by almost 50% in some cases, says Diane Becker, MPH, ScD, a researcher with the John Hopkins University School of Medicine. Becker’s research found that blood platelets clotted more slowly in people who had eaten chocolate than in those who had not. This is significant because when platelets clump, a clot can form, and when the clot blocks a blood vessel, it can lead to a heart attack.

The Possible Health Benefits of Chocolate continued…

“The flavanols in cocoa beans have a biochemical effect of reducing platelet clumping, similar to but much less than aspirin,” Becker says in an email interview.

After reviewing 136 scientific publications on chocolate and its components and heart disease, researchers from Harvard University School of Public Health concluded that short-term studies suggest cocoa and chocolate may reduce the risk of cardiovascular disease by:

• Lowering blood pressure
• Decreasing LDL oxidation
• Anti-inflammation action

2. They May Decrease Blood Pressure and Increase Insulin Sensitivity

Researchers in Italy recently fed 15 healthy people either 3 ounces of dark chocolate or the same amount of white chocolate — which contains no flavanol phytochemicals — for 15 days. They found that insulin resistance (a risk factor for diabetes) was significantly lowered in those who ate the dark chocolate. Systolic blood pressure (the first number in a blood pressure reading), measured daily, was also lower in the group eating dark chocolate.

3. They May Improve Arterial Blood Flow

Healthy men who consume flavanol-rich cocoa may see improvements in the flow of blood through their arteries, according to recent research. The researchers found that when healthy men consumed the flavanol-rich cocoa, the ability of their blood vessels to relax improved significantly. And arterial blood flow is important for cardiovascular health.

4. They May Help People with Chronic Fatigue Syndrome

In a small study in England, 1 1/2 ounces of 85% cocoa dark chocolate was given to a group of adults with chronic fatigue syndrome every day for eight weeks. In the study, which has been submitted for publication, the participants reported feeling less fatigued after eating the chocolate. Surprisingly, no weight gain was reported in the chocolate-eating group, according to researcher Steve Atkin, PhD.

How might it work? The researchers believe that chocolate enhances the action of neurotransmitters, like serotonin, which help regulate mood and sleep. More research needs to be done to confirm a benefit in this area.

Not All Chocolate Is Created Equal

While the amount of the healthy antioxidant flavonoids varies from one type of chocolate to another, there’s one guideline you can take to the bank: The more nonfat cocoa solids in a chocolate product, the more antioxidants it likely contains.

So which type of chocolate has the most flavonoids? The highest levels are in natural cocoa powder (not Dutch cocoa, though, because it is alkalized cocoa). The type second highest in flavonoids is unsweetened baking chocolate. Dark chocolate and semisweet chocolate chips rank third, with milk chocolate and chocolate syrup at the bottom of the list.

Keep in mind, though, that flavanol levels in types of chocolate can vary based on:

• The cocoa beans selected.
• The processing of the beans and chocolate.
• Storage and handling conditions.

Perhaps in the near future, labels on chocolate products will list amounts of flavanols.

Which Type of Chocolate Has the Most Calories and Fat?

By far the lowest-calorie, lowest-fat form of chocolate is cocoa (the unsweetened type). A serving of 3 tablespoons has about:

• 60 calories
• 1.5 grams fat
• 0 grams saturated fat
• 3 grams fiber

The equivalent in unsweetened baking chocolate is 1 square (1 ounce), which contributes:

• 140 calories
• 14 grams fat
• 9 grams saturated fat
• 4 grams fiber

By comparison, a typical 2-ounce serving of semisweet or milk chocolate (with sweetener and other ingredients added) contains:

• 270 calories
• 17 grams of fat
• 10 grams of saturated fat

Semisweet chocolate adds around 3 grams of fiber per 2 ounces, while milk chocolate typically contributes zero. The mostly insoluble fiber in cocoa comes from the seed coat on the unprocessed cocoa bean.

All of this brings us to Health by Chocolate Rule of Thumb #3: For a better flavonoid-to-calorie ratio, choose cocoa powder whenever possible for baking and making hot chocolate.

Don’t Forget the Calories

One thing most chocolate bars have in common is calories. An ounce of sweetened chocolate will cost you about 150 calories — that’s about six to seven chocolate kisses. Here’s my take on it as a chocolate lover: Those six kisses are worth every calorie.

But here’s a word of caution: The health benefits of chocolate may disappear if you are adding the calories above and beyond your regular intake. This could mean you’re adding pounds along with the flavonoids.

Researchers from the University of California at Davis said it best in a scientific review on cocoa and chocolate flavonoids published in the Journal of the American Dietetic Association. They concluded that people may benefit from including a variety of flavonoid-rich foods as part of a healthful diet — and dark chocolate, in moderate amounts, can be part of this plan.

New and Improved Chocolate Products

Now that the word is out that chocolate may have health benefits, special chocolate products are hitting the shelves. Two examples are CocoaVia and Hershey’s Cacao Reserve.

1. CocoaVia (by Mars Inc.)

This product contains cocoa powder with a higher amount of flavanol than your average chocolate bar. The company has also added cholesterol-lowering soy sterol esters (similar to the type in Benecol and Take Control margarines). They have also added B-vitamins and calcium and two antioxidant vitamins, C and E.

Whether all this leads to much health benefits remains to be seen. I can tell you that the products I’ve tried taste worthy of your attention. If you are interested in trying CocoaVia, try to find them on sale because as the amount of nutrients and flavanols went up, so did the price.

There are several types of CocoaVia bars. The Original Chocolate Bars contain (per 22-gram serving):

• 100 calories
• 6 grams fat
• 3.5 grams saturated fat
• 9 grams sugars

2. Hershey’s Cacao Reserve

Want some of the benefits of dark chocolate but with the flavor of milk chocolate? Try the milk chocolate bars in the Cacao Reserve line by Hershey’s. I found them in my drugstore. I tried the Milk Chocolate with Hazelnuts with 35% Cacao. It was delicious, and a cross between a milk chocolate bar and a dark chocolate bar, I think.

Per 1 ounce (that’s a little more than 28 grams):

• 162 calories
• 11 grams fat
• 5 grams saturated fat
• 11.8 grams sugars

Chocolate Recipes

If you’re ready to cash in on the possible health benefits of chocolate (or at least the taste benefits), here are a couple of lighter dessert recipes to fulfill your chocolate cravings.

Chocolate Raspberry Pound Cake

WebMD Weight Loss Clinic members: Journal as 1 portion medium dessert

Dust this cake with powdered sugar and serve with fresh raspberries and a dollop of Light Cool Whip or whipping cream, if desired. If you don’t want to use Splenda, increase the sugar to 1 1/2 cups.

3/4 cup less-sugar raspberry preserves
1 cup whole-wheat flour
1 cup unbleached white flour
1 cup granulated sugar
1/2 cup Splenda
3/4 cup baking cocoa
1 1/2 teaspoons baking soda
1 teaspoon salt
1/2 cup less-fat margarine (with 8 grams of fat per tablespoon), preferably with plant sterols added
3 tablespoons raspberry-flavored liqueur (fat-free half-and-half can be substituted)
16 ounces fat-free sour cream
2 large eggs (use higher omega-3 type, if available)
1 1/2 teaspoons vanilla extract
Powdered sugar (for dusting)

• Preheat oven to 350 degrees. Coat an angel food pan (tube pan) with canola cooking spray and dust lightly with flour. Place the raspberry preserves in a small microwave-safe bowl and heat on HIGH for 15 seconds or until softened.
• Add whole-wheat and white flours, sugar, Splenda, cocoa, baking soda, and salt to large mixing bowl and beat on low to blend well. Stop mixer and add margarine, liqueur, sour cream, eggs, vanilla, and softened preserves all at once. Beat on medium speed for two minutes, scraping sides of mixing bowl after a minute.
• Pour batter into prepared pan and bake for 50-60 minutes, or until cake tester inserted in center comes out clean. Cool in pan 10 minutes, then remove cake from pan and place on serving plate to cool completely. When ready to serve, dust powdered sugar over the top. Serve with fresh raspberries and a dollop of whipped topping or whipping cream. if desired.

Yield: 16 servings

Per serving: 195 calories, 5 g protein, 36 g carbohydrate, 4 g fat, 1 g saturated fat, 3 g fiber, 311 mg sodium. Calories from fat: 18%.

Chocolate Truffle Bars

WebMD Weight Loss Clinic members: Journal as 1 portion of light dessert + 1 tablespoon nuts

If you would rather not use Splenda, simply delete it. These brownie-like bars have a wonderful texture, too.

2/3 cup less-fat margarine (with 8 grams of fat per tablespoon) like Take Control
1/3 cup fat-free half-and-half
7 ounces (7 squares) unsweetened baking chocolate, chopped
1 1/2 cups granulated sugar
1/2 cup Splenda
2 large eggs (use higher omega-3 type, if available)
1/2 cup egg substitute
1/2 cup whole-wheat flour
1/2 cup all-purpose white flour
1 1/2 teaspoon vanilla extract
1 cup walnut pieces

• Preheat oven to 350 degrees. Lightly coat a 9 x 13-inch pan (or two 9-inch square baking pans) with canola spray. Set aside.
• Add the margarine and fat-free half-and-half to a medium nonstick saucepan and melt the butter, stirring constantly, over medium-low heat. Once the margarine is melted, remove the pan from the heat.
• Add the chopped baking chocolate to the melted butter, stirring constantly with a wooden spoon until chocolate is completely melted. Add the sugar and Splenda and stir to blend well.
• Add the eggs, one at a time, stirring vigorously after each. Add egg substitute and stir to combine. Add the whole-wheat and white flours and stir to combine. Stir in the vanilla extract and walnuts.
• Pour batter into prepared baking pan(s) and bake for 23-25 minutes (20 minutes if using two pans). The brownies will still look somewhat soft and shiny. Remove from the oven and place on cooling rack.

Yield: 24 bars

Per serving: 130 calories, 3 g protein, 15 g carbohydrate, 7 g fat, 2 g saturated fat, 2.5 g monounsaturated fat, 2.5 g polyunsaturated fat, 13 mg cholesterol, 2 g fiber, 31 mg sodium. Calories from fat: 50%.

Treatments for Depression

The good news about depression is that you have a number of excellent treatments to choose from. More than 80% of people who get treatment for depression say that it helps them feel better.

Here’s a rundown of some of the most common approaches. Many people use a mix. For instance, you might try medicine and therapy at the same time. Some studies show that using both together is better than using either one alone.

Talk Therapy for Depression

Talking with a trained therapist is one of the best treatments for depression. Many studies show that it helps. Some people choose to be in therapy for several months to work on a few key issues. Other people prefer to stay in therapy for years, gradually working through larger problems. The choice is up to you. Here are some common types of therapy.

• Cognitive behavioral therapy helps you see how behaviors — and the way you think about things — play a role in your depression. Your therapist will help you change some of these unhealthy patterns.
• Interpersonal therapy focuses on your relationships with other people and how they affect you. Your therapist will also help you identify and change unhealthy behaviors.
• Problem solving therapy focuses on the specific problems you currently face, and on helping you find solutions to those problems.

Antidepressant Medicines

Medicines are the other key treatment for depression. There are now dozens of antidepressants that your health care provider can choose from. They include:

• SSRIs (selective serotonin reuptake inhibitors.) These common medicines include some well-known names, like Lexapro, Paxil, Prozac, and Zoloft. Side effects are generally mild. They include stomach upset, sexual problems, insomnia, dizziness, weight change, and headaches.
• Researchers have developed many types of antidepressants in recent years. These include drugs like Remeron, Wellbutrin, Cymbalta, and Effexor. Cymbalta and Effexor may also ease chronic pain in people with depression. Side effects are usually mild. They include stomach upset, sleep problems, sexual problems, dizziness, and weakness.
• Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) were some of the first medicines used to treat depression. While they work well, they can cause serious side effects and interact with some drugs and foods. Because newer medicines work just as well, these drugs aren’t used as often anymore. But if you can’t take newer medicines for some reason, your health care provider may suggest these.

ECT (Electroconvulsive Therapy) for Depression

This is a safe and effective treatment for people with depression that is resistant to medication. It’s typically used on people who haven’t been helped by medicines or therapy.

In ECT, your doctor will use electric charges to create a controlled seizure. These seizures seem to change the chemical balance of the brain. It may sound scary. But during the procedure, you’ll be unconscious, so you won’t feel anything.

ECT tends to work very quickly. It also works well — about 80%-90% of people who receive it show improvement. The most common side effect is temporary memory loss.

You might have up to 12 sessions over a few weeks. Some people get “maintenance” therapy with ECT to prevent depression from returning.

Vagus Nerve Stimulation (VNS) for Depression

Vagus Nerve Stimulation (VNS) is a new option for people with severe, treatment-resistant depression. Approved by the FDA in 2005, it’s used only on people who haven’t been helped by at least four antidepressants.

VNS involves implanting a small electrical generator in your chest, like a pacemaker. The device is attached with wires to the vagus nerve, which runs from the neck into the brain. Once implanted, the device sends electrical pulses to the vagus nerve every few seconds. The pulses are then delivered via the vagus nerve to the area of the brain thought to regulate mood. The electrical charges may change the balance of chemicals in your brain and relieve depression.

The device must be implanted by a surgeon, but patients can usually go home the same day.

Alternative Treatments for Depression

Some people use herbs, supplements, and other alternative therapies for depression. However, none of these approaches has been proven to work. Herbs and supplements — like St. John’s wort — can have side effects and cause interactions with other medicines. Never start taking an herb or supplement without talking to your doctor first.

Other alternative treatments — like acupuncture, hypnosis, and meditation — may help some people with their symptoms. Since they have few risks, you might want to try them, provided that your health care provider says it’s OK.

Sexual Problems in Women – Topic Overview

What are sexual problems?

A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.

Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.

There is no “normal” level of sexual response, because it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it’s common for an exhausted mother of a baby to have little interest in sex. And it’s common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.

What are some causes of sexual problems in women?

Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.

Some common causes include:

• Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
• Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
• Aging, which can cause changes in the vagina, such as dryness and stiffening.
• Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.

What are the symptoms?

Sexual problems can include:

• Having less desire for sex.
• Having trouble feeling aroused.
• Not being able to have an orgasm.
• Having pain during intercourse.

How are sexual problems in women diagnosed?

Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn’t working in the body and in life. For example:

• Are you ill, or do you take a medicine that can lower your sexual desire or response?
• Are you stressed or often very tired?
• Do you have a caring, respectful connection with a partner?
• Do you and your partner have the time and privacy to relax together?
• Do you have painful memories about sex or intimacy?

Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.

Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like “For the past few months, I haven’t enjoyed sex as much as I used to.” Or you could say “Ever since I started taking that medicine, I haven’t felt like having sex.”

How are they treated?

Treatment for sexual problems depends on what is causing the problem. There may be one or more issues causing the problems. Many sexual problems can be worked out after you know the cause or causes.

Sex involves emotional, physical, and relationship issues. Successful treatment requires a high level of comfort between you and your doctor. Ideally, you and your partner will also be able to talk openly about sexual concerns. Treatment may include treating health problems, getting communication counseling, and learning about things you can practice at home. For example, you might take a warm bath to relax, have plenty of foreplay before sex, or try different positions during sex.

Sexual Health: Sexual Problems in Men

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.

While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or psychological problem.

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who Is Affected by Sexual Problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation — This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation — This is when ejaculation is slow to occur.
• Retrograde ejaculation — This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.

What Is Erectile Dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (hardening of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie’s disease (scar tissue in the penis) also can cause erectile dysfunction.

What Is Inhibited Sexual Desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

How Are Male Sexual Problems Diagnosed?

The doctor likely will begin with a thorough history of symptoms. He or she may order other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other doctors, including a urologist (a doctor specializing in the urinary tract and male reproductive system), an endocrinologist (a doctor specializing in glandular disorders), a neurologist (a doctor specializing in disorders of the nervous system), sex therapists and other counselors.

What Tests Are Used to Evaluate Sexual Problems?

Several tests can be used to evaluate the causes and extent of sexual problems. They include:

• Blood tests — These tests are done to evaluate hormone levels.
• Vascular assessment — This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
• Sensory testing — Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body.
• Nocturnal penile tumescence and rigidity testing — This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man’s erectile problems are due to physical or psychological causes.

How Is Male Sexual Dysfunction Treated?

Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

• Medical treatment — This involves treatment of any physical problem that may be contributing to a man’s sexual dysfunction.
• Medications — Medications, such as Cialis, Viagra or Levitra, may help improve sexual function in men by increasing blood flow to the penis.
• Hormones — Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy).
• Psychological therapy — Therapy with a trained counselor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function.
• Mechanical aids — Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
• Education and communication — Education about sex and sexual behaviors and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can Sexual Problems Be Cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

Can Sexual Problems Be Prevented?

While sexual problems cannot be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor’s treatment plan for any medical/health conditions.
• Limit your alcohol intake.
• Quit smoking.
• Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed.
• Increase communication with your partner.

When Should I Call My Doctor?

Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, see your doctor for evaluation and treatment.

Seasonal Mood and Hormonal Changes – Does your menstrual cycle and the seasons affect your mood?

Many women report mood changes linked to their monthly menstrual cycles. Between 3% and 9% of women of reproductive age experience premenstrual dysphoric disorder (PMDD), often with severe depression symptoms.

How are these monthly mood changes — mild or severe — affected by seasonal weather and activities? When should you talk to a doctor and seek treatment for depression?

Seasonal Mood Cycles

“When we screen women to get into our studies of PMDD, many of them mention that they generally feel somewhat better in the summer, and worse in the winter,” says Jean Endicott, PhD, professor of clinical psychology in psychiatry at Columbia University College of Physicians and Surgeons. “We’ll sometimes get phone calls in the summer from women saying ‘It’s not so bad now, but will you be taking new patients in November?’”

Endicott doesn’t know of any scientific studies that specifically link severity of cycle-related mood changes to the seasons, but says it makes sense.

“In addition to the effect that light has on mood and depression, there’s the fact that women could be outdoors and exercising more during the summer months, and exercise can help with depressive symptoms linked to the hormonal cycle,” she says.

The link also makes biologic sense, adds Dorothy Sit, MD, assistant professor of psychiatry at the University of Pittsburgh Medical Center. “People who have changes in mood related to season may experience this partially due to changes in circadian rhythm,” she explains. “Estrogen and progesterone fluctuations have also been shown to advance and delay circadian rhythms.”

Whether these cyclic changes are enough to bring on or worsen mood changes or PMDD symptoms probably depends on the individual woman, and how sensitive she is to estrogen and progesterone.

Is It PMDD or Depression?

Before you conclude that your mood changes or depression are definitely linked to your menstrual cycle, try keeping a diary for three months, suggests Nada Stotland, MD, MPH, professor of psychiatry and obstetrics and gynecology at Rush Medical College in Chicago.

“Many women who think they have PMS [actually] have symptoms that have nothing to do with their cycles at all,” she says. “We tend to blame everything on that.”

Buy a calendar and chart your daily moods — up, down, happy, sad, tired, euphoric, angry, irritable, or fatigued. But make sure it’s a page-a-day calendar, not a monthly one.

“If you’re looking at a monthly calendar, you anticipate your period and are thinking, ‘That’s when I’m going to feel bad,’” Stotland says. “In order not to prejudice yourself, find a way to keep track of your moods day by day and not pay attention to where you are in your cycle. You can put that together later.”

Do You Need Treatment?

If your diary does indeed reveal that your ups and downs are linked to your cycle, how do you know if you should seek treatment? Consider some of these questions:

• Are you not just irritable at these times, but having the worst fights ever with your partner or children?
• Do you find yourself unable to enjoy work or family life at these times?
• Do you experience major disruptions in your ability to function, your eating habits, or your sleep patterns?
• Do you have extreme levels of anxiety and self-criticism?
• Do you have morbid thoughts about death, dying, or wanting to die?

If you answer yes to several of these questions (especially the last one), call your doctor. “If your cyclic symptoms really start to impair your work or personal life significantly, it’s time to seek professional help,” says Sit.

Treating PMDD

There are several options for treating PMDD, from cognitive behavioral therapy and light box therapy to medications such as antidepressants, anxiety medicine, birth control pills, or other hormone treatments.

Antidepressants
Some women are given antidepressants called SSRIs (selective serotonin reuptake inhibitors) to take just before they start menstruating. Typically treatment is started on cycle day 14 and stopped when menstrual bleeding starts. Generally, it takes several weeks for these antidepressants to have an effect, but for women suffering depression linked to menstrual cycles, the medicine seems to work more quickly.

Cognitive Behavioral Therapy
Cognitive behavioral therapy can help you develop skills to manage depression and mood changes linked to your menstrual cycle, says Catherine Monk, Herbert Irving Assistant Professor of Clinical Psychology in the departments of psychiatry and obstetrics at Columbia University College of Physicians and Surgeons.

“You can learn to have resources in place for when you go into your vulnerable period,” she explains. That may mean knowing not to schedule tough work deadlines during those days, or making sure to plan for a massage or not to miss your yoga class.

“Ahead of time, you should write a list of things that you really enjoy and that allow you to move outside yourself,” says Monk. “This may include books and DVDs that keep you from ruminating, or activities that energize you, like running or painting. Make the list ahead of time, because if you don’t, you won’t have the energy to do it when you’re feeling down. Then commit yourself to trying them even if you don’t want to.”

Light Box Therapy

Studies have also found that light box therapy — a specific treatment that mimics outdoor light and causes biochemical changes in the brain that improve your mood — may be effective for women with PMDD. It may be that light therapy improves melatonin levels, which have been found to be abnormal in women with PMDD.

Whatever treatment may work for you, it’s important not to dismiss your symptoms as “just PMS.”

“If we’re in a situation where we’re fortunate, we tend to think we couldn’t possibly be depressed and have no right to be,” says Stotland. “Or if our circumstances are lousy, we say, ‘No wonder I feel bad.’ But if you’re out in the cold and you get frostbite, you don’t say, ‘No wonder I have frostbite’ — you treat it. If you’re depressed, it’s important to do the same thing.”

Tips for Summer Depression – School’s out. It’s hot. And you’re not having any fun.

Ah, the joys of summer. The withering heat. School vacations, when your kids give you minute-to-minute updates on their boredom levels. Isn’t summer supposed to be fun and relaxing? If you’ve got summer depression, it isn’t.

For some people, summer depression has a biological cause, says Ian A. Cook, MD, the director of the Depression Research Program at UCLA. For others, the particular stresses of summer can pile up and make them feel miserable.

What makes depression in summer especially hard is that you feel like you’re supposed to be having a great time. Everyone else seems so happy splashing in the water and sweating in their lawn chairs. So why can’t you? And more importantly, what can you do to make this summer easier? Here’s what you need to know about summer depression.

Understanding Summer Depression

Why do some people feel more depressed in summer? Here’s a rundown of reasons.

• Summertime SAD. You’ve probably heard about seasonal affective disorder, or SAD, which affects about 4% to 6% of the U.S. population. SAD typically causes depression as the days get shorter and colder. But about 10% of people with SAD get it in the reverse — the onset of summer triggers their depression symptoms. Cook notes that some studies have found that in countries near the equator – like India – summer SAD is more common than winter SAD. Why do seasonal changes cause depression? Experts aren’t sure, but the longer days, and increasing heat and humidity may play a role. Specific symptoms of summer depression often include loss of appetite, trouble sleeping, weight loss, and anxiety.
• Disrupted schedules in summer. If you’ve had depression before, you probably know that having a reliable routine is often key to staving off symptoms. But during the summer, routine goes out the window – and that disruption can be stressful, Cook says. If you have children in grade school, you’re suddenly faced with the prospect of keeping them occupied all day, every day. If your kids are in college, you may suddenly find them – and all their boxes of stuff – back in the house after a nine-month absence. Vacations can disrupt your work, sleep, and eating habits – all of which can all contribute to summer depression.
• Body image issues. As the temperature climbs and the layers of clothing fall away, a lot of people feel terribly self-conscious about their bodies, says Cook. Feeling embarrassed in shorts or a bathing suit can make life awkward, not to mention hot. Since so many summertime gatherings revolve around beaches and pools, some people start avoiding social situations out of embarrassment.
• Financial worries. Summers can be expensive. There’s the vacation, of course. And if you’re a working parent, you may have to fork over a lot of money to summer camps or babysitters to keep your kids occupied while you’re on the job. The expenses can add to a feeling of summer depression.“This summer, we have worries about the economic crisis layered on top of everything else,” says Cook.  “People are feeling more financially strapped. They’re wondering, ‘If I go on vacation, will be job still be there when I get back?’”

• The heat. Lots of people relish the sweltering heat. They love baking on a beach all day. But for the people who don’t, summer heat can become truly oppressive. You may start spending every weekend hiding out in your air-conditioned bedroom, watching pay-per-view until your eyes ache. You may begin to skip your usual before-dinner walks because of the humidity. You may rely on unhealthy takeout because it’s just too stifling to cook. Any of these things can contribute to summer depression.

Tips for Coping With Summer Depression

What can help you feel better? What can you do to make this summer different? Here are some tips on taking control of summer depression.

• Get help. It’s simple. If you think you’re getting depressed, no matter what time of year, get help. Talk to a therapist, like a psychologist or social worker. Or see your doctor or a psychiatrist who can prescribe medicines. Never take the signs of depression lightly. Don’t wait them out, assuming they’ll resolve. Sometimes, what started as summer depression can turn into a longer-lasting bout of major depression, Cook tells WebMD.

  And even if your depression will resolve in September, that’s no reason to ignore it in June. We’re talking about three months of potentially avoidable misery. “A temporary depression can still be pretty awful,” says Cook. While the symptoms lift in a few months, the impact on your family and job can be permanent.

• Plan ahead. Cook says there’s one advantage to a summer depression: you know when it’s coming. June is right there on the calendar. So if you’re feeling OK in the spring, think about the specific aspects of your life that become difficult during the summer. What will help prevent summer depression? What’s the best way to take time off from work? Would signing up the kids for summer programs or camp help relieve your stress? You’ll feel a lot more in control heading into the summer if you have plans in place.
• Sleep. Vacations, summer barbecues, the short nights – they can all encourage you to stay up later than usual. But not getting enough sleep is a common trigger for depression. So make a concerted effort to get to bed on time.
• Keep up with your exercise. Many studies have found that regular physical activity can help keep depression at bay. So even if it’s getting too hot for your normal activities, find other ways to stay active and head off summer depression. Start earlier in the morning or later in the evening, when it’s not so hot. Consider fitness equipment for the cool basement. If an annual membership to a gym is too expensive, consider joining one for a couple of months just to get you through the summer.
• Don’t overdo dieting and fitness. Don’t kick off the summer with a frenzy of dieting and exercise in order to fit into last year’s bathing suit. It’s bound to make you unhappy and anxious. Instead, exercise sensibly and eat moderately. If you try an insanely restrictive diet, you probably won’t be able to keep it up. And that “failure” will just leave you more demoralized and worsen your summer depression.
• Protect yourself. Don’t let obligations drag you down. Maybe you always host the enormous family barbecue on Memorial Day or the July 4 picnic. But if you’re feeling overwhelmed, give it a pass this year. Ask another relative to host. Don’t risk pushing yourself into a summer depression just to live up to tradition.
• Think about why. If you struggle with summer depression year after year, ask yourself if there’s a reason. Do you associate summer with a difficult time in the past – the death of a loved one or the break-up of a relationship? Have you had previous bouts of depression during the summer? Without even realizing it, you may have started to associate the summer with sadness – an association that gets stronger every summer that you spend depressed. If you do have some unhappy connection with the summer, sorting it out could help you break the cycle.
• Talk to your doctor about adjusting your medication. If you’re on medicine for depression, and you find that summer – year after year – makes your depression worse, talk to your doctor about changing your dosage. Maybe he or she could up your dose in the late spring and taper it back down in the fall. It could really help head off summer depression problems, Cook says.
• Plan your vacation carefully. Before you book your plane tickets or load up your car’s roof rack for your annual summer vacation, ask yourself this: Is this what you really want? Or is it an obligation you’re fulfilling to a relative? Will it make you happy? Or will it stretch your finances, stress you out, and make you fall behind at work? Consider alternatives. Instead of taking a whole week off at once, might it be better to take off several long weekends spread out through the summer? Would taking time off but staying at home – a “staycation” – be more relaxing? Don’t get locked into a vacation that won’t feel like a vacation.

• Don’t beat yourself up. One thing that’s hard about summer depression is that you feel so out of step. Everyone else seems to be having such a swell time. You aren’t. You keep asking yourself, “What’s wrong with me?”

  Try not to think that way. “So much of our misery grows out of the gap between where we are and where we think we ought to be,” says Cook. So stop worrying about how you feel relative to other people. Stop assuming that you’re supposed to be happy just because the calendar says it’s June. Instead, concentrate on what’s triggering your summer depression and how you can overcome it.

  “Treatments do work,” says Cook. “Psychotherapy or medication can blunt the effects of a seasonal depression. Summers really don’t have to be so bad.”