How Bipolar's Manic and Depressive Episodes Affect Your Sex Life
Bipolar disorder is a brain disorder that spurs changes in an individual’s energy and mood, and it can impact their ability to function. It's regarded as a common issue, affecting more than 6 million American adults. The average age at onset is typically during a person's early 20s.
Medical science offers no conclusive cause but it’s thought altered brain structure and chemistry, environment, and genetics all play a role.
Due to the potential effects of bipolar disorder on libido, behavior and mood, navigating your sex life and intimate relationship can be challenging during bipolar's manic and depressive episodes.
The highs and lows of bipolar disorder
"During manic episodes, individuals with bipolar disorder not may not only see their sex drive elevated, but they may also be acting under high impulsivity as well," said Edward Ratush, M.D., a practicing psychiatrist in New York City and the co-founder of the national holistic telepsychiatry platform SOHOMD.com. "As a result, they might engage in risky sexual behaviors like infidelity and unprotected sex. This, in turn, can lead to sexually transmitted infections, unintended pregnancies, and irreparable damage to intimate relationships."
During depressive episodes, on the other hand, people with bipolar disorder may experience a lack of interest in sex. In addition, they may find difficulty experiencing pleasure or reaching orgasm.
It's important to understand that the implications of bipolar disorder go beyond a single manic or depressive episode, Ratush added. Rather, bipolar disorder can continue to impact self-esteem, intimacy and overall well-being over a whole lifetime, even for people who receive successful treatment.
"Remember that for sufferers, past episodes also become memories and are a part of how individuals see themselves, for better or for worse," Ratush said. "Some may have thrilling memories from their bouts of hypomania—times when they felt invincible and sought out excitement. Stability is the goal for those seeking and receiving treatment, but they may sometimes find 'normal life' mundane, despite normalcy's clear advantages."
Unsurprisingly, because a relationship involves at least two people, bipolar disorder affects both the individual in the relationship who has the condition and any romantic partner(s).
"Partners may also have to contend with the specter of past mania," Ratush said. "Knowing that newer, shared experiences may never match those from their partner's previous histories, even if those moments were ill-advised to begin with. As with everything pertaining to bipolar disorder, a delicate balance must be set."
Looking for the perfect balance
So what does this delicate balance mean in the practical sense for the partners?
"A partner must maintain enough self-confidence to recognize that a more exciting past is not necessarily better than the present," Ratush said. "At the same time, a bipolar patient must resist idealizing past manic episodes without repressing them either. Repressing those memories can lead to deeper issues."
Although it can prove challenging, it is possible to enjoy a healthy and satisfying sex life, intimate relationships and romantic partnerships if you suffer from bipolar disorder or if you love someone who has bipolar disorder.
"It can interfere with consistency in relationships, undermine self-image, lead to disruptions, and as with other serious medical conditions, place a strain on close relationships with intimate partners, friends and family members as well as in the workplace," Ratush said. "Bipolar disorder can also undermine self-esteem, and increase the risk for self-injury and suicide."
Similar to other chronic illnesses, physical or mental, couples need to work together to provide support for each other, according to Grant Brenner, M.D., a board-certified psychiatrist and psychotherapist in New York City and the co-founder of Neighborhood Psychiatry & Wellness.
"Individuals with bipolar disorder may feel ashamed or embarrassed about their symptoms," Ratush said. "This can lead to feelings of isolation and disconnection from their partner, and those in their friend group they'd normally reach out to for help."
How to maintain a healthy and satisfying sex life
"Bipolar disorder is a complex mental illness, and it may take time to find the right treatment plan and strategies for managing symptoms," Ratush said. "That said, simply diagnosing the disorder represents a huge step forward. Acknowledging that there is a psychological disorder at play—and that it's treatable—helps couples reopen the lines of communication."
He added that for couples engaged in a sexual relationship when one or both partners are dealing with bipolar disorder, couples should share their sexual needs and desires to maintain intimacy.
"For those suffering from bipolar disorder, it's doubly important," Ratush said. "But when open communication, support and a willingness to work together are features of their relationships, individuals with bipolar disorder (and their partners) can cultivate fulfilling long-lasting and satisfying sex lives."
According to Brenner, overall relationship satisfaction for couples is a predictor of a satisfying sexual relationship.
"So focusing on the relationship quality itself is key for many couples' sexual satisfaction," he said. "Active coping and education are key for couples to maintain a satisfying relationship, and couples therapy may be helpful to identify and develop a healthy overall relationship. For sexuality in particular, a lot depends on the individual presentation of bipolar disorder symptoms around sexuality, and the impact of medications."
Libido that is elevated during manic episodes can put a strain on partners if the other partner does not share the same level of sexual desire, he added. The same can be said during a depressive episode where the other partner is seeking a higher level of frequency of sexual activity.
"If there are unintended sexual relations outside of a committed relationship, this can create strong negative feelings and be destructive to relationships even if it is understood to be related to the impulsivity, expansiveness and impaired decision-making during manic episodes," Brenner said. "Depressive episodes and medications may reduce libido. Even if the partner is aware that libido is reduced for psychiatric reasons or as a medication reaction, it can nevertheless be difficult due to a lack of sexual satisfaction for the partner.
"It may also be that in many cases the partner feels they are undesirable, even if intellectually they understand it's not them. Even if their partner reassures them."
Sexual challenges when navigating a relationship in which a partner has bipolar disorder are common, but Brenner said the illness can also affect other aspects of a relationship.
"Relationships may also be negatively affected by other impulsive behaviors," Brenner said. "For example, excessive spending leading to financial strain and feelings of unsafety and betrayal, beyond sexual infidelity.
"During periods of elevated mood, the relationship may be very exciting, even exhilarating, which can be attractive at times and a source of enjoyment, though this is offset by the often more destructive aspects."
The sexual and interpersonal challenges
To deal with the sexual and interpersonal challenges of navigating a relationship in which one or both partners suffer from bipolar disorder, Brenner recommended the couple work with a sex therapist experienced with bipolar disorder. It's also vital to cultivate emotional intimacy and other aspects of your relationship aside from physical intimacy.
Tom Murray, Ph.D., a certified sex therapist in North Carolina and the author of "Making Nice with Naughty," offered some tips to maintain a satisfying sex life if you or your partner has bipolar disorder.
"Communicate openly with your partner(s) and discuss your sexual health and any concerns or challenges you may be experiencing related to bipolar disorder," he said. "This can help you both understand each other's needs and boundaries and find ways to maintain intimacy and connection."
He said it's crucial to take care of your mental and physical health if you have bipolar disorder. Manage it through medication, self-care and therapy. Prioritize getting enough sleep, exercising and eating healthy. All of those can positively impact your sexual health.
"Working with a therapist or counselor can help you explore any emotional or psychological issues that may be impacting your sexual health," he said. "This can be especially helpful if you are experiencing depression or anxiety that's affecting your libido."
It's important to talk to your doctor about medication options and to practice safer sex.
"If you're experiencing sexual side effects from your bipolar medication, talk to your doctor about alternatives or adjustments to your medication regimen," Murray said. "Using condoms or other forms of contraception can help protect against unintended pregnancy and STIs, which can be especially important if you're experiencing hypersexuality during manic episodes.
"Remember, it's important to prioritize your mental and physical health and communicate openly with your partner(s) to maintain a healthy and satisfying sex life."