Ian Kerner, a sexuality counselor and New York Times best-selling author, blogs about sex weekly on The Chart. Read more from him on his website, GoodInBed.

We live in a culture in which use of SSRIs (selective serotonin re-uptake inhibitors), talk therapy, and mental health days have become nearly as common as gym memberships and multi-purpose vitamins.

In fact, the National Institute of Mental Health reports that more than 20 million people in the U.S. experience depression. Unfortunately, mood swings aren’t the only symptom of depression - it can also have a negative effect on your romantic relationships, especially when it comes to sex.

"One symptom of depression is anhedonia, a lack of pleasure in things that were once enjoyable,” sex therapist Dr. Stephanie Buehler writes in her timely new book, “Sex, Love, and Mental Illness.”

“Sex is often one of those activities in which a person loses interest. Add to that fatigue, lethargy, and a tendency to want to be alone and there are plenty of reasons for depressed persons and their partners to experience a decline in their sex life."



Additionally, when a person is depressed, the non-depressed partner may become susceptible to depression as well.

Kathleen, a 32-year-old, stay-at-home mom, spoke to me about the role depression currently plays in her marriage.

"For a long time, I have made an effort to get Karl interested in sex, but I am constantly getting rejected. Not only does my ego take a hit, I also feel selfish bringing my sexual needs into the picture. They seem so trivial next to his depression. So we basically have both given up, but I need that closeness from him."

“Because people who are depressed may also have low self-esteem, they may feel that they are poor sexual partners,” Buehler writes on the complex dynamics that often emerge when depressions rears its head in an intimate relationship. “This can have the effect of a pushing a partner away, which only makes the depressed person feel more isolated or inadequate as a partner.”

So what can you do if depression has creeped its way into your bedroom?

1. Get help from an expert.

For those grappling with milder forms of depression — such as dysthymia, a low-grade, chronic depression that affects about three million Americans — cognitive behavior therapy (CBT) may be useful. This type of therapy focuses on combating negative thoughts and behaviors with positive ones.

2. Consider medication.

While SSRIs do come with sexual side effects, making a dent in your underlying depression is important. Still, research has shown that SSRIs can dull sexual sensation or diminish the brain's neural pathways associated with arousal and orgasm.

If you’re experiencing severe side effects from your antidepressants, talk to your doctor about trying other medications. Some — such as Bupropion (Wellbutrin) — have fewer sexual side effects, and may even help stimulate sexual desire. Medication affects everyone differently, and your psychopharmacologist may be able to find a balance of meds that helps improve your mood without wreaking havoc on your sex life.

3. Take a break.

Then there are the steps you can take on your own, back at home. First, try taking sex out of the picture. At least temporarily. Instead, play around with other forms of intimacy.

While sex may not be a possibility for the immediate future, connection is still important, and holding hands, hugging, and kissing can all go a long way toward thawing out the sexual frost between you.

4. Just do it.

When you feel slightly more ready for it, have sex - with a partner or even just with yourself. When you're depressed, even putting yourself through the motions of sex can be helpful.

As Buehler writes, "When a person has an orgasm alone or with a partner, it gives a boost to serotonin and raises endorphins and opioids, the brain's so-called happy chemicals."

Sex also relaxes you, and boosts self-esteem.

5. Communicate.

It goes without saying that when you're depressed, you feel isolated and, as a result, communication can be a struggle.

“Sex is a communication tool that partners use to connect with each other in good times and in tougher times,” says Sara Benincasa, a comedian and author of a new memoir “Agorafabulous!: Dispatches from my Bedroom,” which documents her own battles with depression.

“When you're depressed and feel a lack of sexual desire, it's almost as if a voice has been silenced.”

That’s why it's important to communicate about the side effects of your depression, with both your partner — who may not fully understand what's going on — and with your health care provider.

Between the three of you, you’re sure to find a way back to better sex, and a better state of mind. And the road will be much easier than it would have been if you were going it alone.