Hypoactive sexual desire disorder and depression: A treatment outcome study

Hypoactive sexual desire disorder is a complex clinical phenomenon that is thought to involve biological, affective, and interpersonal components. There is high comorbidity between problems of sexual desire and depression, particularly in married women. Relationship discontent is frequently postulated to play a role both in the genesis of the conditions and/or the maintenance of symptoms. Despite significant over-lap of hypoactive sexual desire and depression, no empirically validated treatments currently exist that address both problems simultaneously. This paper presents results from five case studies designed to test a comprehensive treatment for married women suffering from major depression and/or dysthymia and hypoactive sexual desire disorder. Married women and their husbands participated in 15-20 weeks of cognitive-behavioral marital/sex therapy. In addition, women were treated with bupropion (wellbutrin), a second generation anti-depressant medication with established efficacy in treatment of depression, and probable efficacy in treatment of some sexual dysfunctions. Clinically significant improvement in depression was found for four of the five subjects. Four of the five couples showed an increase in frequency of sexual activity, and all couples reported greater satisfaction with their sexual relationship. Three subjects showed a clear increase in sexual desire. One subject did not improve in this area, and a final subject showed such variability in desire ratings that response was impossible to evaluate. Positive changes in the marital relationship occurred for the majority of participants in the study. Factors that seemed to limit response to treatment included axis 2 personality traits, history of sexual trauma in the present relationship, and presence of male sexual dysfunction. Results suggest that comprehensive treatment involving both pharmacological and relationship interventions may have efficacy for these cases which have previously proven remarkably difficult to treat.