Psychological Treatment of Major Depression: An Analysis of the Sexual Desire

Objective: Sexual dysfunction is frequently reported as a side effect of many antidepressant medications. As a result, for those depressed patients to whom sexual desire is important, psychological treatment may be a better intervention. Thus, the present study aimed to determine the possible changes in sexual desire following psychological treatments in depression, when focus of therapy is not on sexual function. Methods: This is a quasi-experimental study, which was conducted in Tehran, Iran. A total of 281 depressed patients in the remission phase underwent psychological treatments, either cognitive behavioral therapy (CBT, n=131) or mindfulness-based cognitive therapy (MBCT, n=150). The therapy did not focus on any aspect of sexual function. Using a single item measure before and after treatment, sexual desire of the patients was categorized into intact, mild, moderate, or severe decline. A total of 255 participants completed the study questionnaires and were randomly assigned to CBT (122) and MBCT groups (133). Before therapy, 128(50.2%) participants were categorized in intact sexual desire group, 73(28.6%) in mild sexual desire dysfunction group, 40(15.7%) in moderate sexual desire dysfunction group, and 14(5.5%) in severe sexual desire dysfunction group. Logistic regression was used for analyzing the data by SPSS-16. Results: Low sexual desire in depression remission was predicted by age (P<0.001, OR=0.21, CI=0.01–0.03), presence of comorbid anxiety disorder (P<0.04, OR=-0.13, CI=-0.46–0.02), and global assessment of functioning (GAF) (P<0.001, OR=-0.23, CI=-0.03–0.01). Clinical improvement in sexual desire was predicted by the type of intervention (P=0.023, OR=0.351, CI=0.142–0.869) and GAF (P=0.003, OR=0.927, CI=0.881–0.975). Conclusion: CBT might be superior to MBCT in improving sexual desire in patients with depression. Further studies using validated sexual function questionnaires are necessary.